These days everyone we know suffers from headaches. The stress of the daily grind, sitting in traffic, bad posture and so many other reasons contribute to it.
Headaches are unavoidable for the most part. But there are better alternatives to treating this pain other than popping pain killers.
Physical therapy (PT) has excellent techniques to treat the root cause of your headache, while also suggesting long-term treatments. But most people are unaware of a PT’s role in relieving headaches.[i]
In this article, we’ll explore what type of headaches can be treated with physical therapy. And also cover the research proving the effectiveness of PT for relieving headaches. Let’s begin!
Types of Headaches
Headaches can be primary or secondary. Primary is when no underlying conditions are causing your headaches. And secondary headaches are the result of an injury, illness or pathology. For example, if you get a headache due to a cold, then that could be classified as a secondary headache.
Commonly occurring headaches are of four main types. These are:[ii]
- Tension Headaches: The pain is located in the forehead and around the skull. Patients report having dull pain and feel as if some pressure is being applied around their skull. This is also known as a stress-related headache because one of its leading causes is stress.
- Migraines: The pain is located on one side of the head and the face. You may feel a throbbing or pulsating pain followed by nausea, fatigue and a loss of appetite. This is the only type of headache that can be genetically influenced.
- Cluster Headaches: there is usually throbbing pain around or behind one eye. This could cause you to wake up from sleep. Other symptoms include drooping eyelids and running nose and eyes.
- Sinus Headaches: the pain is localized to the cheekbones, nose and forehead. That’s because these areas have sinuses (cavities in the skull). Sinus headaches often accompany a cold or when your sinuses are inflamed. These tend to resolve when the sinuses clear up.
Other rare forms of headaches include post-traumatic headaches, exercise headaches, Hemicrania Continua, new daily persistent headaches (NDP) and hormone headaches.
Headaches that last for more than 15 days and longer than 3 months are called chronic. [iii]
What are Tension-Type Headaches?
The pain of a tension-type headache is usually located in the forehead, sides and back of the skull. But occasionally it radiates down the neck as well. The pain intensity varies widely from mild pain that goes away in an hour to disabling pain that doesn’t resolve even with over the counter medications.[iv]
These can be divided into episodic (less than 15 days a month) and chronic (more than 15 days a month). Patients suffering from chronic tension headaches also get nausea as the condition gets worse.
The key feature of tension headaches is that it affects both sides of the head equally unlike migraines.
The pain often starts from the back of the head and radiates forward as it gets worse.
Causes of Tension-Type Chronic Headaches
The exact cause of tension headaches is not yet known. A group of experts contribute this pain to life stresses while another group hypothesizes that tight muscles around the head could be the cause.
There was a time when tension-type headaches were called psychogenic because doctors believed their cause to be psychological. But now we know that there are neurological and physiological components at play here. [v]
Although we don’t know the causes, there are several identified risk factors for tension headaches. Some of these include:[vi]
- Tight muscles in the neck or the upper back.
- Accumulative stresses from work and home.
- Poor posture.
- Hunger, dehydration and lack of enough sleep.
- Straining on the eyes due to excessive sunlight or computer screens.
What Are Migraines?
The characteristic feature of migraines is one-sided pain in the head and the face. This can get worse with physical activity, lights and sounds and it can last for hours or days.
Just like any other form of headache, the pain intensity of migraines varies from person to person[vii].
Approximately 12% of the population suffers from migraines. This includes kids under the age of 12, teenagers and adults.
Some common triggers of migraines include:[viii]
- Hormonal changes in women
- Bright lights and loud sounds.
- Overexertion and physical exhaustion
- Tobacco, caffeine and alcohol.
- Medication overuse.
Physical Therapy Can Relieve Migraines and Tension Headaches
Muscle tightness and imbalance in strengths are some of the causes of headaches. But a change in muscle activity is also a consequence of chronic headaches.
A study by Lidiane L.Florencio et al. (2016) found that women with chronic migraines had increased activity of their superficial neck extensor muscles (muscles in the back of their neck) when acting as antagonists.[ix]
PT can help improve posture and reduce muscle stiffness to relieve headaches. Not only that, but physical therapy can also help you combat some of the risk factors associated with headaches.
PT treatment is limited in some ways. This approach does not help patients who have headaches due to chemical or hormonal causes.
In this section, we’ll explore the various techniques PTs use to treat headaches. And also discuss some research that proves the effectiveness of physical therapy for headaches.
What Treatments Do Physical Therapists Use to Treat Headaches
Physical therapists use manual therapy to locate and release trigger points in cervical muscles (muscles in your neck).
The stiffness or tightness of these structures can either cause headaches or make them worse. These are known as Cervicogenic headaches and PT can help you recover from them.
Manual therapy can mobilize the area and reduce stiffness. A lack of mobility can also pinch nerves in the area thus leading to pain in the shoulders or head.
A physical therapist can also prescribe you an exercise program to maintain mobility so that headache recurrences are reduced.
Biofeedback is a muscle relearning technique that employs equipment. Electrodes are attached to the muscles of the skull and the patient learns to contract the right muscles for certain activities.
The movements are repeated. And the results of the electrodes serve as visual feedback that help you refine your movement patterns and muscle activation.[x]
It’s not an effective treatment to be used on its own. But when combined with other forms of PT or medications, it can show positive results.
Postural retraining is an important technique that is quite simple to use but effective.
Your physical therapist might use this if you have a forward head posture or upper cross syndrome. That means there is an imbalance in the strength of the muscles in your chest and the back.
When muscles are forced to uphold the head in unnatural postures for extended periods, these muscles get fatigued and then refer pain to the head.
Lastly, education is a vital component of any PT treatment regimen. Your physical therapist might help you understand the underlying pathology of your headaches, the causes, risk factors and triggers. Then emphasize the importance of following the prescribed exercise program.
Research That Supports Use of PT for Chronic Headaches
There is sufficient documented evidence to show that physical therapy techniques are effective in treating headaches – primarily tension-type and migraines.
Jane Carlsson and colleagues compared the effects of acupuncture and physiotherapy in female patients with chronic tension-type headaches. They found a reduction in intensity and frequency of headaches in both groups. But the physiotherapy group had better improvements in overall function, the intensity of headaches and mental well-being. The results showed consistent improvement for 7-12 months after the treatment.[xi]
Physical therapy can be used as a substitute for medications in some cases. A randomized controlled trial by Débora Bevilaqua-Grossi PT et al. (2016) found that physical therapy and medications had similar effects in reducing the frequency of headaches. Physical therapy also improved the cervical muscle pressure pain threshold. [xii]
Quick tip:
Randomized controlled trial: RCTs are the gold standard of research. Here, two groups are formed – control and experiment. Participants are assigned randomly and are usually not told what group they are in. This type of research often generates excellent results.
A systematic review by C. Lozano Lopez et al. (2016) found that manual therapy has numerous positive effects on headaches. Some of these include a reduction in medication intake, improvement in quality of life and a reduction in frequency and intensity of headaches. 14 RCT were considered in this review and only two were of low quality. [xiii]
A 2008 meta-analysis showed that biofeedback techniques can reduce the frequency of headache episodes. It also helps with reducing muscle tension, analgesic consumption and symptoms of anxiety. The effects were particularly pronounced in children and teens.[xiv]
You might also like: Here Are the Signs That Mean It’s Time for You to Visit a Physical Therapist
Headaches And PT – In a Nutshell
Headaches are such a common painful condition that most people learn to live with the pain after some time. Medications do help relieve pain but your body might quickly develop resistance against them and reduce their effectiveness.
Physical therapy has several techniques that can be used independently or with medications to help relieve headaches. These include manual therapy, biofeedback, muscle relearning and postural adjustment to name a few. There is significant scientific literature that shows the effectiveness of PT for chronic headaches.
If you suffer from chronic migraines or tension-type headaches, then contact a physical therapist or a doctor to learn more about alternative treatments.
PT isn’t a golden bullet that can fix your pain but it might help significantly decrease the frequency and intensity of your headaches!
[i] https://www.tandfonline.com/doi/abs/10.1080/21679169.2017.1352023
[ii] https://www.drshehadi.com/4-common-types-of-headaches-symptoms-duration/
[iii] https://www.webmd.com/migraines-headaches/migraines-headaches-basics
[iv] https://americanmigrainefoundation.org/resource-library/tension-type-headache/
[v] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Headache-Hope-Through-Research
[vi] https://www.webmd.com/migraines-headaches/tension-headaches
[vii] https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches#:~:text=A%20migraine%20is%20a%20common,four%20hours%20or%20even%20days.
[viii] https://medlineplus.gov/migraine.html
[ix] https://www.sciencedirect.com/science/article/abs/pii/S1050641116300517
[x] https://pubmed.ncbi.nlm.nih.gov/20622082/
[xi] https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.1990.hed3009593.x
[xii] https://www.sciencedirect.com/science/article/abs/pii/S0003999315015580
[xiii] https://www.sciencedirect.com/science/article/pii/S2173580816300360