May 20, 2023

A Guide to Physical Therapy for Headaches

Do you suffer from headaches? If so, you're not alone. According to the World Health Organization1, at least half of adults worldwide report headaches each year.

Headaches can lead to disability and general poor health, placing a burden on the suffering individual and society. This is especially true since many headache sufferers do not seek care, even though it affects their ability to be productive and keep a high quality of life.

While there are many different types of headaches, tension headaches and migraines are the most common.1 If you're looking for relief from your headache pain, working with a CityPT physical therapist can be a good option for sustainable long-term relief.2

In this blog post, we will discuss the symptoms, causes, and conservative treatment options available through physical therapy.

Table of Contents

Understanding Headaches

A headache is a general term used to describe pain in any head area.

There are many different types of headaches. Let's review:3

  • Cervicogenic headaches: Cervicogenic headaches are caused by bone, muscle, and/or nerve problems of the cervical spine (neck) that can refer pain to head region. They are often associated with tension headaches (below) and tend to occur on just one side of the head.4
  • Tension headaches: The most common type of headache that is caused by muscle tension and spasms.
  • Migraines: Often categorized as a neurological disorder, this type of headache is cyclical and chronic. It is characterized by severe pain, throbbing, and sensitivity to light and sound. Migraines often come with other symptoms like nausea and vomiting.
  • Cluster headaches: An uncommon type of headache that is characterized by severe, sharp pain on one side of the head. They often come in "clusters" or groups and aren't typically associated with triggers like other headache types.
  • Secondary headaches: Pain caused by an underlying condition such as a sinus infection, fever, vascular issues, or head/spine injury. In rare cases, it can be caused by a tumor, stroke, or chronic conditions like multiple sclerosis.

Migraine vs Tension Headache: What's the Difference?

Tension headaches usually feel like a dull ache or pressure on both sides of the head. They are not typically accompanied by other symptoms like nausea and vomiting. Tension headaches can be caused by stress, neck pain, fatigue, and many other daily factors.

Migraines, on the other hand, are characterized by severe pain, throbbing, and sensitivity to light and sound that often come and go chronically. Migraines often come with other symptoms like nausea and vomiting. They can last for a few hours or even a few days. Migraines can be caused by stress, hormonal changes, certain foods or drinks, or bright lights.

Symptoms of a Headache

The symptoms of a headache can vary depending on the severity and type of headache. However, some common symptoms include:

  • Pain in the head, neck, or face
  • Tenderness or stiffness in the head or neck
  • Sensitivity to light or sound
  • Nausea or vomiting
  • Loss of appetite
  • Fatigue
  • Difficulty concentrating or general "brain fog"
  • Irritability

While most headaches will resolve on their own, they can return frequently or become chronic in nature as well.

What are the Most Common Causes of Headaches?

There are many different causes of headaches. However, some of the most common underlying factors include:1

  • Muscle tension or spasms (from overuse, imbalances, or strain)
  • Temporomandibular joint disorder (TMD, jaw dysfunction/pain)
  • Prolonged postural imbalances
  • Dehydration
  • Alcohol consumption
  • Caffeine withdrawal
  • Skipped meals or hunger
  • Stress or anxiety
  • Sleep deprivation or changes in sleep patterns
  • Hormonal changes
  • Weather changes
  • Bright lights
  • Loud noises
  • Trauma
  • Medication overdose
  • Underlying medical conditions

Thankfully, physical therapy can help manage these underlying triggers. Evidence best supports physical therapy treatment for tension headaches.2

Diagnosing Headaches

Understanding what type of headache you are experiencing is the first step in getting relief. Your primary care provider or physical therapist can help you determine what type of headache you are suffering from and work with you to develop a treatment plan.

The best way to diagnose a headache is through a combination of medical history and physical examination, including looking at neck range of motion, strength, posture, and upper body movement patterns. Depending on what they find, an imaging test such as an MRI can help confirm or rule out certain causes of headaches and neck pain.

If you suspect your headache is tension related, you can book directly with a CityPT physical therapist for the quickest pain relief results. If needed, they can then refer you to your primary care physician for further workup.

What to Expect from Physical Therapy for Headaches

Your physical therapist will work with you to develop a specific treatment plan that meets your needs and goals by addressing the underlying causes. A combination of treatment options will help you find relief. These may include:

  • Manual therapy techniques: Such as soft tissue massage, dry needling, trigger point release, and joint mobilization can help to release muscle tension and spasms.
  • Therapeutic exercises: To help improve postural awareness, restore any muscle imbalances and reduce stiffness in the neck.
  • Ergonomic assessment: To help you identify and avoid headache triggers with daily activities and positions.
  • Lifestyle education: To build awareness around triggers like sleep, nutrition, and stress.
  • Relaxation techniques: Such as breathing exercises and progressive muscle relaxation to help to reduce stress and tension headaches.

What If Conservative Treatment Doesn't Work?

If you've tried conservative treatment for your headaches and haven't found relief, there are other options to explore and discuss with your doctor. These may include:

  • Botox injections (to address muscle tension or spasm)
  • Prescription medications
  • Surgery

Preventing Headaches

There are several things you can do to help prevent headaches:

  • Stay hydrated by drinking plenty of water throughout the day.
  • Eat regular, balanced meals and snacks.
  • Avoid or limit caffeine and alcohol consumption.
  • Get enough sleep (remember: both quantity and quality matter).
  • Manage stress with adequate self-care and relaxation techniques such as deep breathing exercises or progressive muscle relaxation.
  • Exercise regularly to help reduce muscle tension of the head and neck and boost optimal muscle balance.
  • See a CityPT physical therapist to identify and correct any muscle imbalances, posture concerns, or ergonomic issues that may be contributing to your headaches.
  • Keep a journal to increase awareness around any headache triggers that you can modify or adjust in your life.

Is It Time to Seek Treatment?

Headaches, particularly when they become chronic, can make it hard to participate in life the way you'd like. If you're struggling with chronic or recurrent headaches, it may be time to seek help from a trusted healthcare professional.

A CityPT clinician can help you determine the underlying cause of your headaches and develop a personalized plan to address the root cause. To get started, book an initial evaluation today.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. World Health Organization. Headache disorders. WHO. Accessed November 3, 2022. https://www.who.int/news-room/fact-sheets/detail/headache-disorders 2 3

  2. Espí-López GV, Arnal-Gómez A, Arbós-Berenguer T, González ÁA, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. J Jpn Phys Ther Assoc. 2014;17(1):31–38. doi:10.1298/jjpta.17.31 2

  3. Vincent MB. Cervicogenic headache: a review comparison with migraine, tension-type headache, and whiplash. Curr Pain Headache Rep. 2010 Jun;14(3):238-43. doi: 10.1007/s11916-010-0114-x. PMID: 20428974.

  4. Al Khalili Y, Ly N, Murphy PB. Cervicogenic Headache. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507862/

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