Headaches, Migraines, and Physical Therapy – Can It Really Help?

Did you know that headaches impact HALF of the adult population worldwide?  According to the World Health Organization, around 50% of people experience at least 1 headache a year. An estimated 12% of people globally experience migraines, making it the 3rd most prevalent illness and 6th most disabling in the world.

So, what IS a headache?

Headaches are broadly defined as pain located in the head, but they come in many shapes and forms. Headaches can vary in intensity, frequency, and symptom presentation. While headaches often stem from local head and neck structures (muscle, joint, and nerve), they can also be associated with dehydration, changes in blood sugar, food sensitivities, or even stroke.

More often than not, headaches are not a high risk condition – but that doesn’t make them any less debilitating. Individuals who suffer from headaches often find that pain and symptoms interfere with daily activities including work, daily chores, and recreational activities.

Common Types of Headaches

Tension headaches are described as a dull aching in the head (often near the temples, forehead, and/or base of the skull). They are often accompanied by muscular soreness and stiffness in the head, neck, and shoulders. Pain can be bilateral or on both sides of the head, and can be exacerbated by stress. Symptoms are believed to generate from muscular sensitivity, trigger points, and increased central sensitivity.

Cervicogenic headaches stem specifically from neck related structures, especially the small joints along the spine called facet joints. These joints have specific referral patterns for pain and can present as symptoms in the back of the head and neck, behind the eyes, and in the temples. Pain can be one sided or on both sides, but is often accompanied by neck pain and easily triggered with certain movements or sustained postures.

Migraines are considered a neurological event, and often present with a more intense headache. They are often (but not always) accompanied by other symptoms including sensitivity to light and sound, nausea, and/or the presence of an aura. An aura is a visual disturbance that can present as blurry lines or floaters, blind spots, or flashes of light. Migraines are often described as pulsing, are typically one sided, and can last hours to days. They are linked to sensitivity of neural structures in the head and neck, specifically the trigeminal nerve (which is associated with sensation of the face, jaw function, the upper neck, and parts of the brain).

What can physical therapy do to help?

Headaches, especially migraines, are often poorly managed with a large dependency on pharmacological interventions. But there may be another treatment option! Physical therapy can be an effective treatment (or part of treatment) for tension headaches, cervicogenic headaches, and migraines.

Physical therapists are well equipped to treat headache conditions because we are well versed in the underlying anatomy, can identify what structures are contributing to symptoms, and will create an individualized treatment plan specific to YOUR presentation and needs.

What should I expect at physical therapy?

A thorough subjective examination, or discussion, of your current symptoms

Our goal is to identify what type of headache you are experiencing, to help guide our treatments. This will include:

  • the nature of your headaches – type of pain/symptoms, frequency, duration, severity, changing or consistent symptoms, etc.
  • any known triggers or aggravating activities as well as what provides symptom relief
  • functional limitations/activities limited by your symptoms
  • prior medical history
  • other potential contributing factors/triggers including diet and food sensitivities, dehydration, sleep, stress (and stress management), eye strain/vision, neck or jaw pain or injury

A physical examination to help identify what structures are contributing to your pain

With a better understanding of the anatomy involved, we can individualize your treatment approach. The examination will include:

  • assessment of the head, neck, shoulders, and jaw/TMJ (temporomandibular joint) including range of motion, strength, positioning, and overall sensitivity

  • assessment of posture, breathing, and movement mechanics

A collaborative discussion of appropriate treatment and plan of action

Education is key! We will review ways to manage and treat symptoms moving forward. This may include:

  • manual therapy (mobilization or manipulation of muscles and joints) to decrease pain/sensitivity and improve mobility
  • exercises – for strength, flexibility and improved ROM (range of motion), stability, improved control, and/or improved posture
  • behavior modifications and strategies for symptom management (including potential work ergonomics, lifting strategies, sleep position, etc)
  • referral to another healthcare provider if appropriate (physician, neurologist, etc.)

If you are experiencing headaches, please contact us at Evolve Physical Therapy for an evaluation today!


Melisa Abesa is a California transplant who has come to love the Pacific Northwest. Since graduating with her Doctorate of Physical Therapy from the University of Southern California in 2014, she has practiced in the Portland/Salem area. She is a huge advocate for patient empowerment, individualized care, and a holistic approach to health and wellness.

As a board-certified clinical specialist in orthopedic physical therapy, she enjoys working with a large variety of orthopedic and sports related conditions, with special interests including runners, headache treatments, post-operative care, and adolescent athletes.