Understanding Headaches/Migraines: What you need to know & how Physiotherapy can help

Headache & Migraine Care

Do you suffer from constant headaches? Find that your migraines come out of nowhere and derail your day? Or maybe pain starts at the base of your skull and creeps over your head or into your eyes?

You’re not alone and these could be signs of cervicogenic involvement in your headache or migraine condition, something which can be treated in physiotherapy using modern, evidence-informed techniques. (I was the one suffering too, just like you, and would say I still fight through some of the difficult days. But over time I’ve learned it’s more about a conscious effort toward long-term strengthening and maintenance than expecting a one-time magical fix.)

What Are Headache Migraines?

The term migraine often brings to mind pulsing head pain, nausea, and sensitivity to light or sound. But not all headaches are created equal, and not all migraines start in the head.

Many people are surprised to learn that the upper neck can be a major contributor to their headache symptoms. According to internationally recognised physiotherapist Dean Watson, there’s often a missing link between the neck (cervical spine) and the brainstem in people suffering from migraines and chronic headaches.

When the top three neck joints become sensitised, often due to posture, stress, or injury, they can stimulate the same nerve pathways involved in migraines. This is called cervicogenic dysfunction and treating it can drastically reduce symptoms even if your headaches have been around for years.

Why Your Neck Matters More Than You Think

Back when I was studying my bachelor’s degree, I chose cervicogenic headaches as my final-year research topic. To my surprise, not many people were aware that physiotherapy could be a treatment option for migraines and headaches—beyond relying on medications or injections.

One of the most interesting things I discovered in my research was just how sensitive the tiny muscles at the base of your skull are (called the sub-occipital muscles). These muscles, like the obliquus capitis and rectus capitis, act almost like the body’s “GPS system,” constantly telling your brain where your head is in space.

To put it into perspective:

• The big muscles in your legs and back have only 1–2 sensors per gram of muscle.
• The small muscles in your hands (known for fine movements) have about 15–20 sensors per gram.
• Your core stabilisers, which carry most of your trunk load, have around 50 sensors per gram.
• But the sub-occipital muscles? They have 98, 160, and even up to 250 sensors per gram—making them the most sensitive muscles in your whole body.

Because of this, even small amounts of stress, tension, or poor posture can send overwhelming signals to your brain. These signals can directly affect areas that control balance, vision, blood pressure, sleep, and even mood. That’s why problems in these muscles and the top joints of your neck (where your skull meets C1–C3) can cause symptoms like dizziness, nausea, blurred vision, migraine aura, or anxiety—on top of headaches themselves.

Types of Headaches

Headaches are not all the same, and knowing the type you experience is key to choosing the right treatment:

1. Tension-Type Headache

• Feels like a tight band or pressure around the head
• Often triggered by stress, fatigue, or posture
• Can last hours to days

2. Migraine

• Throbbing or pulsating pain, often one-sided
• May include nausea, sensitivity to light/sound, or visual disturbances (aura)
• Can last 4–72 hours

3. Cervicogenic Headache

• Pain starts in the neck and radiates to the head or behind the eyes
• Worsens with neck movement or sustained posture
• Often misdiagnosed as migraine, but originates from cervical dysfunction

4. Cluster Headache

• Intense, stabbing pain around one eye
• Occurs in clusters (several times a day for weeks)
• May cause eye redness, tearing, or nasal congestion

5. Sinus Headache

• Localised pain in the forehead, cheeks, or nose area
• Associated with sinus infection, congestion, or seasonal allergies

6. Menstrual Headache (Hormonal Migraine)

• Linked to hormonal changes around menstruation (usually 2 days before to 3 days after onset of period)
• Often more severe, longer lasting, and harder to treat than regular migraines
• May include nausea, mood changes, or heightened sensitivity to light/sound
• Can overlap with classic migraine features, but timing with the menstrual cycle is the key differentiator

7. TMJ-Related Headache (Jaw)

• Dull, aching pain around the jaw, temples, or ears
• Worsens with jaw movement (chewing, talking, yawning)
• May cause jaw clicking, popping, or limited mouth opening
• Can radiate to neck, shoulders, or head
• Often accompanied by jaw muscle tenderness or bruxism (teeth grinding) because of stress.

Why Do They Happen?

Migraines and cervicogenic headaches can stem from a variety of causes:

• Poor posture (especially forward head posture during computer or phone use)
• Stress and tension in the upper neck muscles
• Previous trauma (like whiplash or concussion)
• Sensitisation of the brainstem
• Long-term overload of neck joints and nerves

Interestingly, many patients with migraine symptoms have no idea their neck is involved, until treatment starts to make a difference.

How Physiotherapy Can Help

Precise Assessment – We assess the neck and surrounding joints to determine if they’re contributing to your headache. The goal? Reproduce and then relieve your headache in a controlled way —something no scan can do.

Targeted Treatment – Using gentle, sustained pressure techniques, we calm the sensitised nerves and reduce input to the brainstem.

Postural Education – We guide you on how to sit, move, and rest in ways that reduce neck tension and improve spinal alignment.

Exercise and Movement – Once pain settles, we introduce tailored exercises to restore control and gradually help to reduce the frequency of headaches.

Long-Term Relief – Many people report fewer headaches, less medication use, and even complete resolution after a course of treatment. It’s not magic—it’s science, applied with precision.

Don’t Just “Live With It”

If you’ve been told your headaches are “just something you have to deal with,” or that your scans look normal, don’t give up. We regularly help patients who have struggled for years, until the neck connection is explored.

Early intervention and a skilled, hands-on approach can make a life-changing difference.

Chanpreet Isher

Physiotherapist