Neurological Symptom

Headaches

Headaches are one of the most common health complaints globally, affecting the vast majority of people at some point. From tension-type headaches and migraines to cervicogenic and cluster headaches, effective management depends on accurate diagnosis. Physiotherapy, acupuncture, mindfulness and psychological approaches complement medical management and can significantly reduce frequency and impact.

See therapies that may help

What is Headaches?

Headaches are classified into primary headaches (where the headache is the condition itself) and secondary headaches (where headache is a symptom of another condition). Primary headache disorders include tension-type headache (TTH) — the most common type; migraine — highly disabling, affecting around 10 million people in the UK; and cluster headache — severe, episodic, predominantly affecting men.

Tension-type headaches are typically bilateral, pressing or tightening in quality, and associated with muscle tension in the head, neck and shoulders. They are strongly linked to stress, poor posture, dehydration and sleep disruption. Migraine involves moderate to severe, often unilateral throbbing pain associated with nausea, light and sound sensitivity, and sometimes visual aura.

Signs and symptoms

Features that help distinguish headache types:

Tension-type: bilateral, pressing or tightening, mild-moderate severity, not worsened by activity
Migraine: unilateral or bilateral, pulsating, moderate-severe, worsened by activity, with nausea and/or light/sound sensitivity
Cervicogenic: originating from the neck, typically unilateral, associated with neck stiffness or movement restriction
Red flags requiring urgent assessment: sudden severe "thunderclap" headache; headache with fever, neck stiffness or rash; headache with neurological symptoms; new headache in someone over 50; or headache following head injury

How therapy can help

Non-pharmacological approaches with evidence for headache management:

Physiotherapy — particularly for cervicogenic and tension-type headaches; addressing neck and shoulder muscle dysfunction, posture and trigger points
Acupuncture — NICE recommends acupuncture for both tension-type headache and migraine prevention; evidence for reducing frequency and severity
Mindfulness-based stress reduction (MBSR) — evidence for reducing migraine frequency and disability
CBT — for headache with significant psychological maintaining factors or high headache-related disability and avoidance
Massage therapy — for tension-type headaches with significant muscle component

Seeking help

A GP is the appropriate first contact for persistent, changing or severe headaches to establish diagnosis and rule out secondary causes. A physiotherapist is most appropriate for tension-type or cervicogenic headaches. Migraine Action and The Migraine Trust provide resources and specialist referral pathways.

Therapies that may help with Headaches

Therapy	Evidence	Notes
Acupressurist	moderate	Frequently used for tension-type headache.
Acupuncturist	moderate	Good evidence for tension headache.
Alexander Technique Practitioner	moderate	Evidence for tension headache via postural work.
Biofeedback Practitioner	moderate	Tension-related headaches.
Chiropractor	moderate	Commonly used for tension-type headache.
Cognitive Behavioural Therapist	strong	CBT for headache with psychological component.
Massage Therapist	moderate	Commonly used for tension headache.
Mindfulness Practitioner	moderate	Mindfulness for headache.
Osteopath	moderate	Commonly used for tension headache.
Physiotherapist	moderate	Used for cervicogenic headache.
Psych-K Practitioner	moderate	Tension and cervicogenic headaches.
Rolfing Practitioner	moderate	Migraine and tension headaches.
Body Stress Release Practitioner	limited	Nervous system calming.
Bowen Technique Practitioner	moderate	Bowen for headache management.
Craniosacral Therapist	moderate	Used for headache management.
Fascial Stretch Therapist	moderate	Fascial stretch therapy for headache.
Hydroterm Masseuse	moderate	Hydrotherm massage for tension headache.
Hypnotherapist	moderate	Used for tension headache via relaxation.
Indian Head Masseuse	moderate	Commonly used for tension headache.
Myofascial Release Practitioner	moderate	Myofascial release for headache.
Shiatsu Practitioner	moderate	Used for tension headache.
Sports Therapist	moderate	Sports therapy for cervicogenic headache.
Structural Integration Practitioner	moderate	Used for headache via postural and fascial work.
Thai Masseuse	moderate	Thai massage for tension headache.
Yoga Therapist	moderate	Yoga for tension headache.
Emmet Technique Practitioner	limited	Emmett technique for headache.
Homeopath	limited	Used for headache support.
Kinesiologist	limited	Used for headache with stress component.
Zero Balancing Practitioner	limited	Zero balancing for headache.

Frequently asked questions

What triggers tension headaches?

Common triggers include stress (the most consistent trigger), dehydration, poor posture (particularly prolonged screen use), sleep disruption, caffeine (both excess and withdrawal), muscle tension in the neck and shoulders, and eye strain. Keeping a headache diary to identify personal patterns is one of the most useful self-management steps.

Can acupuncture help with migraines?

Yes — NICE recommends acupuncture as a preventive treatment for both chronic tension-type headache and migraine where pharmacological prevention is ineffective or not tolerated. Evidence suggests acupuncture produces reductions in headache frequency comparable to prophylactic medication.

What is medication overuse headache?

Medication overuse headache (MOH) occurs when acute headache medication (including paracetamol, aspirin, triptans and opioids) is used on 10 or more days per month, paradoxically worsening headache frequency. It is one of the most common causes of chronic daily headache. Treatment involves gradual withdrawal from the overused medication, which is uncomfortable but typically produces significant improvement.

Can physiotherapy help with headaches?

Yes — physiotherapy is effective for tension-type and cervicogenic headaches, addressing the neck and shoulder muscle dysfunction, joint restriction and posture that contribute to these types. Manual therapy and exercise programmes produce significant reduction in frequency and severity for appropriate presentations.

When should I see a GP urgently about a headache?

Urgent assessment is needed for: sudden, severe 'thunderclap' headache (maximum intensity within seconds); headache with fever, neck stiffness or non-blanching rash; headache with new neurological symptoms (weakness, speech changes, visual loss); headache following head injury; or headache in someone with cancer or immune compromise.