Physical Therapy & Migraine Headaches

Is physical therapy helpful in treating migraine pain?

Migraine headaches can be a severe, disabling condition. Unfortunately, "cures" are generally elusive. So where does physical therapy fit into the management of migraine headaches? The answer depends on the individual headache sufferer, as there is a wide range of clinical presentations in patients with migraine headache.

Migraine is a centrally-mediated pain disorder. This means that there is a disorder in the central nervous system (the brain and spinal cord), involving the nerves and blood vessels, which results in the pain and the neurologic symptoms associated with a migraine headache. Whereas medications affect the central nervous system in an attempt to address dysfunction, physical therapy primarily involves work on the muscles and joints in the peripheral system. This means that how an individual migraine sufferer responds to physical therapy depends partly on the extent to which the muscles and joints are involved in his or her headache.

For the individual experiencing an infrequent, classic migraine headache (i.e., one that occurs once a month or so, with clear triggers and neurologic accompaniments such as aura), the benefits of physical therapy are limited.

How do physical therapy techniques help with migraine pain?

Certain physical therapy techniques used during a headache (especially at the beginning) can help to reduce the pain of the attack at least temporarily. Patients can be taught the best way to utilize modalities such as ice and relaxation. Family members can be instructed in massage techniques or manual cervical traction.

Migraine headaches may occur with a feeling of tension and discomfort in the neck. Although this tension is thought to be secondary to the migraine (not the cause of it), stretching exercises can sometimes be useful in helping to reduce the discomfort.

How helpful is physical therapy if the pain problem starts in muscles or joints?

There is a group of patients for whom physical therapy is likely to be beneficial and may help to prevent headaches from occurring in the first place. These are patients who suffer headaches with musculoskeletal problems involving the neck and/or jaw.

There are two ways that the muscles and joints in these areas can produce pain in the head. The first is called referred pain. The most well-known example of referred pain is a heart attack. Most people know that pain in the chest, left shoulder, and left arm can signal a problem with the heart muscle. This is because when the heart muscle is stressed, the pain experienced can be referred into the arm. This is likely due to the particular way in which the nerves from the arm and the heart travel conjointly up to the brain. Similarly, the muscles and joints of the neck can refer pain into the head.

For example, the upper trapezius muscle on the top of the shoulder is frequently problematic in headache patients. This muscle is commonly overused during activities such as computer work, leading to the development of trigger points (TPs). TPs are focal areas of muscle fiber contracture that, in the case of the upper trapezius, refer pain up the neck and into the temple.

The second way in which structures in the neck can produce headache is by triggering a migraine event. In some patients, cervical spine and muscle tightness and dysfunction can occur, creating pain and discomfort that triggers a migraine headache. This is similar to how certain foods or environmental stimuli can trigger a migraine. In these patients, the hope is that by adequately treating the problems in the neck or jaw, one trigger for the individual's migraine problem can be eliminated or greatly reduced.

How is the need for physical therapy determined? What is the goal of physical therapy?

A careful history and physical examination by a physical therapist who is knowledgeable and experienced in treating patients with migraine headache can help determine whether and to what extent treatment may be helpful. The goals of physical therapy treatment are generally to normalize the musculoskeletal system as much as possible in order to reduce stress and tension on soft tissues and joints. For example, in the instance described above for trigger points in the upper trapezius muscle, the therapist would likely work on stretching the problematic muscle fibers. In addition, posture, alignment, and strength issues would need to be addressed, as faulty mechanics in these areas can contribute to the development of trigger points.

The joints of the upper cervical spine can also be culprits in referring pain into the head. These joints can be injured in an accident, or can develop increasing stiffness and pain gradually over time. The physical therapist's job is to help restore mobility in these joints and correct muscle imbalances, poor postures, and physical activities that contributed to the problem in the first place. Problems with the joints and the muscles often occur together and contribute to one another, thus both must be adequately addressed for effective pain control to result.