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  • Writer's pictureGlenn Charbonneau, P.T.

Headaches - How, Why & What You Can do

Headaches are a very common, and often costly medical problem for people all over the world. With a lifetime prevalence between 93 to 98% of the population, the most common types of headaches include: cervicogenic, migraine and tension-type. Their symptoms and causes vary, as do treatment options.

Cervicogenic headaches

These types of headaches refer to a disorder of the soft tissues within the neck (e.g. joints, disks and ligaments), and is usually accompanied with neck pain. Prevalence can be as high as 53% after a whiplash injury.

Clinical Features

Sex: 50% Female

Location: One side of the head

Severity: Moderate to severe pain

Triggers: Neck movement and postures

Duration: 1 hour to weeks, episodic or chronic

Migraine headaches

These headaches are complex and multifaceted, involving activation and sensitization of certain pathways within the brain. Although our understanding behind the origin of pain is still limited, migraines are commonly described today as a “neurovascular disorder.”

Clinical Features

Sex: 75% Female

Location: One side of the head that may shift

Severity: Moderate to severe pain

Triggers: *Multiple

Duration: 4 to 72 hours, 1 to 4 times per month

*Triggers are still unclear, as common migraine experiences of sleep deprivation, hunger, or bright light may in fact be early symptoms of an already ongoing attack.

Tension-type headaches

These are the most common sub-type, and are associated with musculoskeletal disorders such as muscle pain and myofascial trigger points around the head, neck and shoulders.

Clinical Features

Sex: 60% Female

Location: One or both side(s) of the head

Severity: Mild to moderate pain

Triggers: Multiple (e.g. stress, fatigue, dehydration)

Duration: Days to weeks, 1-30 per month

Note that each of these headache sub-types may coexist with each other, particularly migraine and tension-type headaches.


Physical therapy interventions proposed to be effective for headaches include: spinal joint manipulation and/or mobilization, soft tissue compression, therapeutic exercises and dry needling (intramuscular stimulation or IMS ).

**Not sure what Intramuscular Stimulation (IMS) is? - Check out our previous blog post**

Other interventions may include: pharmacological, acupuncture, relaxation and cognitive-behavioural therapy, biofeedback, taping, heat therapy and electrical stimulation (e.g. TENS).

Specifically, aerobic exercise may be effective prophylactically for individuals with migraine who do not want to take daily medication, while targeted neck and shoulder strengthening is better for cervicogenic and tension-type headaches. Limitations to exercise that need to be considered include adherence and self-reported satisfaction.

Headaches should be managed with openness to a variety interventions. Evidence suggests that effectiveness depends on proper reasoning by the clinician, as not all interventions are equally effective for each individual with their headache condition. The best course of action is to talk with your healthcare professional to find the best treatment options for you.


Fernández-de-las-Penas, C. & Cuadrado, M. (2015). Physical therapy for headaches. Cephalalgia, 0(0), 1–9. doi: 10.1177/0333102415596445

Dunning, JR., Butts, R., Mourad, F., Young, I., Fernandez-de-Las Peñas, C., Hagins, M., Stanislawski, T., Donley, J., Buck, D., Hooks, T.R. & Cleland, J.A. (2016). Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskeletal Disorders, 17, 64. doi: 10.1186/s12891-016-0912-3

Fernández-de-las-Peñas, C., & Courtney, C. Clinical reasoning for manual therapy management of tension type and cervicogenic headache. (2014). Journal of Manual Manipulation Therapy, 22(1), 44–50. doi: 10.1179/2042618613Y.0000000050

Goadsby, P., Holland, P., Martins-Oliveira, M., Hoffmann, J., Schankin, C. & Akerman, S. (2017). Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews, 97(2), 553–622. doi: 10.1152/physrev.00034.2015

Krøll, L.S., Hammarlund, C.S., Westergaard, M.L., Nielsen, T., Sloth L.B., Jensen R.H. & Gard, G. Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. (2017). Journal of Headache Pain, 18(1), 46. doi: 10.1186/s10194-017-0753-y.

Phu Do, T., Heldarskard, G., Kolding, L., Hvedstrup, J. & Schytz, H. (2018). Myofascial trigger points in migraine and tension-type headache. Journal of Headache Pain, 19(1), 84. doi: 10.1186/s10194-018-0913-8

Wöber, C. & Wöber-Bingöl, C. (2010). Triggers of migraine and tension-type headache. Handbook of Clinical Neurology, 97, 161-72. Retrieved February 28, 2019, from PubMed database. doi: 10.1016/S0072-9752(10)97012-7.

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