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Physical Therapy for Headaches and Migraines

April 4, 2016

If you experience headaches or migraines, you understand how debilitating this condition can be. Ninety percent of people with migraines are unable to work or function normally during a migraine attack. In those experiencing chronic daily headache (at least 15 episodes per month), depression, anxiety, and sleep disturbances are common. Despite the severe nature of this condition, most sufferers do not seek medical attention.1

There are several different types of headaches, the most common being migraine and tension-type headache. Migraine headaches are characterized by an intense throbbing pain on one or both sides of the head. This is usually accompanied by visual disturbances, nausea, vomiting, dizziness, sensitivity to sound, light, touch, smell, and even numbness and tingling in the face or extremities.1 In contrast, tension-type headaches are most frequently felt on both sides of the head, have a pressing/tightening quality (non-pulsating), are of mild to moderate intensity, and are not aggravated by routine physical activity (however this may vary among individuals).2

If any of these symptoms sound all too familiar, contact your physical therapist. Since headaches can be the result of complex neurological symptoms, a detailed history and examination must be performed by a physical therapist or medical doctor to rule out other causes. Unfortunately migraines are not well understood, and modern medicine has yet to find a cure. Research has, however, shown that physical therapy including dry needling can significantly reduce headache frequency/intensity and improve quality of life.

Several research studies have determined that dry needling combined with medical management provides long-term, significant benefits for patients experiencing chronic headache, particularly migraine.3 In fact, studies have found that dry needling can improve clinical outcomes beyond that which would be expected from medical management alone.4

Research has demonstrated that people with tension-type headaches have more trigger points (“knots”) in muscles of the head and neck compared with those who do not have headaches. Decreased neck range of motion and forward-head postures are also more common in those with tension-type headaches.5 Further research has found these patients have significantly decreased neck extension strength along with a tendency for weaker shoulder abduction strength.6 All of these issues – trigger points, tight muscles, weak muscles, and posture abnormalities – can be resolved with help from your physical therapist.

Following a thorough history and examination, your therapist will develop a plan of care tailored to your individual needs. A typical session would include manual therapy techniques (including massage, joint mobilizations, manual stretching, and dry needling), therapeutic exercises, postural stabilization, modalities, and education for dealing with chronic headache. Open communication with your therapist about response to treatment, during and after the session, is essential to optimize effectiveness. So seek medical attention for your migraines, and contact your physical therapist today!

1. Migraine Fact Sheet. Migraine Research Foundation website. Accessed March 13, 2016.
2. Chowdhury D. Tension type headache. Annals of Indian Academy of Neurology. 2012;15(Suppl 1):S83-S88. doi:10.4103/0972-2327.100023.
3. Vickers AJ, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004;328:744. doi:
4. Coeytaux RR, et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache. 2005 Oct;45(9):1113-23.
5. Fernández-de-Las-Peñas C1, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007 May;47(5):662-72.
6. Madsen BK, Søgaard K, Andersen LL, Skotte JH, Jensen RH. Neck and shoulder muscle strength in patients with tension-type headache: A case-control study. Cephalalgia. 2015. doi: 10.1177/0333102415576726

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