When I set out to become a physical therapist, I initially thought I wanted to work exclusively with athletes recovering from sports injuries. As I progressed through school and eventually into clinical practice, I grew to learn that this was not how I wanted to use my skills.
After graduation I took a job in a small outpatient clinic in Arizona where one of my first patients was a young woman who had been in a car accident about 1 year prior.
She was suffering from severe, chronic migraines that could last up to 2-3 days at a time.
In one of our first treatment sessions, she was in the middle of a debilitating episode and wasn’t sure if she would be able to finish her appointment due to the pain she was experiencing. We started with some very gentle soft tissue mobilization and relaxation techniques which seemed to help a little bit, but she continued to complain of throbbing pain. She told me that she had dry needling done before for her condition with a former therapist and that it gave her quite a bit of relief.
Being a new clinician, I was a little bit hesitant to dive right into needling her on the first visit but because she had been treated with it before and knew the risks/benefits already, I agreed to do it.
This turned out to be the best clinical decision I ever made.
After a few minutes of inserting the needles into her suboccipitals, I heard her say “Oh my God, my migraine is gone!” I remember thinking “there is no way this helped that quickly…” After 15 minutes of laying with the needles in her, I removed them and she stood up and she was a COMPLETELY different person than the woman who walked in the door just 30 minutes earlier.
I was absolutely amazed at the change I was able to create in her so quickly and from then on, I knew that I wanted to focus my career on treating patients just like her. This ultimately led to me starting Carroll Physiotherapy to be able to help as many people as I can that were experiencing exactly what she was.
How common are headache and migraine?
Headaches are one of the most common conditions that people seek treatment for in the world and the prevalence of them is as much as 96%.
Migraines are not quite as common, though can certainly be just as much, if not more debilitating than your average headache and are the third most prevalent reason for patients to visit a medical provider.
When we experience pain from these conditions, especially in chronic cases, our nervous system can become ramped up and lead to a variety of symptoms!
While there are quite a few types of both conditions, this article will focus primarily on the broad use of manual therapy for the treatment of all forms.
How can manual therapy help with headache and migraine?
While manual therapy does not necessarily treat the root cause for all types of headaches or migraines, it can certainly be beneficial for improving the secondary musculoskeletal effects that they can contribute to! When our nervous system becomes ramped up from the pain, the muscles of the head and neck can become tight and overworked due to increased tone.
Manual therapy can greatly improve the pain and function for many patients who experience:
Muscle tightness or tension
Poor posture
Increased stress and anxiety
The different techniques used can help promote relaxation to the muscles affected, can improve the mobility of the joints in the neck, and can decrease overall stress and anxiety to calm the nervous system.
Types of manual therapy for headache and migraine relief
There are many manual techniques that your physical therapist can use to treat your headaches and migraines. These techniques can include:
Soft tissue mobilization/massage
Trigger point therapy
Joint mobilization
Spinal manipulation
Dry needling
Soft tissue mobilization and massage
This is what most patients think of when they think of manual therapy provided by a physical therapist. There are a few different techniques involved including:
Massage
Myofascial release
Trigger point release
Ischemic compression
Manual stretching techniques
Joint mobilization
This is used when you have restrictions and stiffness in the various joints in the body. This can either cause the surrounding muscles to tense up and further restrict mobility.
When a joint is stiff, your therapist will apply a graded pressure to the affected joint to help it move better. This mobilization can then help the surrounding muscles relax and the other soft tissues to become less stiff.
Spinal manipulation or high velocity low amplitude thrust (HVLAT)
Commonly referred to as an “adjustment” in chiropractic care, spinal manipulation is also useful for stiff joints.
It involves taking a specific joint to its mid to end range of motion and providing a quick thrust to take it past that point. When this happens, it creates a negative pressure environment in the joint space which causes the collapse of gases inside the joint to create a cavitation. This "crack" or "pop" can improve mobility and decrease pain, often more quickly than more gentle mobilization techniques.
Depending on your specific condition and past medical history, your therapist may use either technique to achieve the same goal.
Dry needling
Similar to acupuncture, dry needling is performed by inserting very thin needles into muscles, tendons, and near other tissue like bone and nerves to:
Promote muscle relaxation and increased blood flow
Provide pain relief from the spinal cord and endogenous opioids
Alter myofascial tissues with unilateral winding and tenting
Promote improved joint and cartilage function
Sometimes only the needles are used, though often can be combined with electrical stimulation to promote continuous, repetitive contraction of the targeted muscles to promote further pain relief and relaxation.
What to expect during a manual therapy session
During your physical therapy session, you can expect your physical therapist to begin with a thorough dive into your medical history and your specific symptoms.
After ruling out any red flag symptoms your therapist will then assess your posture, the strength and tone of your neck muscles, as well as the mobility and range of motion of the various joints of the head and neck.
Many patients initially report pain or increased tenderness to touch at the start of a session, with some of the assessment and treatment techniques even provoking your familiar symptoms. This is normal and temporary and can usually help guide your therapist in the treatment of your specific symptoms.
In my practice, a large part of the treatment for headaches and migraines is the use of guided relaxation and breathing techniques in conjunction with the other manual interventions provided. This relaxation is vitally important to calm down the nervous system and can help significantly with pain relief.
Some people can get relief in their very first session!
Risks and side effects of manual therapy
The risks and side effects of manual therapy for treatment of headaches and migraines can vary depending on the interventions used in your sessions. Some clients can experience temporary (usually up to 24-48 hours) soreness from the soft tissue techniques and joint mobilizations used, and even from the exercises prescribed in your plan of care.
Dry needling is largely safe when performed by a skilled clinician, though due to the nature of the intervention there are still some risks involved. Some of the more common risks include bleeding, bruising and muscle soreness. Other less common risks include fainting, sweating, and infection if not properly performed.
Spinal manipulation can be a very beneficial and safe treatment though it is not without risk either.
Those with osteopenia and osteoporosis are at an increased risk of fracture. There have also been very rare cases where spinal manipulation may have caused vertebral artery dissection which can lead to stroke.
Thankfully, this risk is extremely minimal and the treatment is quite safe when performed by a trained licensed professional after a detailed medical screen and physical examination to help rule out those who are at an increased risk of this.
In my experience, these minor side effects are temporary and become less prevalent with each successive treatment session.
Conclusion
As you can see, there are numerous ways that manual therapy can be used to help people get relief from headaches and migraines.
It’s important to remember that not everyone will have the same experience of instant relief as the woman I talked about in the beginning of this article!
The techniques used will depend on your specific condition and preferences but intimately the goal is to help you get out of pain and get back to what you want to do!
If you experience chronic headaches or migraines, or have any specific questions about how your condition can benefit from physical therapy, schedule a free phone consultation with me by clicking here and filling out the form with your information!
**Disclaimer: The information provided in this article is intended for educational and entertainment purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for personalized guidance and recommendations regarding your specific health concerns. The content presented here is based on general knowledge and research available up to the date of this article's publication. Any reliance on the information provided is at your own discretion and risk. The author and publisher do not assume any liability for any actions taken based on the information presented in this article.
References:
Rizzoli, Paul, and William J. Mullally. “Headache.” The American Journal of Medicine, vol. 131, no. 1, 2018, pp. 17–24, https://doi.org/10.1016/j.amjmed.2017.09.005.
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