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Physical Therapy Solutions for Headache Relief

Physical Therapy Solutions for Headache Relief

Headache disorders affect a staggering 46% of people worldwide, and several independent studies have classified headache disorders as one of the ten most common causes of disability globally[2]. Headaches can have multiple causes including nerve dysfunction, hormonal dysfunction, musculoskeletal dysfunction or injury, and more. Some of the most common headache disorders treated by clinicians include migraines, tension headaches, and cervicogenic headaches—a type of headache caused by injury to the neck. Research has shown that for each of these common headache disorders, physical therapists can provide valuable additions to treatment. Current evidence suggests that the most effective treatments for headache disorders are multimodal, meaning a combination of treatments[2]. At Synergy Physical Therapy and Wellness, our clinicians use clinical reasoning and evidence based solutions to help find the best treatment for each individual. The treatments we use to treat headaches are evidence based and include manual therapy, exercise prescription and performance, as well as dry needling.

Manual therapy is a specialized type of physical therapy used for managing neuro-musculoskeletal conditions. It utilizes manual examination and clinical reasoning to provide drug-free treatment. For headache disorders, manual therapy often includes cervical traction and cervical mobilization. Several meta analyses have been performed investigating its effectiveness on migraines, tension headaches, and cervicogenic headaches. For migraines, studies indicate that individuals who received manual therapy alongside medication experienced greater relief compared to those who used medication alone [5]. Similarly, a 2015 meta-analysis found that multiple sessions of cervical manipulation provided superior pain relief and functional improvement for patients with cervicogenic headaches compared to medication alone [3]. In cases of tension-type headaches, a systematic review revealed that manual therapy reduced pain intensity, frequency, and disability[1]. Patients receiving manual therapy for tension headaches also saw improvement in cervical range of motion[1]. In each of these studies, the best results were achieved with multiple sessions. Manual therapy performed by licensed physical therapists is rarely associated with negative side effects and proves to be a safe and effective treatment for migraines, cervicogenic headaches, and tension headaches. 

In addition to manual therapy, physical therapists also use evidence based  prescription of therapeutic exercises to help patients manage headache disorders. Therapeutic exercise is a natural and effective treatment for headaches, tailored to address the unique causes of migraines, tension-type headaches, and cervicogenic headaches. Research has shown that moderate aerobic exercise can help prevent migraine flare-ups or reduce their intensity[5]. However, migraines often act as a barrier to physical activity. To address this, physical therapists use interventions such as manual therapy to help patients manage their migraine symptoms and regain the ability to exercise. Physical therapists also provide guidance on suitable aerobic exercises customized to each patient’s fitness level and needs. For tension-type headaches and cervicogenic headaches, therapeutic exercises that engage, strengthen, and stabilize cervical muscles are highly effective [2]. Therapeutic exercises are clinically proven to significantly reduce the intensity, duration, and frequency of headaches[2]. Physical therapists provide a valuable addition to headache treatment by demonstrating and guiding patients through individualized exercise programs to promote relief from headache disorders. 

While manual therapy and therapeutic exercise are the most commonly associated physical therapy treatments for headaches, our clinic also offers functional dry needling. This therapy involves the insertion of solid filiform needles into soft tissue to alleviate pain and improve function. The needles used are very small, making dry needling a safe treatment option with minimal side effects. The side effects of functional dry needling are limited to mild discomfort, tenderness, and occasional bruising [6]. A meta-analysis published in the Physical Therapy and Rehabilitation Journal found that dry needling significantly reduced disability scores on the Migraine Disability Assessment Scale (MIDAS) and the Headache Disability Index [6]. When combined with other physical therapy approaches, dry needling can play a pivotal role in addressing the multifaceted challenges of headache disorders.

Headaches can significantly impact daily life, but physical therapy offers a range of effective, evidence-based treatments to help individuals find relief. From manual therapy and therapeutic exercises to innovative approaches like dry needling, these therapies target the root causes of migraines, tension-type headaches, and cervicogenic headaches. By addressing both symptoms and underlying dysfunctions, physical therapy empowers patients to take control of their health and improve their quality of life. If you’re struggling with headaches, consider consulting a licensed physical therapist to explore a personalized treatment plan that works for you. 

Written by Caiden McPherson 

Works Cited: 

[1] Cumplido-Trasmonte, C., Fernández-González, P., Alguacil-Diego, I., & Molina-Rueda, F. (2020). Manual therapy in adults with tension-type headache: A systematic review. Neurología (English Edition), 36(7), 537–547. https://doi.org/10.1016/j.nrleng.2017.12.005

[2] Fernández-De-Las-Peñas, C., & Cuadrado, M. L. (2015). Physical therapy for headaches. Cephalalgia, 36(12), 1134–1142. https://doi.org/10.1177/0333102415596445

[3] Gross, A., Langevin, P., Burnie, S. J., Bédard-Brochu, M., Empey, B., Dugas, E., Faber-Dobrescu, M., Andres, C., Graham, N., Goldsmith, C. H., Brønfort, G., Hoving, J. L., & LeBlanc, F. (2015). Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Library, 2015(9). https://doi.org/10.1002/14651858.cd004249.pub4

[4] Jung, A., Eschke, R., Struss, J., Taucher, W., & Luedtke, K. (2022). Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia, 42(9), 944–965. https://doi.org/10.1177/03331024221082073

[5] Onan, D., Ekizoğlu, E., Arıkan, H., Taşdelen, B., Özge, A., & Martelletti, P. (2023). The Efficacy of Physical Therapy and Rehabilitation Approaches in Chronic Migraine: A Systematic Review and Meta-Analysis. Journal of Integrative Neuroscience, 22(5), 126. https://doi.org/10.31083/j.jin2205126

[6] Pourahmadi, M., Dommerholt, J., Fernández-De-Las-Peñas, C., Koes, B. W., Mohseni-Bandpei, M. A., Mansournia, M. A., Delavari, S., Keshtkar, A., & Bahramian, M. (2021). Dry needling for the Treatment of Tension-Type, Cervicogenic, or Migraine headaches: A Systematic Review and Meta-Analysis. Physical Therapy, 101(5). https://doi.org/10.1093/ptj/pzab068

As we age, maintaining health and independence becomes a top priority. Strength training, a type of resistance exercise often overshadowed by cardio or flexibility exercises, is a cornerstone of healthy aging. Whether you’re in your 30s or 80s, incorporating strength training into your routine can help you live a longer, more vibrant life. Here’s why everyone needs to embrace strength training and how to overcome common barriers to getting started.

1. Avoiding Frailty

Frailty, marked by reduced strength, endurance, and physical function, is a growing concern with age. According to the National Institute on Aging, frailty increases the risk of falls, disability, and hospitalization. For women, who face a higher risk of osteoporosis, frailty can also lead to fractures with prolonged recovery. Strength training combats frailty by building muscle mass and bone density. 

A 2021 study in the Journal of Clinical Medicine found that resistance training significantly improved muscle strength and reduced frailty markers in older adults. For women, this is especially critical, as stronger muscles and bones reduce the risk of osteoporotic fractures. Exercises like weightlifting, bodyweight workouts, or resistance bands enhance physical resilience, making daily tasks like carrying groceries or climbing stairs safer and easier.

(Want to know more about osteoporosis and PT’s role in it’s prevention and treatment? Check out our previous article for more information: Osteoporosis, Osteopenia, and Physical Therapy) 

2. Staying Able to Do the Things You Love

Strength training ensures you can keep enjoying activities like gardening, hiking, or playing with grandkids. According to an article in Harvard Health Publishing, muscle strength can begin to decline by about 1-2% per year after age 35 due to sarcopenia, also known as age-related muscle loss. This muscle loss accelerates as our bodies age. This loss can limit your ability to perform daily tasks or pursue hobbies, particularly for women who may experience accelerated muscle loss during menopause due to declining estrogen levels. 

Regular strength training preserves functional capacity, and benefits multiple domains of health. A  2019 study published in Frontiers in Physiology showed that resistance exercise not only improved musculoskeletal health, but also helped patients manage chronic conditions like cardiovascular disease and diabetes (Mcleod et al., 2019). Older adults who participated consistently in resistance strength exercise maintained better mobility, overall health, and independence than those who did not. Additionally, the same study found that those using light weight or only body weight while strength training was just as effective as heavy weights (McLeod et al., 2019). The most important factor of strength training for healthy aging is finding a routine that is suited to your body and your ability. A consultation with a physical therapist can help you find the right routine and guide you through proper exercise form to ensure your exercise is preventing injury, not causing it.  Strength training empowers you to stay active, healthy, and independent.

3. More Muscle Mass Equals Improved Blood Sugar Control

Building muscle isn’t just about strength—it’s about metabolic health. Muscle tissue helps regulate blood sugar by improving insulin sensitivity, which is vital for preventing or managing type 2 diabetes, a condition more prevalent with age (Mcleod et al., 2019). Increased muscle mass enhances glucose uptake, reducing blood sugar spikes. This is particularly important for women, who may face increased risks for diabetes complications. Researchers have found that  resistance training improved glycemic control in older adults with type 2 diabetes (Mcleod et al., 2019). In their review of resistance exercise and blood sugar management, resistance exercise performed for 8 weeks resulted in clinical improvements in A1C management and improvements in insulin resistance. These findings are relevant not just to individuals living with diabetes, but also those with insulin resistance, metabolic disorders, or a family history of diabetes. More muscle mass means greater glucose storage capacity, supporting overall metabolic health. Even moderate strength training, like lifting weights twice a week, can make a significant difference.

Common Barriers to Starting Strength Training

Despite its benefits, many hesitate to start strength training. Here are common barriers and solutions:

  • Lack of Knowledge: Many feel intimidated by unfamiliar exercises. 
    • Solution: Start with simple bodyweight moves like squats or push-ups. Online resources from the American Council on Exercise (ACE) offer free beginner guides, or consult a certified personal trainer for a tailored program.
  • Fear of Injury: Older adults, especially women with lower bone density, may worry about getting hurt. 
    • Solution: Begin with low weights or resistance bands under professional guidance. A 2018 study in Journal of Strength and Conditioning Research confirms supervised strength training is safe and effective for all ages when done correctly.
  • Time Constraints: Busy schedules can make exercise feel daunting. 
    • Solution: Short, 20-minute strength workouts 2-3 times per week still deliver impactful benefits, per American College of Sports Medicine guidelines.
  • Gym Intimidation: Gyms can feel overwhelming for beginners. 
    • Solution: Try home workouts with minimal equipment or join small group classes for older adults, which foster a supportive environment. Women-only classes can also provide a comfortable starting point.

Getting Started with Strength Training

To reap the benefits, aim for 3 sessions per week. Focus on compound movements—exercises that work multiple muscle groups at once, like squats, deadlifts, lunges, assisted pull-ups, and pushing-pressing motions. These maximize efficiency and functional strength. Start with light weights, resistance bands, or bodyweight exercises, gradually increasing intensity.

Safety Tip: Deadlifts, a powerful and functional movement, we commonly integrate this into out-patient rehabilitation strategy, but it does require proper technique to avoid injury. Begin with no weight, using a broomstick or similar tool to master form under a skilled coach’s guidance before adding weight. This is especially important to protect against lower back strain or injury.

Always consult a healthcare provider before starting a new exercise program, especially if you have chronic conditions like osteoporosis, chronic low back pain or shoulder problems. If you do struggle with any of these, one of our physical therapists can design a program tailored to your needs, and we’re here to support you every step of the way. If you are free from chronic conditions or pain a skilled coach or trainer can also be a great fit to get you started safely.

Strength training isn’t just for bodybuilders—it’s for everyone who values aging gracefully, staying active, and feeling their best. By building strength now, you’re investing in a healthier, more independent future.

References:

Harvard Health. (2023, February 14). Age and muscle loss. https://www.health.harvard.edu/exercise-and-fitness/age-and-muscle-loss

Mcleod, J. C., Stokes, T., & Phillips, S. M. (2019). Resistance Exercise training as a primary Countermeasure to Age-Related Chronic Disease. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.00645

Talar, K., Hernández-Belmonte, A., Vetrovsky, T., Steffl, M., Kałamacka, E., & Courel-Ibáñez, J. (2021). Benefits of Resistance training in Early and late Stages of Frailty and sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of Clinical Medicine, 10(8), 1630. https://doi.org/10.3390/jcm10081630

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