Primary headaches occur without an underlying condition to point to and include migraines and tension-type headaches. Secondary headaches can be associated with underlying disease requiring medical care, or can be referred from other structures of the body such as the cervical spine (neck). The primary focus of this discussion is on headache types that are usually most responsive to physical therapy intervention.

To be clear – not all types of headaches present themselves the same way. Some headache symptoms that may constitute a medical emergency include vomiting, seizures, fever, muscle pain, night sweat, weight loss, and neurologic symptoms such as blurred or double vision. If you are experiencing any of these symptoms alongside your headache, or your symptoms change to involve these phenomena, it is recommended that you seek medical attention. Any headache that is unusual for you and does not resolve itself in a reasonable amount of time should be brought to your primary care physician’s attention.

Primary Headaches:

Migraines: Migraines are a form of headache that typically lasts from 4 – 72 hours, ranging from moderate to severe pain and typically are located on only one side of the head. Often they are accompanied by an aura (distinct sensation such as flashing lights that comes before the migraine), nausea or vomiting, sensitivity to sound (phonophobia), or light sensitivity (photophobia). Migraines can be made worse by routine physical activity such as going up stairs or household chores. This type of headache is thought to occur in the central nervous system in relation to blood vessel dilation and constriction, though the exact mechanism is uncertain in many people.

Tension-type: Tension-type headaches are the most common primary headache and can last anywhere from 30 minutes to 7 days. These headaches often have a “pressing” or “tightening” quality that occurs usually on both sides of the head. Typically there is not nausea, vomiting, photo/phonophobia or aggravation with routine physical activity. Tension headaches are thought to occur in the central nervous system but again can differ from person to person. Recent studies suggest, but do not prove, a hereditary component to these headaches and they are frequently associated with muscle tender points. Tension – type headaches can be treated with relaxation techniques such as Progressive Muscle Relaxation (PMR), certain medications, and physical therapy.

Secondary Headaches:

Cervicogenic Headache: The most common secondary headache that is not related to an underlying medical condition. The length of time a cervicogenic headache can last is highly variable. The pain is often only present on one side and usually originates in the neck. This type of headache is generally aggravated or even preceded by suboptimal head/neck postures or neck movements. The nerves of the neck and face that are responsible for carrying sensory information to/from the brain share common connections and locations in the spinal cord. This interconnectivity can sometimes lead to sensory information sent from one region to be misinterpreted and cause discomfort in the other. Physical therapy is shown to be an effective treatment to help relieve the symptoms associated with cervicogenic headache. Some examples of what we work on include: postural correction, therapeutic exercise, ergonomic assessment and optimization, soft tissue massage, manual therapy techniques, cervical traction, trigger point release techniques, dry needling and acupressure.

A cervicogenic headache can be caused by injury or can stem from sustained neck movement and postures. Examples of these postures might include sitting in front of a computer or looking down at your phone for prolonged periods. Changing these postures throughout the day could help reduce symptoms. Specifically, this could mean bringing your phone closer to you using pillows or another supportive surface. If you are someone who works at a desk, it could involve taking breaks or getting a standing desk. However your life requires you to move, there are some simple and effective exercises you can perform throughout the day to help cervicogenic headache symptoms.


1) Progressive Muscle Relaxation: PMR is an effective method for reducing tension not just in the neck, but throughout the entire body. With this method you first tense a muscle group, such as at the neck or shoulder, then relax the muscles noting the difference between the two. This helps reduce both stress and tension. Oftentimes the subconscious tension being held in musculature due to stress or postures is an overlooked factor in the realm of headaches. For more information or to learn how to do PMR, refer to this podcast at:

2) Manage your stress level: While stressors vary from person to person, one method for managing stress is with exercise. Any form of exercise can help reduce stress, but a cost free method is aerobic exercise such as walking or running. A less time consuming method could be to perform deep breathing exercises throughout the day.

3) Heat or cold: When feeling sore or stiff, applying a hot pack or taking a hot shower can help ease a tension headache. Cold packs can also be effective in reducing tension headaches; the choice between hot and cold in this context is largely dependent on personal preference.

4) Posture: Some tips for posture are to make sure your head is over your shoulders rather than sitting forward and making sure you are sitting or standing up straight with your shoulders back. Be sure not to overdo it – holding muscles excessively tight for excessively long periods can actually contribute to the development of symptoms! Postural corrections in this context should not feel like a strenuous effort or exercise, but rather a gentle reminder to oneself to check in on body alignment periodically.

5) Over the counter medications: Talk to your doctor or pharmacist for additional information.


1) Posture: See tips listed under tension headaches.

2) Ergonomics: If your job or hobbies require you to sit for extended periods it may be beneficial to change positions throughout the day or consider getting a standing desk. When sitting make sure the monitor is at eye level, your legs are able to fit under your desk, and you are close to the keyboard and monitor. If you are working with a laptop avoid putting it in your lap, bring your laptop closer to you by putting pillows on your lap.

3) Exercise: Some exercises to help relieve symptoms are chin tucks, shoulder blade pinches, and back extension. These exercises can be performed multiple times throughout the day in sitting or standing. Talk to your physical therapist for further information in this regard.

4) Physical Therapy: some techniques that are often employed in PT may include massage, manual therapy techniques, stretching, traction/decompression and exercise. A physical therapist can assess your posture and provide strategies specific to you.

5) Over the counter medications: While medication may not cure cervicogenic headaches, they may help relieve pain. Talk to your doctor or pharmacist for additional information.