Physical Therapy for Migraine: An Introductory Guide

December 14, 2023
November 16, 2023
Physical Therapy for Migraine: An Introductory Guide

Migraine can be a severely debilitating condition, affecting almost every aspect of one’s daily life.

If you're reading this, chances are you're all too familiar with the pulsating pain, nausea, and sensitivity to light and sound that characterize these attacks. Migraine affects around 14% of the population, making it one of the most common neurological disorders in the world! The impact this condition has on individuals can be truly life-altering.

Physical therapy is increasingly prescribed for migraine management. In some cases, it can even be an alternative to medications, especially for those who experience harsh side effects, find that medications are ineffective, or have other medical conditions that limit their ability to take migraine medications.

Also, a physical therapist can work together with your neurologist to improve treatment. Together, we can form a powerful partnership that can help you regain control over your life, and reduce the frequency and intensity of migraine attacks.

Why PT is Prescribed for Migraine

In the management of migraine, medications have long been the front line defense, and for many, they provide much-needed relief and control. However, they come with their limitations, including harsh side effects and the unfortunate reality that they might not work for everyone. This is where physical therapy can play an important role not as a replacement for medications, but as a powerful ally.

As a physical therapist, I don’t want to demonize medications but aim to enhance their efficacy, and decrease need for frequent use. This way, when you do need them, they can be more effective. Together with your neurologist’s care, a physical therapist can address the aspects of migraine that medications may not reach.

Musculoskeletal Triggers and Beyond

Migraine is very complex, multifaceted disease. It is often not just about the neurological aspects; there's a significant musculoskeletal component too. The number one reason for prescribing physical therapy to help with migraine management is the relationship between neck pain and migraine. Neck pain is a common complaint associated with migraine. And it can become a significant source of burden and disability, particularly when it lingers between attacks.

This neck pain may signal an underlying musculoskeletal dysfunction of the neck, which can act as a potential trigger for migraine attacks. Thus, addressing issues of the neck can lead to a significant reduction in migraine frequency.

A Holistic Approach to Migraine Management

As a physical therapist I take a holistic approach to managing migraine. I recognize that migraine is not an isolated event, and that it is influenced by numerous factors. This includes sleep habits, diet, stress management, and exercise.

In your journey towards migraine relief, we don't only focus on the immediate symptoms but also consider you as a whole person. This means we can help you implement a personalized plan of care that takes into account all the factors and triggers of your unique migraine presentation.

Managing Triggers Beyond Medications

Migraine triggers are not one-size-fits-all, and they can vary widely from one person to the next. From a musculoskeletal perspective issues related to your neck or temporo mandibular joint (TMJ).

The holistic approach of physical therapy allows us to not only identify these triggers but also provide targeted solutions. Through tailored exercise programs and hands-on interventions, we can address peripheral and central sensitization, which are key mechanisms in migraine development. Your personalized plan may include several different treatment techniques and strategies. From exercises and lifestyle adjustments to addressing potential headache-inducing sources like the TMJ.

Physical therapy isn’t necessarily here to replace medications; it's here to make them more effective by providing comprehensive care. Together with your neurologist, a physical therapist works to help you manage your migraine condition by addressing the various musculoskeletal and lifestyle triggers that could be contributing to your attacks.

It's about finding the best of both worlds, pharmacological and non-pharmacological, to provide you with lasting relief and a better quality of life.

How PT Can Help

As a physical therapist specializing in headache and migraine disorders, my approach is patient-centered and designed to meet your specific needs. Over the last 2.5 years, I've worked extensively with individuals with migraine, and I've come to understand that the primary goals of physical therapy often revolve around their unique needs.

Addressing Musculoskeletal Dysfunctions

A significant portion of my patients with migraine presents with musculoskeletal dysfunctions, especially in the upper cervical spine (C1-3), the neck and upper back muscles, the temporo mandibular joint (TMJ), and the muscles of the head and face. Manual therapy and targeted exercises play a crucial role in addressing these areas, helping to alleviate tension and reduce pain.

Modulating Central Nociceptive Pathways

Migraine pain is not only about muscles and external triggers. It involves complex nociceptive pathways within the central nervous system. Physical therapy uses techniques, such as manual therapy and electrical stimulation, to help address these pain pathways. By modulating the central nociceptive pathways, we aim to reduce sensitization of the nervous system, which can significantly reduce both the frequency and intensity of migraine attacks.

Decrease Peripheral Sensitization

Peripheral sensitization is a common problem for many with migraine and tension-type headaches. Think of the excessive tenderness to touch you may experience over the shoulders, traps, and neck.

Physical therapy interventions can help to improve pain pressure thresholds, making you less susceptible to the pain that comes with peripheral sensitization that can maybe contributing to attack frequency, intensity, and disability. By increasing your tolerance to pain, we can help you live with less pain and enjoy a higher quality of life.

Customized Exercise Programs

One size fits all programs don’t work well with chronic conditions, especially when it comes to managing migraine. Part of your physical therapy plan of care will be a customized exercise program.

These exercises are developed to help you manage migraine both in the short-term and long-term. In the short-term, exercise can be used to improve neck function and mobility, and decrease pain. In the long-term, exercise can be use to maintain functional improvements, improve quality of life, and decrease comorbidities associated with migraine.

By controlling triggers and gradually progressing your exercise routine, we work together to minimize the chance of exacerbating your migraine condition due to this physical stressor.

Education on Lifestyle Modification

Migraine can be influenced by your sleep habits, stress levels, diet, and other environmental factors. In physical therapy we work together to identify triggers, learn how to manage them, and reduce the frequency of migraine attacks. Lifestyle interventions are all about improving your recovery and overall well-being.

The primary goals of physical therapy are driven by your unique migraine condition. We focus on addressing musculoskeletal limitations, modulating central and peripheral nociceptive pathways, and providing customized exercise programs. At the end of a plan of care the goal is that you are now equipped with the knowledge and tools to manage migraine.

Most Commonly Used Physical Therapy Interventions

When it comes to managing headaches and migraines through physical therapy, I want you to know that it's not a one-size-fits-all solution. It's a dynamic field that encompasses a variety of techniques and strategies tailored to the individual needs of patients. So, let's dive into the most commonly used physical therapy interventions that can make a real difference in reducing the frequency of your migraine attacks and improving your overall quality of life.

1. Exercise: General and Condition-Specific

Now, when we talk about exercise, there's more to it than just hitting the gym. It can be broadly categorized into two areas: generalized exercise and condition-specific exercise.

Generalized Exercise: This category includes exercises like strength training and aerobic activities, aimed at improving your overall physical fitness. Why is this important? Engaging in regular exercise isn't just about feeling good; it's a crucial part of your long-term headache management plan. It boosts your overall well-being and can go a long way in minimizing the frequency of your headache attacks.

Condition-Specific Exercise: These exercises are a game-changer because they're tailored specifically to your migraine and headache triggers. We're talking about exercises that target the muscles of your head, face, and neck, which are usually the troublemakers when it comes to headache pain. Through carefully designed exercise programs, we address the unique needs of patients like you to help reduce the frequency of your headaches. These exercises focus on improving muscular strength, endurance, mobility, and reducing tension in the areas most commonly associated with headache pain.

2. Manual Therapy

Manual therapy is where the magic happens. Manual therapy refers to a hands-on techniques that involves the skilled treatment of soft tissues and joints by physical therapists. These techniques include massage, mobilization, manipulation, muscle energy technique, and stretching exercises. And there are many other techniques that physical therapist can use. Each technique has its own goals that may include relief from muscle tension, enhance joint mobility, and, most importantly, reduce pain.

3. Modalities

Modalities complement manual therapy and exercise interventions, taking your treatment to the next level. Two commonly used modalities in headache and migraine management are cold therapy (ice), which usually involves the use of ice packs to eased is comfort, and electrical stimulation, often called neuromodulation. These modalities add an extra layer of relief by targeting specific aspects of your headache symptoms.

Cold therapy is often used as a home remedy for decreasing attack duration. Combined with compression can really alleviate symptoms during a migraine.

One modality that is very popular right now is neuromodulation, by devices like Cefaly or Nerivio. Physical therapists, like myself, have training on using and administering electrical stimulation in the treatment of many conditions. What is great about neuromodulation is that research is showing that it can be used both as a preventative treatment as well as an acute migraine treatment!

4. Relaxation Techniques

Stress and muscle tension are so common for those living with migraine. Relaxation techniques can help you manage your body's stress response and promote muscle relaxation. These techniques may include deep breathing exercises, progressive muscle relaxation, or guided motor imagery. No single intervention can cover all areas to effectively manage migraine and other types of headaches. I believe in a comprehensive approach that considers your unique needs and goals.

How Long People Typically Need Physical Therapy

In my experience, a typical plan of care for managing migraine and headaches ranges from 4 to 6 weeks, which translates to roughly 6 to 10 visits. For most of my clients, the sweet spot tends to be around 6 visits. However, some individuals may benefit from extended treatment, spanning up to 10 visits. After 10 visits, if a client wants continued supervision progressing their exercise program and working on lifestyle management technique a transition to a wellness program is appropriate. While we aim for that 4-6 week window, there are various factors that can influence the duration of your physical therapy treatment.

Here's what you need to know:

Sudden Changes: Life has a way of throwing curveballs. Sudden changes like increased stress, changes in work or home life, or even a new health issue can sometimes prolong your treatment plan. The goal is to work as a team and provide you with the tools necessary to navigate these changes successfully.

Illness: Falling ill during your treatment can slow things down. When your body is already dealing with one challenge, it might be harder to focus on managing migraine.We adapt your plan to ensure your treatment remains effective, even during periods of illness.

Consistency during your treatment period sets you up for a smoother transition to your wellness program, where you can continue your journey to headache and migraine management. Remember, this isn't just about feeling better for a few days or weeks; we also want to equip you with the knowledge, skills, exercises, and lifestyle changes that will help you manage your condition for the long term. So, keep showing up for your sessions, stay committed to your exercises, and work together with your healthcare team to reduce the frequency and impact of migraine.


Physical therapy isn't just an alternative to medications. It's a strategy that can significantly improve the effectiveness of your current treatments.Physical therapy offers relief through a personalized journey. Rather than taking a one-size-fits-all approach, it recognizes that each person is unique and their migraine presentation is as well.

From the type of exercise that best suits your needs to manual therapies, modalities, neuromodulation, and relaxation techniques, treatments are tailored to fit you, your condition, and your goals.

As someone dedicated to helping those with migraine and headache disorders, I understand that this journey isn't solely about relieving pain today. As a physical therapist my role is to equip you with the tools and knowledge to manage your condition effectively in the long run. That's the ultimate goal, not just feeling better now, but experiencing fewer migraine attacks in the future.

Sam Kelokates, P.T., D.P.T is a physical therapist out of Philadelphia, PA. He specializes in treating migraine and headache disorders.

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Sam Kelokates, P.T., D.P.T.
Sam is a physical therapist who takes a uniquely individualized approach in the management of headache and migraine. These conditions are very complex and require a thorough plan of care to address the multifactorial causes.
About the Author
Sam is a physical therapist with an extensive background in addressing neurological disorders and is an expert on treating and managing chronic pain. This work led him to start his own practice where he is passionate about helping those suffering from headache disorders. He opened Kelos Physical Therapy in January 2021. He became interested in treating headaches after dealing with tension headaches throughout graduate school and the first few years of practice. After successfully using his physical therapy experience and lifestyle management to address his own headaches he began working with friends and family, and then patients. As a healthcare professional, he strives to provide an comprehensive approach to the treatment of headache disorders.

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