How to Treat That Nagging Headache

By Kateri Kane, PT, DPT

In case you were not aware, this week is National Headache Awareness Week.  Headaches are a common complaint for many individuals, just about as common as back pain. Headaches can be annoying, disruptive, and outright painful.  So what are the causes and how can you get rid of one?

There are several different categories of headaches, including: tension-type, cervicogenic, migraine and cluster, secondary headaches from an underlying condition (fever, infectious disease, sinus disorder, or a tumor or more serious illness), cranial neuralgias, facial pain, and other headaches.  Certain headache sources are treated most effectively through medicine including those related to underlying conditions such as fever, infection, or sinus disorders.  Migraines are often treated with a combination approach including medication, avoiding triggers, and changing the environment to one less irritating. Other non-medication treatments for migraines include using ice (specifically at your feet to draw blood away from your head), biofeedback, relaxation techniques, and sleep.

Tension headaches are the most common headache to occur in adults and can be very successfully treated without the use of medication.  Tension type headaches and cervicogenic headaches are frequently treated by physical therapists and often confused with each other.  Cervicogenic headaches may be the result of a neck or jaw problem. Tension headaches are often caused by stress which causes tension in the muscles of the neck which in turn increases pressure on the nerves of the face and head.  Both of these types of headaches can result from poor posture and muscle fatigue. Poor posture in particular can cause the muscles of the neck to be put in an improper position and overworked, thus resulting in a headache.

The following chart gives a breakdown of the differences between cervicogenic, tension, and migraine headaches. *Note: Chart Terms – ROM = range of motion, FHP = forward head posture, TTP = tender to palpation.

As previously stated, a migraine should be medically regulated by your primary care physician or neurologist. Tension and cervicogenic headaches, on the other hand, can be treated by your local physical therapist. Tension headaches are often treated with soft tissue mobilizations, education, and relaxation techniques. Cervicogenic headaches can be a bit more complex depending on the root cause of the headache, but once again can be treated with manual techniques often in the form of joint and soft tissue mobilizations, in addition to education and postural training.

If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.

Online Resources:

Move Forward PT



Print Resources:

Goodman, CC, Snyder, TE.  Differential Diagnosis for Physical Therapists 4th Ed.  Saunders, 2007. St. Louis, Missouri.  Pg 637,640.

Marcus, D.  Staying on top of headache and musculoskeletal abnormalities -- Understanding of the complete pain picture helps direct treatment. The Journal of Musculoskeletal Medicine [serial online]. 2007;24:219. Available from: ProQuest Nursing & Allied Health Source. Accessed March 22, 2011.

Sjaastad O., Bakketeig L. Tension-type headache. Comparison with migraine without aura and cervicogenic headache. The Vågå study of headache epidemiology. Functional Neurology  [serial online]. 2008;23:71-6.  Available from: ProQuest Health and Medical Complete. Accessed March 22, 2011.

Yadla, S., Gehret, J., Campbell, P., Mandel, S., & Ratliff, J. A Pain in the Neck: Review of Cervicogenic Headache and Associated Disorders. Jefferson Hospital for Neuroscience Journal. 16-18. Available here.


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