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Physiotherapy for Migraines & Headaches: A Holistic Perspective

When it comes to the treatment of migraines & headaches, most people think of using medications ranging from over-the-counter drugs to prescribed antidepressants like amitriptyline (Elavil) or anticonvulsants like topiramate (Topamax). Although medications can be very helpful, increased use can have a backfiring effect called "medication-overuse headache." Other medical-treatments may include Botox-injections and/or occipital nerve blocks, which can be painful, expensive, and difficult to access.

So, what is the alternative? How can we supplement medical-treatments with a more holistic approach? It starts with a physiotherapist who understands the pathophysiology of migraines & headaches, modern pain neuroscience and has the ability to empower you with the knowledge to treat yourself independently.

The main objective of this blog article is to help you view migraines & headaches through a holistic lens and understand how the right physiotherapist can help you. We will discuss the neurological connection between your head & neck, the interplay between aerobic exercise & headaches as well as lifestyle factors including sleep, stress, hydration, etc.


Head-Face-Neck Connection

As mentioned in our previous blog, "3 Tips for Migraines & Headaches: A Pain in the Neck," there is a neurological connection between the sensory nerves of the upper cervical spine (C1-C3) and the trigeminal nerve which is responsible for sensation of the face as well as the motor function of the jaw muscles. This connection is typically referred to as the trigeminocervical complex which helps us understand the interconnectedness of the head & neck while providing a variety of treatment avenues for you and your physiotherapist.

It is one thing to know that there is a neurological connection between the head & neck and it is another to feel it!

The upper trapezius and suboccipital muscles are good examples of the trigeminocervical complex brought to life. These muscles both have pain-referral patterns into the head (trigger-point diagrams above). This means that dysfunction of these muscles can essentially create a headache! As part of your treatment, your physiotherapist may use manual therapy techniques like "trigger-point release" or instrument-assisted techniques like cupping, dry needling, or "tooling" to treat the muscles, fascia and associated neural-structures directly.

Dysfunction of the joints of the upper cervical vertebrae are also be associated with headaches. This may be related to persistent forward-head posture, poor movement habits, etc. Your physio can utilize joint-specific treatments like spinal manipulation ("adjustment") to create a complex neurophysiological response that reduces pain as well as improves joint mobility & muscle function. Stay tuned for our upcoming "Joint Manipulation" blog!

Aside from manual therapy and instrument-assisted techniques. Your physiotherapist should provide movement education and prescribe exercises to promote better function of the head, neck & shoulders. This may include strengthening of the deep neck flexors, teaching you how to perform trigger-point release at home using a lacrosse ball, postural education, etc. This classic combination of physiotherapy treatment in conjunction with appropriate "headache-education" make for a comprehensive and holistic approach to treating migraines & headaches.


Aerobic Exercise

"Exercise is Medicine"

Aerobic exercise (commonly referred to as "cardio") is generally associated with cardiovascular health, but that is just the tip of the iceberg. The potential positive benefits of aerobic exercise include reduction in frequency, duration and intensity of migraines & headaches as well as improved quality of life! Aerobic exercise may positively affect some of the inflammatory processes associated with migraine and has been shown to improve anxiety and depression as well. The American College of Sports Medicine recommends 150 minutes of moderate-intensity aerobic exercise per week. If activities like jogging increase head & neck pain due to the jostling-nature of the activity, you might consider lower-impact activities like hiking, swimming, cycling or a walk around the neighborhood!



The American Academy of Sleep Medicine recommends children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours and children 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. However, most adolescents find it difficult to meet these targets, partly due to the conflict between the physiologic sleep phase delay (shift in circadian rhythm to stay awake later and sleep in later) in adolescents and the early start-times of most North American middle and high schools. Adolescents will often compensate by sleeping in more on the weekends, which can lead to difficulty falling asleep Sunday night. This, combined with an early wake-up time on Monday, may contribute to Monday being the most common day for a migraine attack in adolescents. Plenty of adults adopt a similar routine and may fall prey to a similar outcome.

For adults, a minimum of 7 hours of sleep is recommended. Less than 1% of the population can sleep less than 7 hours without a measurable, negative-effect. Prioritizing your sleep is crucial for your health overall, but can also have a profound impact on migraines & headaches. To learn more about improving your sleep, check out our blog "5 Strategies for Better Sleep Quality: Your Foundation."



Unsurprising to most, migraines & headaches are more likely to occur when people are stressed. Stress can trigger headaches or simply make them worse. Relaxation & mindfulness techniques can reduce symptoms of stress, including your headaches! Our blog, "Breathing: How & Why You Should Start Practicing" is a great place to start a simple breathing & mindfulness practice to reduce your stress and pain!


Hydration, Caffeine & Diet

Dehydration is commonly a trigger for headaches so a minimum of 1-3 Liters of fluid intake per day with slight increases in dietary sodium (salt) are often recommended. It is estimated that up to 55% of all children and adolescents are not adequately hydrated. Adult studies have shown that increasing water intake is associated with reduced headache severity and improved health-related quality of life!

As for caffeine... it can be tricky. For some people, caffeine or caffeinated beverages may be a headache-trigger, for others they can be a treatment. There is evidence to support the use of caffeine in the treatment of tension type headaches and migraines, but this is best handled on a case-by-case basis. Another thing to consider is the impact of your caffeine-intake on your sleep!

Caffeine is tricky, but food can be trickier. There does not appear to be an established set of dietary recommendations for people suffering from migraines & headaches. However, there is evidence to suggest that low carbohydrate & ketogenic diets may be beneficial as well as a diet that increases Omega 3 Fatty Acids and decreases Omega 6 Fatty Acids. The main idea is to have a less-inflammatory diet. General recommendations are to reduce the intake of processed foods and promote a "whole foods" diet. Fasting (prolonged periods without eating) can be a headache-trigger for some and this seems to be especially true for children.

Wrapping Things Up

In summary, the treatment options for your migraines & headaches do not stop with medical-approaches. A physiotherapist with the appropriate knowledge & experience can help you combat migraines & headaches from a holistic perspective while empowering you with the knowledge to manage your health independently.

We hope this article helped you adopt a more holistic view of migraines & headaches. At Mend Montana Physiotherapy, Dr. Ryan MacNeill PT, DPT has specialty-experience treating people with chronic migraines & headaches.

To learn more about how we can help you with your migraines, headaches, jaw pain and/or neck pain, schedule a Free Discovery Call with Dr. MacNeill!


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