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Physiotherapy for headaches: how effective is it?

 

Physiotherapy for headaches: how effective is it? 

Anyone who suffers from headaches knows how brutal they can be. Everyone agrees that the pain is awful, but different people try all kinds of different ways to deal with it. Among all the treatments and promises out there, it can be difficult to tell what actually works, based on genuine evidence. One approach that has been getting more attention recently on the research front is physiotherapy. Interestingly, research is increasingly showing that physiotherapy can have a measurable effect on both migraine and tension-type headaches.


Physiotherapy for migraines?

More and more studies have been looking at whether physiotherapy can help treat migraines. A Spanish review that examined existing research found that physiotherapy can noticeably reduce how often migraine attacks happen. One common method is manual therapy, which is usually used to treat movement-related problems in joints, muscles, and nerves. Several studies have shown that certain manual therapy techniques can also help with migraines.

Compared to placebo treatment, manual therapy can significantly improve migraine pain intensity and frequency, as well as patients’ quality of life – not only immediately after the last treatment session but for up to four weeks afterwards. The research also shows that different manual therapy techniques produce different results. Methods that focus on improving movement patterns work differently to specific stretching and mobilisation exercises for heavily stressed areas like the neck and shoulders, or the face and mouth region (you can find details in the studies listed in the “References” section below).

When the right techniques are used, physiotherapy can greatly reduce migraine symptoms and improve perceived quality of life for people with migraine.


Physiotherapy as a non-drug treatment: a big opportunity

Current research suggests that physiotherapy can be a meaningful treatment option for migraine. One big advantage compared to medication is that physiotherapy avoids potential side effects, including the risk of medication-overuse headache (for more about this condition related to overuse of painkillers, read ). This makes physiotherapy especially interesting for people who want to avoid taking medication, wherever possible.

Migraines are particularly common in women of reproductive age, and may be severe during pregnancy and breastfeeding. During these stages, people often avoid medications to protect their unborn or newborn baby. One study examined physiotherapy combined with relaxation exercises in pregnant women with migraine. After eight weeks of treatment, participants experienced a clear reduction in the frequency, duration and severity of migraine attacks. Their quality of life, stress levels, and sleep quality also improved noticeably.

The researchers concluded that the interventions studied are effective, non-invasive and safe for treating and preventing migraine during pregnancy. These methods are evidence-based alternatives to medication-based approaches. The authors recommend using this type of holistic strategy for pregnant migraine patients.    


Physiotherapy for tension-type headaches: the research looks promising

When it comes to tension-type headaches, the research is not as advanced as for migraines, but it is still very encouraging. A major Italian review analysed existing studies and concluded that physiotherapy is a good way to positively influence this type of headache.

Again, the effectiveness of different physiotherapy techniques was compared (for details, see the “References” section below this article). For tension headaches, combining several physiotherapy methods appears to be the most effective strategy. Strengthening certain muscle groups and loosening tight muscles both have noticeable effects, and targeted relaxation exercises have also been proven effective.

This can reduce how often headaches occur and how severe they are. It can also improve how people cope with their headaches on an emotional level. Feeling more in control can help reduce the impact headaches have on everyday life.


Looking ahead: physiotherapy as an evidence-based treatment for headache disorders

What’s interesting is that even though the evidence supporting physiotherapy for headache disorders is growing, doctors are still more likely to prescribe medications. Researchers in this field argue that medical practitioners should take the evidence into account and use proven physiotherapy methods more often. They also emphasise that more research is still needed to fully understand and develop all the physiotherapy options that could help reduce the burden and improve the lives of people living with headaches.

Published: January 2026

 

  • Baykan Çopuroğlu Ö, Çopuroğlu M. Multistrategic Approaches in the Treatment of Acute Migraine During Pregnancy: The Effectiveness of Physiotherapy, Exercise, and Relaxation Techniques. Medicina (Kaunas). 2024 Dec 28;61(1):28. doi: 10.3390/medicina61010028. PMID: 39859010; PMCID: PMC11766731.

    Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain. 2014 Oct 2;15(1):67. doi: 10.1186/1129-2377-15-67. PMID: 25278005; PMCID: PMC4194455.

    Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, Molina-Rueda F. Manual therapy in adults with tension-type headache: A systematic review. Neurologia (Engl Ed). 2021 Sep;36(7):537-547. doi: 10.1016/j.nrleng.2017.12.005. Epub 2020 Apr 7. PMID: 34537167.

    Espí-López GV, Rodríguez-Blanco C, Oliva-Pascual-Vaca A, Benítez-Martínez JC, Lluch E, Falla D. Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial. Eur J Phys Rehabil Med. 2014 Dec;50(6):641-7. Epub 2014 Apr 30. PMID: 24785463.

    Falsiroli Maistrello L, Rafanelli M, Turolla A. Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Pain Headache Rep. 2019 Aug 10;23(10):78. doi: 10.1007/s11916-019-0815-8. PMID: 31401702.

    Ferragut-Garcías A, Plaza-Manzano G, Rodríguez-Blanco C, Velasco-Roldán O, Pecos-Martín D, Oliva-Pascual-Vaca J, Llabrés-Bennasar B, Oliva-Pascual-Vaca Á. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2017 Feb;98(2):211-219.e2. doi: 10.1016/j.apmr.2016.08.466. Epub 2016 Sep 10. PMID: 27623523.

    Garrigós-Pedrón M, La Touche R, Navarro-Desentre P, Gracia-Naya M, Segura-Ortí E. Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial. J Oral Facial Pain Headache. 2018 Spring;32(2):137-150. doi: 10.11607/ofph.1912. PMID: 29694464.

    Jung A, Eschke RC, Gabler T, Pawlowsky V, Luedtke K. Effektivität physiotherapeutischer Behandlungsmaßnahmen in Bezug auf die Schmerzintensität, -dauer und -frequenz sowie Lebensqualität von Patient*innen mit Migräne: Eine systematische Übersichtsarbeit [Effectiveness of physiotherapeutic treatment interventions on pain intensity, duration, frequency, and quality of life of patients with migraine : A systematic review]. Schmerz. 2022 Aug;36(4):272-283. German. doi: 10.1007/s00482-021-00611-z. Epub 2021 Dec 22. PMID: 34936005.

    Muñoz-Gómez E, Inglés M, Serra-Añó P, Espí-López GV. Effectiveness of a manual therapy protocol based on articulatory techniques in migraine patients. A randomized controlled trial. Musculoskelet Sci Pract. 2021 Aug;54:102386. doi: 10.1016/j.msksp.2021.102386. Epub 2021 Apr 30. PMID: 33989990.

    Onan D, Arıkan H, Ekizoğlu E, Taşdelen B, Özge A, Martelletti P. The efficacy of physiotherapy approaches in chronic tension-type headache: a systematic review and meta-analysis. J Oral Facial Pain Headache. 2025 Mar;39(1):34-48. doi: 10.22514/jofph.2025.003. Epub 2025 Mar 12. PMID: 40129422; PMCID: PMC11934752.

    Tedeschi R. Integrating manual therapy into headache management: bridging the evidence gap. Neurol Sci. 2025 Jul;46(7):3287-3289. doi: 10.1007/s10072-025-08093-y. Epub 2025 Mar 12. PMID: 40072697.  

    Torelli P, Jensen R, Olesen J. Physiotherapy for tension-type headache: a controlled study. Cephalalgia. 2004 Jan;24(1):29-36. doi: 10.1111/j.1468-2982.2004.00633.x. PMID: 14687010.

    Wanderley D, Valença MM, de Souza Costa Neto JJ, Martins JV, Raposo MCF, de Oliveira DA. Contract-relax technique compared to static stretching in treating migraine in women: A randomized pilot trial. J Bodyw Mov Ther. 2020 Apr;24(2):43-49. doi: 10.1016/j.jbmt.2019.05.023. Epub 2019 May 22. PMID: 32507151.

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