Headaches & Migraines

Nearly everyone experiences an occasional headache, but when they become frequent or severe, it’s worth looking beyond pain relief to find and address the underlying cause — rather than just managing each episode as it comes. Many headaches, particularly tension-type and cervicogenic headaches, are driven by restrictions in the neck and upper spine, which means they can respond well to physiotherapy rather than needing to be managed with medication alone.

There are several distinct types of headache, and identifying which one you have matters because the right treatment differs between them. The most common are tension headaches, cervicogenic headaches, and migraines — each with a different underlying mechanism, though they can also overlap and coexist in the same person.

What causes headaches and migraines

Tension headaches and cervicogenic headaches are both commonly linked to restrictions within the neck and upper spine, often related to poor posture, prolonged desk work, or stress-related muscle tension. When the joints of the neck become restricted, this can irritate the surrounding nerves and blood vessels, referring pain up into the head and causing the tight, tender muscles often felt around the neck and base of the skull. A cervicogenic headache — one originating from the neck — is one of the most common causes of recurring headaches Andrew sees, and it’s frequently mistaken for a standalone headache disorder when the neck is actually the main driver.

Migraines are a different, more complex neurological condition. Their exact triggers aren’t fully understood, but they’re thought to involve changes in blood vessel function and nerve activity in the brain, along with shifts in chemical balance within the body. Common migraine triggers include stress, certain foods, some medications, disrupted sleep, hormonal changes such as menstruation, and — importantly — tension in the neck. This is why neck-related treatment can still play a meaningful role even in true migraine, when the neck is contributing to how often or how severely attacks occur.

Symptoms

Tension headaches typically feel like a squeezing pressure or tight band around the head. Cervicogenic headaches often start at the base of the skull or neck and spread up into the head, frequently on one side, and are usually accompanied by neck stiffness or restricted neck movement. Migraines tend to be more severe, often described as throbbing, pulsing or stabbing pain, usually on one side of the head, and can come with nausea, loss of appetite, and increased sensitivity to light or sound. Some people experience an “aura” before a migraine — visual disturbances, changes in smell, or other sensory changes signalling an attack is coming.

When to see a physiotherapist

Most recurring headaches, particularly tension-type and cervicogenic headaches, are well suited to physiotherapy assessment. However, some headache presentations need urgent medical attention rather than physiotherapy first. Seek prompt medical care for a sudden, severe headache unlike any you’ve had before (sometimes described as a “worst-ever” headache), a headache accompanied by fever, neck stiffness, confusion or visual disturbance, or any headache following a head injury or trauma. These can indicate something more serious that needs to be ruled out before physiotherapy is appropriate. For everything else, Andrew’s assessment includes a thorough physical, orthopaedic and neurological examination to help determine what’s driving your particular headaches and confirm physiotherapy is the right approach.

Physiotherapy treatment for headaches and migraines

Once other causes have been appropriately ruled out, treatment focuses on identifying and addressing restrictions in the neck and upper spine that may be triggering or worsening your headaches:

• Manual therapy to restore movement in restricted neck and upper back joints, easing the irritation to nearby nerves and blood vessels that can refer pain into the head
• Dry needling for the tight, tender muscles around the neck and base of the skull that commonly accompany both tension-type and cervicogenic headaches
• Postural and ergonomic advice targeting the desk-based habits and sustained positions that often build up neck tension over the course of a working week
• A tailored exercise programme to improve neck mobility and postural endurance, reducing how often restrictions build up in the first place

What to expect from treatment

Some people notice a meaningful, fairly immediate reduction in headache intensity once neck restrictions have been addressed, while others experience a more gradual reduction in frequency and severity over several sessions, depending on how long the problem has been building and how much it’s related to the neck versus other factors. For migraine sufferers, physiotherapy is generally most useful as part of a broader management approach that also considers other triggers such as sleep, stress and diet, rather than as a standalone cure.

Managing recurrence

Because postural habits and neck tension tend to rebuild gradually — particularly with desk-based work — staying on top of neck mobility and posture between flare-ups makes a real difference to how often headaches come back. Andrew will give you a home programme aimed at maintaining the improvements made in the clinic, and will flag if your pattern of headaches suggests something that needs a different kind of assessment.