Headaches & Migraine

What Physiotherapy Can — and Can't — Help With

We want to be completely upfront on this page: physiotherapy is not a treatment or cure for migraine as a neurological condition. Migraine is a recognised medical condition with its own underlying mechanisms, triggers and treatment pathways, and if you have diagnosed migraine, or suspect you might, your GP or a neurologist is the right professional to lead your diagnosis and medical management. We would never claim otherwise, and we'd encourage you to be wary of anyone who does.

What physiotherapy is genuinely well placed to help with is headaches that have a musculoskeletal, postural or neck-related component — often called cervicogenic headaches, or tension-type headaches linked to muscle tightness and posture. For many people, these overlap with migraine: neck tension and postural strain can act as a trigger or aggravating factor that increases the frequency or intensity of migraine attacks, even though they aren't the underlying cause of migraine itself. In these cases, physiotherapy aimed at the muscular and postural contribution can be a genuinely useful part of an overall management approach — used alongside, never instead of, appropriate medical care for the migraine itself.

Cervicogenic Headaches

A cervicogenic headache is a headache that originates from problems in the neck, rather than within the head itself. Because the upper neck joints and muscles share nerve pathways with parts of the head and face, stiffness, irritation or dysfunction in this area can refer pain upward, typically producing a headache that starts at the back of the head or neck and spreads towards the forehead, temple or behind the eye, often on one side. Common features include pain that's aggravated by particular neck positions or movements, worse after prolonged sitting or screen use, and sometimes accompanied by restricted neck movement or tenderness over the upper neck joints.

Cervicogenic headaches respond well, in many cases, to a physiotherapy approach focused directly on the neck — identifying which joints or muscles are contributing, and treating them directly through hands-on therapy, movement and postural change.

Tension-Type Headaches and Posture

Tension-type headaches are the most common type of headache, typically felt as a dull, band-like pressure around the head, often linked to muscular tightness in the neck, jaw, shoulders and scalp. Prolonged desk work, screen use, stress, poor sleep and sustained forward-head posture are all commonly associated with this pattern of muscular tension, and many people notice their headaches building gradually across a demanding working day. While tension-type headaches are rarely dangerous, they can be genuinely disruptive when frequent, and addressing the underlying muscular and postural contributors through physiotherapy can meaningfully reduce how often they occur and how severe they feel.

Our Assessment Approach

A thorough headache assessment at JW Physio Clinic starts with a detailed conversation about your headache pattern — where the pain is felt, how it starts and progresses, what triggers or eases it, how often it occurs, and whether you have a formal migraine or other headache diagnosis already. We'll also ask about your daily habits, including desk setup, screen use, sleep and stress levels, as these commonly interact with any physical findings. This is followed by a hands-on physical examination of your neck, upper back and shoulder area, assessing movement, muscle tension, joint stiffness and tenderness, to establish how much of a musculoskeletal or postural component is contributing to your symptoms.

Crucially, this assessment is about honestly establishing whether — and how much — your headaches are linked to your neck and posture, rather than assuming a physical cause for every type of headache. If your presentation suggests a primary headache disorder such as migraine, or if anything in your history or examination raises concern, we'll say so clearly and recommend you see your GP, rather than proceeding as though physiotherapy is guaranteed to help.

Our Treatment Approach

Where we identify a genuine musculoskeletal or postural contribution to your headaches, treatment typically includes:

• Manual therapy to the neck and upper back, addressing stiff joints and tight muscles commonly involved in cervicogenic and tension-type headaches.
• Postural and ergonomic advice, tailored to your workstation, driving position and daily habits, aimed at reducing the sustained muscular strain that often builds into headache symptoms.
• Targeted exercise for the deep neck and upper back muscles, building postural endurance and reducing the likelihood of tension building up over the course of a day.
• Advice on pacing and habits, such as regular movement breaks during prolonged desk work or screen use, which many people find helps reduce the build-up of muscular tension that contributes to their headaches.
• Coordination with your GP or specialist where relevant, particularly if you have a diagnosed headache or migraine condition already under medical management, so that physiotherapy complements rather than duplicates or contradicts your existing care.

We monitor your response to treatment carefully and adjust as we go. If your headaches don't respond as expected to a physiotherapy approach focused on the neck, this is itself useful information, and we'll be honest that further medical assessment may be the more appropriate next step.

When to See Your GP First — Red Flags

Most headaches, including many that bring people to physiotherapy, are not a sign of anything serious. However, certain symptoms should always be assessed by a GP, NHS 111 or A&E promptly, rather than starting with a physiotherapy appointment. Please seek medical advice urgently if you experience:

• A sudden, severe headache unlike any you've had before, especially if it comes on within seconds ("thunderclap" headache)
• A headache accompanied by neurological symptoms such as weakness, numbness, confusion, difficulty speaking, or loss of coordination
• Sudden changes in vision, including double vision or loss of vision
• A headache following a head injury, particularly with loss of consciousness or worsening symptoms
• Headache with fever, neck stiffness and sensitivity to light, which could indicate meningitis
• A new, persistent headache pattern in someone over 50, or a headache that steadily worsens over days or weeks
• Headaches that wake you from sleep, or are consistently worse first thing in the morning

If any of these apply to you, please seek medical attention promptly rather than booking a physiotherapy appointment. If you're ever unsure whether your headache needs urgent medical assessment, it's always safer to check with your GP or NHS 111 first.

Working Alongside Your GP or Neurologist

If you have a diagnosed headache disorder or migraine, we see our role as complementary to, not a replacement for, your existing medical care. We're happy to work alongside your GP or neurologist, focusing specifically on any neck or postural contribution to your symptoms, and communicating clearly about what we find during assessment and treatment. We won't suggest changes to your medication or medical management, as this sits outside our scope of practice, but we can help make sure any musculoskeletal factors that might be adding to your headache burden are properly addressed.

What to Expect from Treatment

For cervicogenic and tension-type headaches with a clear neck or postural component, many people notice a gradual improvement in frequency and intensity over a course of physiotherapy, though this varies depending on how long symptoms have been present and how much muscular or postural change needs to be addressed. We'll always give you a realistic sense of expected progress after your assessment, and will be honest with you if your response to treatment is slower or more limited than hoped, rather than continuing an approach that isn't working.

The Overlap Between Headache Types

In reality, headaches rarely fit neatly into a single labelled category, and it's common for people to have a mix of features — some tension-type, some more migraine-like, and some clearly linked to neck position or posture. Rather than trying to force your symptoms into one diagnostic box, our assessment focuses on identifying, as clearly as possible, how much of what you're experiencing looks musculoskeletal in nature, and how much looks like it needs a different kind of medical input. Being honest about this overlap — rather than overselling physiotherapy as a solution to every headache pattern — is central to how we approach this condition.

Desk Work and Screen-Related Headaches

A significant proportion of the tension-type headaches we see are linked to prolonged desk work and screen use, particularly where posture has gradually drifted into a forward-head, rounded-shoulder position over months or years of habit. Simple, practical changes — such as raising a screen to eye level, taking regular short breaks to move, and adjusting chair and desk height — often make a meaningful difference when combined with hands-on treatment, and we're happy to give you specific, personalised advice based on your particular workstation and daily routine.

Lifestyle Factors Worth Considering

Alongside any neck or postural contribution, a number of everyday lifestyle factors are commonly associated with headache frequency and severity, including sleep quality, hydration, caffeine intake, screen time, and stress levels. We're not able to diagnose or treat headaches purely through lifestyle advice, and these factors don't replace proper assessment where a neck or postural cause is suspected, but discussing them as part of a broader conversation about your headaches is often a useful complement to hands-on physiotherapy treatment, and something we're happy to explore with you during your assessment.

Keeping a Headache Diary

Many people find it helpful to keep a simple diary of their headaches in the lead-up to an assessment, noting when they occur, roughly how severe they are, what seems to trigger or worsen them, and whether neck stiffness or pain is present at the same time. This kind of pattern information can be genuinely useful in helping us — and your GP, if you're also seeing them about your headaches — build a clearer picture of what's going on, and can help clarify whether a neck-related pattern is present or whether your symptoms look more consistent with a primary headache disorder needing medical assessment.

See Also: Neck Pain

Because headaches and neck pain are so closely linked, it's worth reading our neck pain page too, which covers whiplash, disc-related neck pain and general neck conditions in more detail. This page focuses specifically on the headache side of that picture — including the important distinction between what physiotherapy can help with and what needs medical input — while our neck pain page covers the broader range of neck problems we treat.

Booking a Headache Assessment

If you experience frequent headaches and suspect your neck or posture might be playing a role, a thorough physiotherapy assessment at JW Physio Clinic in Loughton can help clarify what's contributing to your symptoms — and just as importantly, whether physiotherapy is the right avenue for you, or whether we should recommend you see your GP first. Same-week appointments are usually available, and our team is happy to answer any questions before you book.

Frequently Asked Questions