Exercise and Manual Therapy to Manage Headaches
Headaches are a common type of pain problem, with studies citing a large percentage of the population experiencing them with varying types, degrees of regularity, and severity. For people with infrequent or less intense headaches, this can amount to a painful inconvenience or annoyance. However, for people who experience regular or more intense headaches, there can be a significant impact on quality of life, including missing more days of work, and being less able to participate in recreational activities.
While the experience varies between people, there are different classifications for headache with some of the broadest categories being primary headaches, like migraines or tension headaches, and secondary headaches, which are directly related to neck pain due to issues with joints and muscles of the neck (cervicogenic headache). Common external and modifiable factors that can affect headaches include neck pain, fatigue, poor sleep, lights and sound, dehydration, stress, caffeine, and diet.
So what can we do about them? In addition to medications deemed appropriate by your doctor, a plan of care should address external and modifiable contributors including fatigue, sleep, stress, diet, as well as manual and exercise treatments aimed at desensitization. Physical, non-invasive treatments can also contribute to a positive change in frequency and severity of headache of multiple types.
There is some evidence that migraine headaches will respond positively to regular exercise, including both aerobic exercise and resistance exercise. Other types of headache, including tension type headaches and cervicogenic headaches, are more likely to respond positively to manual therapy. This may include soft tissue mobilization, trigger point release, and, for cervicogenic headache, can include joint mobilization to address articular impairments at the spine to decrease neck pain and headache associated with impairments at the neck. Research has shown better outcomes can occur when types of treatment are combined. This is particularly true for cervicogenic type headaches, which, as a group, often are the best responders to physical treatments. In addition to manual treatments, those with cervicogenic headaches will often benefit from exercise to improve motor control at the neck and strengthen the muscles of the shoulders and neck. These exercises can also serve as a means of desensitizing the system, and facilitate increased resilience to triggers.
A few exercises that can be used to strengthen muscles include:
Rows
Scapular retraction and depression
Upper Cervical Nods
If you experience regular headaches, a physical therapist may be able to assist by creating a comprehensive treatment plan including manual therapy and exercise to help you manage your headaches and get back to what you want to do.
By Jesse Dupre, DPT
References:
GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2018 Nov;17(11):954-976. doi: 10.1016/S1474-4422(18)30322-3. Erratum in: Lancet Neurol. 2021 Dec;20(12):e7. PMID: 30353868; PMCID: PMC6191530.
Woldeamanuel YW, Oliveira ABD. What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. J Headache Pain. 2022 Oct 13;23(1):134. doi: 10.1186/s10194-022-01503-y. PMID: 36229774; PMCID: PMC9563744.
Lerner-Lentz A, O'Halloran B, Donaldson M, Cleland JA. Pragmatic application of manipulation versus mobilization to the upper segments of the cervical spine plus exercise for treatment of cervicogenic headache: a randomized clinical trial. J Man Manip Ther. 2021 Oct;29(5):267-275. doi: 10.1080/10669817.2020.1834322. Epub 2020 Nov 5. PMID: 33148134; PMCID: PMC8491670.