Physical therapy for headaches has a narrow, useful job. It helps with two kinds: tension-type headaches, the common pressing or band-like kind, and cervicogenic headaches, which start in the neck and are felt in the head. It is not the right first step for a new, severe or unusual headache, and it doesn’t replace a medical workup. So before anything else, here are the signs that mean a doctor should see you first.
See a doctor first if any of these apply
Call 911 or go to an emergency department for:
- A sudden, severe headache that hits full force within seconds to a minute (a thunderclap headache), or the worst headache of your life
- A headache with weakness, numbness, trouble speaking, vision changes, confusion or loss of balance, which can be signs of a stroke
- A headache with fever and a stiff neck, repeated vomiting, a seizure or trouble breathing
Call or see your doctor right away if:
- The headache followed a head injury
- Your headaches are getting worse over days or weeks, or their pattern has changed
- You have a new, constant headache, especially if you’re over 50
- You have new headaches and a history of cancer or HIV
- You’re having two or more headaches a week
- Your headaches are worse when you lie down
- You need pain medicine more than 3 days a week, which can lead to rebound headaches
- You’re pregnant or could be, since some headache medicines shouldn’t be taken in pregnancy
These lists come from NINDS and MedlinePlus guidance. Physical therapy does not replace a medical diagnosis, and for any persistent headache it makes sense to see your physician first and come to us once other causes are ruled out.
Tension-type or neck-related?
The two overlap, and both are easy to confuse with migraine. Here’s how they usually differ:
| Tension-type headache | Cervicogenic (neck-related) headache | |
|---|---|---|
| Where | Both sides of the head, often like a tight band; scalp, temples or back of the neck | Usually one side, starting at the back or base of the head and spreading forward, sometimes behind the eye |
| How it feels | Dull, steady pressure rather than throbbing | Pain referred from joints, muscles or nerves in the neck |
| Neck clues | Tender neck and shoulder muscles are common | Neck motion is limited, and moving the neck can make the headache worse |
| Common triggers | Stress, poor sleep, holding your head still for long periods, alcohol, dehydration | Neck injury (including whiplash), arthritis, a pinched nerve or disc problem |
| What it usually lacks | Nausea or vomiting; walking and stairs don’t make it worse | Migraine features such as light and sound sensitivity or nausea |
A cervicogenic headache is a secondary headache, meaning a problem in the neck causes it. You may or may not feel neck pain at the same time, and a normal scan doesn’t rule it out, since imaging shows structure rather than how your neck moves. If you have migraine, your physician leads that care; some people with migraine also have neck pain, and we can assess that separately.
Physical therapy for headaches: what we treat and how
Your first visit focuses on your neck and the habits around it:
- Your headache history. How often, where, how long, and what you were doing beforehand. A headache diary helps; NINDS suggests noting the time of day, intensity, sleep, stress, medicines, food and activity.
- Neck movement testing. With the McKenzie Method (MDT), we check whether repeated neck movements or sustained positions bring on, change or ease your familiar headache. That response tells us whether the neck is likely involved.
- A hands-on exam of the upper neck joints and muscles, plus a look at your posture at the desk, in the car and on your phone.
If the neck is involved, treatment usually combines hands-on manual therapy for the neck and upper back, exercises for the deep neck and shoulder blade muscles, posture and workstation changes, and a short routine you can use when you feel a headache building. Cleveland Clinic notes that headaches can worsen when treatment begins, so we pace exercise and stretching to avoid that. Our neck pain page explains the neck exam in more detail.
If your neck exam doesn’t change your headache at all, we’ll say so plainly and suggest you follow up with your physician. And if dizziness or vertigo is part of the picture, talk with your doctor, because we don’t provide vestibular therapy.
What tends to feed these headaches
- Holding your head still for long stretches. MedlinePlus lists computer work, fine hand work and even microscope work. If your day is spent at a screen or a lab bench on the Buffalo Niagara Medical Campus, set a timer to move.
- Stress and short or poor sleep, both common tension-type triggers.
- Sleeping with your neck at an awkward angle, or in a cold room.
- Dehydration and alcohol.
- Pain medicine overuse. Taking it more than 3 days a week can keep headaches coming back.
With most plans, you can start physical therapy in New York without a referral for up to 10 visits or 30 days, whichever comes first (how direct access works), but if anything on the warning lists applies, see your doctor before us. When you’re ready, call (716) 332-4838 or request an appointment. We’re on Virginia Street, about a 4-minute walk from the Allen/Medical Campus Metro Rail station.
Sources
- Headache, National Institute of Neurological Disorders and Stroke (NINDS)
- Tension headache, MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine
- Cervicogenic Headache, Cleveland Clinic