Why is my doctor sending me to physical therapy for my headaches?

Headaches are not all in your head. In fact, tightness through the joints or muscles of your neck, upper back, or shoulders can often be the underlying cause of pain through this area. Patients are often surprised when their physicians send them to physical therapy for their headaches or migraines and wonder how PT can help.

There are multiple types of headaches, including tension and cluster headaches, cervicogenic headaches, post-traumatic headaches after a concussion or brain injury, migraines, and those related to the temporomandibular joint (TMJ or from the jaw) or facial muscles. Tension-type headaches are the most common type in adults, but can also occur in children. They may occur after a neck injury, whiplash, heavy activities, prolonged sitting, poor posture or workstation set-up, or with stress.

On average, your head weighs somewhere between 8-12 pounds. Imagine holding an 8-pound bowling ball in your hands. If you keep it close to you, you can hold the ball for awhile without too much strain through the muscles of your arms.

Now imagine holding the same bowling ball in front of you with your arms straight, away from your body. Despite the fact that the weight is the same, your muscles have to work much harder to hold the bowling ball up against gravity. You most likely won’t be able to hold it up very long. The same thing happens with your neck muscles. Prolonged positions with the head forward places increased strain through the muscles as they try to keep the head up as you work on your computer or read this blog post on your phone. Eventually those muscles get tired of working so hard, joints can get stiff and the increased strain can lead to headaches.

Treatment

So how do we fix this? As physical therapists, we do a comprehensive evaluation to determine what is exactly causing your headaches. Often, patients have compensated for a long time due to their symptoms. They may have stiffness through their neck, upper back, jaw, or shoulder blades. Hands-on techniques, including mobilizations or manipulations, can improve mobility and improve pain. Patients may also have tightness or “knots” through the muscles in the area. Tight areas through the shoulders or neck can often refer pain to the head or trigger migraines. Soft-tissue mobilization techniques, myofascial release and trigger point treatments can all be effective in reducing some of the pain associated with tightness through the muscles. 

Hands-on techniques are important for improving mobility and reducing pain, but working on strength and posture is typically crucial to keep headaches in check long-term. The deep neck muscles and those between your shoulder blades are the “core” muscles of your neck and upper body. Improving the strength, control and coordination of these muscles help you to maintain better posture during the day and take pressure off of the joints and muscles in your neck that can cause headaches. A physical therapist can help you determine what exercises may be beneficial for you, as well as make recommendations on setting up your workstation in a way that may help with improving posture and reducing pain.

Need Help?

Frequent headaches can be miserable and significantly affect someone’s quality of life. The good news is that most can be treated without medication. Improving mobility, strength and posture can often decrease the frequency and intensity of headaches and improve daily function. If you have been struggling with headaches, physical therapy may be a great option for you. Most patients do not need a referral to see a physical therapist. Reach out if you have further questions or would like to set up a consultation to see how physical therapy can help your pain.