Understanding Headaches: How Physiotherapy Can Help
Headaches are common, but they are not all the same.
Some are mild and short-lived, while others recur or significantly affect work, sleep, exercise and daily life. The International Classification of Headache Disorders describes numerous headache conditions, each with different features and possible causes.
Many headaches are not caused by a problem that physiotherapy can treat. However, physiotherapy may help when neck pain, neck movement or other musculoskeletal factors contribute to the presentation.
This can include some cervicogenic headaches, tension-type headaches accompanied by neck symptoms, and headaches following a whiplash injury.
Can Neck Problems Cause Headaches?
Pain arising from structures in the upper neck can sometimes be experienced in the head. This is known as referred pain.
The nerves that carry information from the upper cervical spine interact with pathways carrying sensation from the head and face. This is one reason a neck problem can be experienced as headache pain.
However, having neck pain or tight muscles during a headache does not automatically mean the neck is its cause. Neck discomfort can also occur as part of migraine and other headache disorders.
A careful history and physical assessment are needed to determine whether physiotherapy is likely to help.
Cervicogenic Headaches
A cervicogenic headache is a secondary headache attributed to a disorder or problem involving the cervical spine or surrounding tissues.
Features that may suggest a cervicogenic headache include:
Headache accompanied by neck pain or stiffness
Reduced neck movement
Headache that is consistently aggravated by particular neck movements or sustained positions
Pain that begins around the neck or base of the skull and spreads towards the head
Pain that is predominantly on one side
Reproduction of familiar head pain during a physical examination of the neck
These features are not exclusive to cervicogenic headache. Migraine and tension-type headache can also involve neck pain, so diagnosis should not be based on one symptom alone.
Physiotherapy management may include:
Education about the condition
Advice about activity and symptom management
Exercises for neck and upper-back strength and endurance
Movement and coordination exercises
Gradual return to relevant activities
Manual therapy where appropriate
Hands-on treatment may provide short-term symptom relief for some people, but active rehabilitation is usually important for building longer-term capacity.
Tension-Type Headaches
Tension-type headache is a common primary headache disorder.
It is often described as:
Pressing or tightening rather than pulsating
Mild to moderate in intensity
Affecting both sides of the head
Not becoming substantially worse with routine physical activity
Lasting from 30 minutes to several days
Tension-type headaches generally do not involve vomiting. Some people may experience sensitivity to light or sound, particularly with more frequent or chronic headaches.
Despite the name, tension-type headaches are not simply caused by tight neck muscles or emotional stress. Their underlying mechanisms are more complex.
Physiotherapy may be useful when tension-type headaches occur alongside neck pain, reduced movement or muscular tenderness. Treatment may include exercise, relaxation or breathing strategies, education, activity advice and hands-on treatment.
Other management may involve medication advice from a GP, psychological strategies, sleep support or treatment of other contributing factors.
Headaches Following Whiplash
Headaches can develop following a whiplash injury, commonly after a motor vehicle collision but also after other rapid acceleration or deceleration injuries.
They may occur alongside:
Neck pain
Neck stiffness
Dizziness
Sensitivity to movement
Difficulty concentrating
Sleep disturbance
Reduced tolerance for work or normal activities
A whiplash-associated headache does not have one fixed pain pattern. It may resemble a tension-type headache, migraine or cervicogenic headache.
The International Classification of Headache Disorders classifies a headache as attributed to whiplash when it develops within seven days of the injury, although clinical assessment still needs to consider concussion and other possible causes.
Physiotherapy management may include:
Reassurance and education
Advice about gradually resuming normal activities
Comfortable neck movement
Progressive strengthening and coordination exercises
Balance or dizziness assessment where appropriate
Strategies for returning to work, driving or exercise
Manual therapy as an adjunct when suitable
Prolonged rest and avoidance of movement are not usually helpful. Rehabilitation should be paced according to symptoms and individual recovery.
A headache after trauma may also require medical assessment, particularly when accompanied by neurological or concussion symptoms.
When Should a Headache Be Medically Assessed?
Because headaches have many possible causes, recurring, persistent or changing headaches should be discussed with a GP or other appropriate medical practitioner.
Arrange medical assessment if:
Headaches are becoming more frequent
The pattern or character of your usual headaches has changed
Headaches regularly interrupt sleep, work or daily life
You require pain medication frequently
You have a new headache without a clear explanation
Headaches developed after a head or neck injury
You are uncertain whether migraine or another headache disorder may be involved
A physiotherapist can screen for concerning features and refer you for medical assessment, but physiotherapy does not replace medical care when a non-musculoskeletal cause is suspected.
When Is a Headache an Emergency?
Seek urgent medical care or call 000 if you experience:
A sudden, extremely severe headache
Headache with weakness, facial drooping, difficulty speaking or confusion
A seizure or loss of consciousness
New loss of balance or difficulty walking
New blurred or double vision
Fever with significant neck stiffness
A severe or worsening headache following a head injury
A headache accompanied by repeated vomiting or marked drowsiness
A headache that feels dramatically different from your usual pattern
This is not a complete list. If a headache feels severe, unusual or concerning, seek medical advice.
What Does a Physiotherapy Headache Assessment Involve?
A physiotherapist will ask about:
Where you feel the headache
How it begins and how long it lasts
Its frequency and intensity
Associated neck pain
Activities or movements that affect it
Nausea, dizziness or sensitivity to light and sound
Previous headaches, injuries and medical history
Medication use
Any changes in the headache pattern
The physical assessment may include:
Neck movement
Joint and muscular sensitivity
Neck and shoulder strength
Movement control and endurance
Neurological screening where appropriate
Balance or dizziness assessment when relevant
This information helps determine whether the neck appears to contribute and whether physiotherapy is appropriate.
Keeping a headache diary can also be useful. Record when headaches occur, how long they last, associated symptoms, medications and possible patterns.
How FutureReady Physio & Wellness Can Help
When physiotherapy is appropriate, treatment will be tailored to your presentation rather than based solely on the location of the pain.
Your plan may include:
Education about likely contributing factors
Exercises for neck and upper-back strength
Movement and coordination training
Advice about work, exercise and everyday activity
Strategies to gradually build physical capacity
Hands-on treatment for short-term symptom relief
Referral to your GP or another practitioner when needed
The aim is not to promise that physiotherapy can treat every headache. It is to identify when musculoskeletal factors are relevant and help you manage those factors effectively.
If you experience headaches alongside neck pain, stiffness or restricted movement, book a physiotherapy assessment to determine whether your neck may be contributing and what the most appropriate next step should be.