How Can Physical Therapy Help Headaches?

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March 18, 2022
March 17, 2022
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How Can Physical Therapy Help Headaches?

Physical therapy is a popular solution for a lot of patients struggling with migraine and headaches. Here is our guide for how to find a proper treatment that can improve your condition.

What are the Goals of Physical Therapy for Headaches?

Many different headache disorders can cause neck pain, and there’s a headache that itself is caused by neck pain. It is possible to have neck pain and migraine, or another headache, and an important part of your appointment with your headache specialist will be discussing any potential connection between the two. If neck pain is present, your doctor may recommend a course of physical therapy.

The goals of physical therapy can vary, but overall your physical therapist will attempt to improve posture, strengthen muscles that have atrophied, and stretch muscles that have become spasmed. You first start with a thorough evaluation of your neck and shoulders, including the muscles in the back of your head. Your therapist will look for areas of tenderness, and test strength. 

How is Physical Therapy for Headaches Personalized?

There isn’t a one-size-fits-all approach to physical therapy for headaches. It completely depends on what the therapist sees on their evaluation: which areas are more or less affected, and to what extent. Your therapist will start, after the evaluation, by recommending a few exercises to do at home a few times daily - and you must follow through with these exercises at home, because if not, you won’t be addressing the neck pain adequately.

The most common muscle groups affected by migraine or other headaches are the cervical paraspinal muscles and the trapezii. These are the muscles in the back of the neck and the top of the shoulders that keep the head upright. Poor posture, over time, can cause those muscles to work too hard and “hypertrophy” or become too large for their own good. Conversely, the muscles located at the front of the neck - the sternocleidomastoid and platysma muscles - don’t work hard enough and they begin to atrophy. 

How Long Does Physical Therapy For Headaches Take?

Most people have to continue these exercises for quite a long time. If it took months or years for your neck to have these issues, it will likely take months or even years to completely resolve this. Some people even need to continue the stretches or strengthening exercises once or twice daily forever - which seems daunting, but if you put it in perspective, would you rather improve this pain with a few stretches a day or with medication or surgery that might have side effects or worse outcomes. 

Just because you have to do those exercises for a long period doesn’t mean you have to go back to the therapist for that long. Although in some extreme cases, some people may have to continue the following therapy for months or years (primarily if they have complicated neck or shoulder issues, or if the pain is so severe they can’t do those exercises alone), most people only need a few sessions to get evaluated and to get started. The physical therapist will make sure you are doing the exercises correctly and may make some initial adjustments to your plan. You should be able to graduate from physical therapy after that - but that doesn’t mean you are free from doing those exercises. 

Comprehensive Pain Therapy 

Some patients may not improve with physical therapy alone, and therapy may be only one of several treatments that your doctor recommends. If there is another underlying headache disorder, like migraine, your doctor may recommend preventive migraine treatments as well. Some oral medications can help musculoskeletal pain - these can be antidepressants, anti-inflammatories, or muscle relaxants, and may be recommended either on a daily or as-needed basis. Some injections can be helpful as well, including trigger point injections, and nerve blocks.


If you'd like to speak with a neurologist specializing in headaches about how you can best manage your headaches and neck pain, join Neura Health today.

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Thomas Berk, MD
Thomas Berk is Medical Director at Neura Health and a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is an emerging leader of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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