Relieving Chronic Headaches

Thursday, March 28, 2013

Physical therapy provides a solution for some patients with recurring headaches.

Pounding headaches caused by tension are the most common type of headache, affecting nearly 90% of people during their lifetimes.1 However, for about one in seven Americans, headaches are not just an occasional occurrence — they are chronic. For chronic headaches, physical therapy may provide relief.

Evaluation and Intervention

“Physical therapists are skilled in identifying effective interventions, including those that target trigger points, muscle weakness/endurance, postural changes and mobility,” says George Girolami, P.T., OCS, MTC, and partner, BenchMark Physical Therapy. Girolami adds that a skilled physical therapist will evaluate the patient and develop a treatment plan that may involve multiple methods, including:

  • Treating the cervicothoracic region of the spine or the temporomandibular joint, a hidden potential source of head pain
  • Addressing potential hyper-functional sympathetic nervous system activity by quieting primitive, withdrawal and joint protective reflexes
  • Using manual therapy techniques on the spine, including mobilization and manipulation
  • Treating soft tissue structures with methods such as soft tissue mobilization or trigger-point dry needling
  • Specific exercises directed at impairments, including postural, strengthening and stretching exercises that support better posture. Poor posture, specifically bending at the neck, can put pressure on nerves and lead to headaches.

Supported by Research

According to Girolami, it is common for patients to have dramatic decreases in frequency and/or intensity of headaches with physical therapy. In fact, evidence-based research reports several benefits of physical therapy for the treatment of headaches:

  • Manipulative therapy and exercise reduce the symptoms of cervicogenic headaches, and these positive effects are maintained over time.2
  • Both neck exercise (low-intensity endurance training) and spinal manipulation are effective in reducing headache intensity and frequency in the short and long term.3
  • Spinal manipulation is effective in the short term for improving pain in comparison with massage or placebo spinal manipulation.4
  • For migraine headache, spinal manipulation may be an effective treatment option, with a short-term effect similar to that of a commonly used, effective drug (amitriptyline). There were fewer side effects with spinal manipulation.5
  • For the treatment of chronic tension-type headache, evidence shows spinal manipulation appears superior to a commonly used drug by providing a sustained short-term effect after cessation of treatment.6


“Chronic headaches pose a significant health problem for patients,” says Girolami. “A comprehensive physical therapy examination can determine the type of headache and the neuromusculoskeletal factors contributing to it. “Physical therapy by a highly skilled clinician is effective for the treatment of patients with headaches related to musculoskeletal dysfunction, restoring mobility, correcting imbalances and poor posture, and identifying physical activities that contributed to the problem.”

1. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population — a prevalence study. Glostrup Population Studies, Department of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark. J Clin Epidemiol. 1991;44(11):1147-57.

2. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976). 2002 Sep 1;27(17):1835-43; discussion 1843.
3. Jacqueline van Duijn, P.T., DPT, OCS, Arie J. van Duijn, P.T., EdD, OCS, and Wanda Nitsch, P.T., Ph.D. Orthopaedic Manual Physical Therapy Including Thrust Manipulation and Exercise in the Management of a Patient with Cervicogenic Headache: A Case Report. J Man Manip Ther. 2007; 15(1): 10–24. PMCID: PMC2565596
4. Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001 Sep;24(7):457-66. 
5. Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev. 2004;(3):CD001878. 
6. Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):148-54.
George Girolami, P.T., OCS, MTC, uses manual therapy in treatment for cervicogenic headaches.