Identifying the type of headache directly determines whether treatment will work. Physiotherapy is not equally effective across all headaches: it is the primary treatment in cervicogenic headache and a supporting one in migraine.
Telling the three apart
| Tension-type | Migraine | Cervicogenic | |
|---|---|---|---|
| Location | Both sides, band-like | Usually one side | One side, always the same side |
| Character | Pressing, tightening | Throbbing | Dull, pressure |
| Severity | Mild to moderate | Moderate to severe | Moderate |
| Duration | 30 min – 7 days | 4–72 hours | Variable, can last days |
| Nausea | Rare | Common | Rare |
| Light/sound sensitivity | Mild | Marked | Mild |
| With movement | Unchanged | Worse with physical activity | Triggered by neck movement |
| Neck findings | Muscle tenderness | May be present | Marked restriction |
What identifies cervicogenic headache is that the pain can be reproduced by a particular neck position or by pressure over the upper cervical region.
Red flags
Urgent medical assessment is needed before physiotherapy if you have:
- A severe headache exploding over seconds ("the worst headache of my life")
- Headache with fever and neck stiffness
- Headache starting after a head injury
- Neurological signs: speech disturbance, one-sided weakness, loss of vision
- A new headache starting after age 50
- Headache that is progressively worsening or changing in character
- Headache markedly worse with coughing or straining
Physiotherapy for cervicogenic headache
Here physiotherapy is the primary treatment and works well.
Treatment includes:
- Joint mobilisation of the upper cervical region (C0–C3)
- Soft tissue work on the suboccipital muscles
- Strengthening the deep neck flexors — the chin tuck exercise
- Scapular control work
- Thoracic spine mobility
- Workstation and sleep position adjustment
Home exercise — chin tuck: Sit tall. Draw your chin gently back (without tipping the head down), lengthening the back of the neck. Hold five seconds, ten repetitions, five or six times a day. Done correctly you feel the deep muscles at the front of the neck working.
Physiotherapy for tension-type headache
- Trigger point work on neck and shoulder girdle muscles
- Changes to posture and working set-up
- Regular aerobic exercise — effective at reducing frequency
- Stress management and breathing work
- Sleep routine
Thirty minutes of brisk walking a few times a week is a simple and effective intervention for reducing tension headache frequency.
Where physiotherapy fits in migraine
Migraine is a neurological condition and its treatment is directed by a doctor. Physiotherapy targets the neck component that accompanies it:
- Most people with migraine have neck pain during or before attacks
- Reducing the additional load coming from the neck can lower attack frequency and severity
- Regular aerobic exercise is among the recommended approaches in migraine prophylaxis
- Relaxation and breathing techniques support attack management
Physiotherapy does not replace migraine medication; it is added to it.
A trigger diary
For two or three weeks, record:
- Time of onset and duration
- Severity (1–10)
- Location and character
- What you ate beforehand, how much you slept
- Stress level, screen time
- For women, day of the menstrual cycle
- Medication taken and its effect
The diary both clarifies the diagnosis and makes triggers visible.
Medication overuse headache
An important and frequently missed heading: taking painkillers on more than 10–15 days a month can turn a headache chronic. The picture becomes a headache caused by the medication itself.
If you are using painkillers on more than 10 days a month, speak to your doctor; in that situation the first step of treatment is tapering the medication.
Six things that help day to day
- Raise your screen to eye level and break every 30–40 minutes
- Sleep on a single pillow of appropriate height
- Keep your fluid intake up — dehydration is a frequent trigger
- Do not skip meals
- Keep sleep times fixed, weekends included
- Thirty minutes of aerobic exercise three days a week
Frequently asked questions
Does loss of the neck curve cause headache? Changes in cervical curvature are commonly seen in people without symptoms. An X-ray finding alone does not make the diagnosis; the clinical examination does.
How many sessions before I see a result? In cervicogenic headache, expect noticeable change within 6–10 sessions. If nothing has changed after three or four, the diagnosis should be reconsidered.
Is massage enough? Massage reduces muscle tension temporarily. Lasting results require strengthening the deep neck muscles and changing daily habits.
Does the jaw joint play a part? Yes — jaw (TMJ) problems can cause pain in the temple and face. If you have a history of clenching, it is included in the assessment.
This article is general information and does not replace an examination. For an assessment of neck-driven headache, book an appointment at our clinic in Muratpaşa, Antalya.