Headaches can be more than just a painful inconvenience. For some people, headaches or migraines can interfere with work, exercise, sleep, social activities, and everyday life.
If you regularly experience headaches, migraines, neck pain, or a combination of these symptoms, you may benefit from a physiotherapy assessment that looks beyond the location of your pain.
At Back In Strength in Deakin, Canberra, our physiotherapists Oscar and Monika have completed training in the Watson Headache® Approach, a specialised, non-manipulative approach to assessing the role of the upper neck in headache and migraine presentations.
What is headache physiotherapy?
Headache physiotherapy involves assessing whether musculoskeletal factors, particularly those involving the neck and upper cervical spine, may be contributing to your headache symptoms.
This doesn’t mean that every headache is caused by the neck. Headaches have many different causes and presentations, and physiotherapy is not a replacement for appropriate medical assessment or diagnosis.
Instead, a headache physiotherapy assessment looks at the bigger picture, including your headache history, symptoms, neck movements, and how your symptoms respond to specific physical examination techniques.
For people whose headaches have a cervical or musculoskeletal component, physiotherapy may form part of a broader management plan.
Research has found that physiotherapy interventions can help reduce headache frequency and intensity in people with cervicogenic headache, with approaches commonly incorporating manual therapy, exercise, and other physical treatments.
What is the Watson Headache® Approach?
The Watson Headache® Approach is a specialised clinical reasoning and manual assessment approach developed by Australian musculoskeletal physiotherapist Dr Dean Watson.
It focuses on carefully examining the upper cervical spine, particularly the upper three segments of the neck, to determine whether dysfunction in this area may be contributing to a person’s headache or migraine.
Unlike traditional spinal manipulation, the Watson approach uses slow, sustained and non-manipulative techniques. In other words, there is no sudden thrusting or “cracking” of the neck.
The examination is designed to assess how the upper cervical spine moves and, importantly, whether the person’s familiar head pain or associated symptoms can be reproduced and then eased during the examination. This information helps the physiotherapist determine whether the neck may be contributing to the person’s symptoms and guides treatment.
The approach is not simply a collection of hands-on techniques. Clinical reasoning is an important part of the process, with the findings from the assessment used to guide an individual treatment plan.
What happens during a headache physiotherapy appointment?
Your first appointment will begin with a detailed discussion about your headaches.
Your physiotherapist may ask about:
- Where you feel your headache
- What your headache feels like
- How often your headaches occur
- How long they usually last
- When your symptoms started
- Whether you experience migraines or other associated symptoms
- Your neck pain or stiffness
- What makes your symptoms better or worse
- Your daily activities, work, and exercise
- Previous treatments and investigations
- Any medications or other strategies you currently use
Your physiotherapist will then perform a physical assessment.
Depending on your presentation, this may include assessing your neck movement, the upper cervical spine, surrounding muscles, and how different movements or techniques influence your familiar symptoms.
If appropriate, your physiotherapist may use elements of the Watson Headache® Approach to assess the upper cervical spine.
The aim isn’t simply to find something that hurts. Instead, the assessment helps determine whether there is a meaningful relationship between your neck and your headache symptoms and whether physiotherapy is an appropriate part of your care.
What might headache physiotherapy treatment involve?
Your treatment will depend on what your physiotherapist finds during your assessment.
Treatment may include:
Manual therapy
Gentle manual techniques may be used to address relevant restrictions or dysfunction in the neck and upper cervical spine.
Where appropriate, your physiotherapist may use techniques from the Watson Headache® Approach. These are slow, sustained and non-manipulative rather than forceful neck manipulations.
Neck and upper body exercises
Exercise may be used to improve strength, mobility, control, and tolerance of the neck and upper body.
For people with cervicogenic headache, research supports exercise as part of physiotherapy management, particularly for longer-term improvements in headache intensity.
Education
Understanding your headaches can be an important part of managing them.
Your physiotherapist may help you understand potential contributing factors, how your neck and headache symptoms may interact, and what you can do between appointments.
A personalised management plan
There isn’t one treatment that works for every type of headache.
Your physiotherapist will use your assessment findings to develop a plan that may combine hands-on treatment, exercise, education, and other strategies that are appropriate for you.
Where necessary, your physiotherapist may also recommend that you see your GP or another health professional for further assessment or management.
Who might benefit from headache physiotherapy?
Headache physiotherapy may be worth considering if you experience:
- Frequent or recurring headaches
- Headaches accompanied by neck pain or stiffness
- Headaches that seem to start in or around the neck
- Headaches that are associated with particular neck movements or positions
- Cervicogenic headaches
- Migraines where neck symptoms appear to be a contributing factor
- Tension-type headaches with associated neck symptoms
- Headaches that are affecting your ability to work, exercise, or enjoy everyday activities
- Recurring headaches where you would like to explore whether musculoskeletal factors may be contributing
You don’t necessarily need to have severe neck pain for your neck to be relevant to your headache presentation. A detailed assessment can help determine whether there is a meaningful connection.
Can physiotherapy help migraines?
This is an important question, and the answer isn’t simple yes or no.
Migraine is a neurological condition and can involve a range of symptoms and contributing factors. Physiotherapy should not be presented as a cure for migraine or as a replacement for medical management.
However, some people with migraine also have neck symptoms or findings that may influence their presentation. The Watson Headache® Approach specifically considers the potential role of the upper cervical spine in people with primary headache conditions, including migraine.
For this reason, a physiotherapy assessment may be useful for determining whether there is a musculoskeletal component that can be addressed alongside your existing migraine management.
What is a cervicogenic headache?
A cervicogenic headache is a headache associated with a disorder of the neck.
The pain is often experienced in the head or face even though the contributing structures are located in the cervical spine. Neck pain, stiffness, or restricted movement may also be present.
Physiotherapy is one of the treatment options used for cervicogenic headache. Research has found that manual therapy and exercise-based interventions can reduce headache frequency and intensity in some people, although the quality and certainty of evidence varies between treatments and studies.
A thorough assessment is therefore important rather than assuming that every headache is cervicogenic.
Do I need to see my doctor about my headaches?
Physiotherapy can be appropriate for many recurring headache presentations, but new, unusual, or concerning headaches should be medically assessed.
Seek urgent medical attention for a sudden, severe headache, or a headache accompanied by symptoms such as confusion, neck stiffness, vision changes, loss of balance, seizure, or other significant neurological symptoms. It is recommended to seek a medical assessment for headaches that are progressively worsening, begin after a head injury, wake you from sleep or are different from your usual headaches.
If you’re unsure whether physiotherapy is appropriate for you, your physiotherapist can discuss your symptoms and help determine the most appropriate next step.
Headache physiotherapy in Canberra
If headaches or migraines are regularly getting in the way of your life, it may be worth looking at more than just managing the pain when it arrives.
At Back In Strength in Deakin, physiotherapists Oscar and Monika have completed training in the Watson Headache® Approach and can assess whether your neck may be contributing to your headache presentation.
Your appointment will involve a thorough assessment and an individualised treatment plan based on your symptoms and findings.
Living with recurring headaches? Book a headache physiotherapy assessment at Back In Strength in Deakin, Canberra.
Frequently Asked Questions
Can a physio help with headaches?
A physiotherapist may be able to help with headaches, particularly where musculoskeletal factors such as the neck are contributing to symptoms. Physiotherapy is commonly used in the management of cervicogenic headache and may include manual therapy, exercise, and education.
What is the Watson Headache® Approach?
The Watson Headache® Approach is an evidence-informed, non-manipulative approach that assesses the upper cervical spine and its potential relationship with headache and migraine symptoms. It uses slow, sustained manual techniques rather than forceful neck manipulation.
Does physiotherapy help with migraine?
Some people with migraine may have associated neck symptoms or musculoskeletal factors that contribute to their presentation. A physiotherapy assessment can help determine whether these factors may be relevant for you. Physiotherapy should be considered alongside, rather than as a replacement for, appropriate medical management of migraine.
How many headache physio appointments will I need?
This varies from person to person. Your physiotherapist will recommend a treatment plan based on your symptoms, assessment findings, and how you respond to treatment. The goal is to give you strategies that you can use beyond your appointments rather than relying solely on ongoing passive treatment.
Where can I get headache physiotherapy in Canberra?
Back In Strength offers headache physiotherapy at our clinic in Deakin, Canberra. Our physiotherapists Oscar and Monika have completed training in the Watson Headache® Approach.
