Managing Migraines & Headaches with Physical Therapy

In the United States, over 37 million people suffer from migraines or chronic headaches. Migraines and headaches can be debilitating, limiting daily activities, work, and quality of life. While neuro-vascular, nutritional, and chemical imbalances can trigger migraines and headaches, musculoskeletal dysfunction in the neck and shoulders is a common cause of headaches and can contribute to the development of a migraine. Physical therapy can ease headache and migraine symptoms, addressing the underlying neuro-musculoskeletal causes for safe and sustainable management of chronic headaches and migraines.

Causes of Migraines & Chronic Headaches

There are two types of headaches that are most common: migraines and tension-type headaches (TTH).

Migraines: Migraines are the third most prevalent illness worldwide and affect women more often than men. A migraine is a central nervous system disorder, involving the nerves and blood vessels and resulting in the pain and neurological symptoms that are associated with a migraine headache. A migraine sufferer may experience light and sound sensitivity, faintness, nausea and vomiting, and “aura,” a transitory neurologic symptom such as visual or language disturbances or sensory or motor issues. Studies have shown that up to 80% of patients with migraines also report neck pain.

Migraines can be triggered by a variety of factors: stress, certain foods, bright lights, loud noises, weather changes, hormonal changes, physical overexertion, and emotional strain. Migraines may be intensified by referring pain from tense muscles in the neck and shoulders. Migraines can also develop due to neck muscle dysfunction that triggers the trigeminal nerve as fibers of the upper cervical spine that regulate neck muscles meet with the trigeminal nerve and can thus affect trigeminal nerve function and trigger a migraine. The trigeminal nerve regulates sensation to the face and is responsible for TMJ functions of biting and chewing.

Tension-Type Headaches:  A tension-type headache (TTH), or cervicogenic headache, is caused by referred pain due to muscular tension in the neck and shoulders. The muscular tension can result from physical imbalances, weaknesses, tightness, or injury to the neck, such as whiplash in which the torn muscles and strained connective tissue can refer pain to the head, face, shoulders, and neck.

Physical stress to the neck and shoulders from repeatedly sitting hunched over a computer or phone screen wears out the muscles, causing soreness and pain and leading to trigger points (tight bands or knots in muscles) which refer pain to the head, causing a headache. The strain of poor posture on the neck and head also increases the sensitivity of the dura mater membrane, which envelops the brain and the base of the skull. The dura mater lies close to the small muscles of the neck; if these muscles spasm or tighten due to poor posture, the dura mater can be tugged and react by referring pain to the head.

Physical Therapy Treatment for Migraines & Headaches

Physical therapy can ease chronic headaches and migraines, addressing the underlying neuromusculoskeletal causes for safe, sustainable management of the headache or migraine. During the initial evaluation, the physical therapist examines the neck and cervical spine and reviews symptoms and lifestyle factors contributing to the headache or migraine. Physical therapists are trained to treat musculoskeletal impairments of the body and reduce tension and stress in soft tissues and joints.

In the case of headaches and migraines, the therapist targets the cervical spine, neck, and shoulder muscles to restore mobility and corrects muscle imbalances that contribute to pain. Both manual therapy and therapeutic exercise help to restore spinal alignment, strengthen muscles that support the neck and shoulder, restore range of motion of the neck, and help patients improve posture. A recent review showed that manual treatment of trigger points, in the muscles of the neck and shoulders and the suboccipital muscles can reduce the frequency, intensity, and duration of migraine attacks.

 Physical therapy treatment for headaches and migraines can include:

• Manual therapy: soft tissue and joint mobilization to release tight muscles and decrease acute pain

• Dry needling of trigger points in neck and shoulder muscles to ease tension

• Myofascial release to decrease pain and restore motion

• Therapeutic exercise, including stretching and strengthening exercises of the neck and shoulders to address muscle imbalances that contribute to neck pain and headaches

• Posture training to reduce posture-related stress on the muscles and joints of the neck and shoulders

• Lifestyle modifications (sleep position and minimizing migraine or headache triggers)

• TMD treatment if the patient is experiencing TMD-induced headaches or migraines

Myofascial release (MFR) is a hands-on technique that involves gentle sustained pressure into the myofascial connective tissues to help decrease pain and restore motion. Fascia is thin connective tissues surrounding muscles, blood vessels, nerves, and organs. When healthy, it is flexible and supports the body’s structures; when inflamed or injured, it can become restricted and not allow tissues to move correctly. MFR helps to relieve stress, restore fascial elasticity, oxygen, blood flow, and lymphatic circulation, and manage the migraine and headache.

Chronic headaches and migraines can negatively impact your quality of life. Incorporate physical therapy into your headache and migraine management to address underlying issues contributing to your pain!