Injuries & Conditions


Headaches are one of the most common types of pain and can be debilitating. According to a clinical perspective published in the Journal of Manual & Manipulative Therapy, “headaches are the most common pain disorder, affecting 66% of the global population.” The proper treatment depends on several factors, including the type and frequency of the headache and its cause. Common causes of headaches can be related to vascular problems, sinus issues, migraine disorders, and tumors. Some headaches are caused by muscle and joint problems of the neck or jaw (TMJ). These can arise after a?motor vehicle accident, fall, concussion, surgery, or without an apparent cause.

While there can be many reasons a person may develop a headache, a common source can be related to stress, tension, and possible dysfunctions in the muscles in your neck. Due to increased tightness and abnormal workload in the muscles that support your neck and head, pain is referred up into the head and perceived as a headache. These are referred to as cervicogenic headaches (the term cervical referring to the neck region, and genic meaning “originates from”).

Causes of headaches and migraines:

  • Muscle tension and tightness
  • Decreased neck range of motion
  • Tightness between the shoulder blades
  • Episodes of dizziness or vertigo
  • Teeth grinding or bruxing

The two most common types of headaches seen in physical therapy are cervicogenic headaches and tension-type headaches:

A neck problem causes Cervicogenic headaches. Typical symptoms include pain on one side of the head, typically felt at the base of the skull, behind the eye, or radiating in a line between the two.

Tension-type headaches are typically related to stress and described as a dull, aching pain felt along the forehead and can radiate to the head’s sides and back. Additionally, soreness in the neck and shoulder muscles may also be felt.

Treatment for headaches and migraines:

Most causes of headaches are benign and can be managed with conservative treatment. A ProActive physical therapist will complete a comprehensive evaluation to determine the musculoskeletal causes of your headaches. This evaluation consists of a subjective and objective interview, asking you questions, and performing specialized tests. Once the cause is determined, the physical therapist will create a patient-specific plan of care to help alleviate your headaches. This plan will improve cervical mobility through specialized manual techniques and improve your strength and posture through exercises. The therapist will also teach you ways to manage your headaches and prevent them from returning through postural and lifestyle changes.

Headaches don’t have to be a way of life; there are many outlets available to you to help treat your headaches. Physical therapy is just one easy way to help you alleviate your chronic head pain and get you back to the life that you want to live.


A concussion is a brain injury that occurs when the brain is violently shaken. The damage can happen during rapid movement changes (such as whiplash) or when the head is directly hit. This shaking or hitting of the head causes unpredictable injury to any brain area, resulting in immediate or delayed changes in the brain’s chemistry and function. Less than 10% of concussions involve a loss of consciousness. Depending on which area of the brain suffers an injury, many different temporary or permanent brain function problems can occur.

Recovery from a concussion can take several weeks to several months and sometimes years, depending on many factors, including the severity of the injury and the age of the person affected.

Concussion may occur along with other injuries, such as those to the neck and surrounding tissues, which should be managed by a licensed physical therapist. More severe brain injuries, such as bruising, bleeding, or tearing, may also occur and require a medical doctor’s immediate care, such as a neurosurgeon.

Immediate and short-term symptoms can include headache, dizziness, difficulty with balance and coordination, nausea/vomiting, fatigue, difficulty sleeping, increased sleepiness, double or blurred vision, sensitivity to light and sound, slurred speech, and a glassy-eyed stare.

Physical therapists can evaluate and treat many problems related to concussions. Because no?two concussions are the same, a physical therapist will examine your neurological, orthopedic, and cardiovascular systems to prescribe a routine best to address your particular symptoms and your needs in all of your daily environments.

Immediate and short-term symptoms

This can include headache, dizziness, difficulty with balance and coordination,  nausea/vomiting, fatigue, difficulty sleeping, increased sleepiness, double or blurred vision, sensitivity to light and sound, slurred speech, and a glassy-eyed stare.

Physical therapists can evaluate and treat many problems related to concussions. Because no two concussions are the same, a physical therapist will examine your neurological, orthopedic, and cardiovascular systems to prescribe a routine best to address your particular symptoms and your needs in all of your daily environments.

Concussion treatments:

Rest and recovery. Your physical therapist will help you and your family understand why you should limit any kind of activity (daily tasks, work, school, sports, recreation, the use of electronics) after a concussion until it is safe to return to these activities. A period of rest helps the brain heal and allows symptoms to clear up as quickly as possible. Your physical therapist will prescribe the rest and recovery program most appropriate for your condition.

Restoring strength and endurance. After a concussion, the physical and mental rest required can result in muscle weakness and decreased physical endurance. Your physical therapist will help you regain your strength and endurance when the right time comes, without making your concussion symptoms worse. It is common for elite-level athletes and fit “weekend warriors” to experience exercise intolerance with concussion and brain injury. Your physical therapist will work with you to identify and treat your particular concussion symptoms.

Stopping dizziness and improving balance. If you have dizziness or difficulty with your balance following a concussion, a type of physical therapy called vestibular therapy may help. The vestibular system, which includes the inner ear and its connections with the brain, enables you to keep your balance and prevent dizziness. A qualified vestibular physical therapist may be able to help reduce or stop your dizziness or balance problems after a concussion by applying treatments or teaching you specific exercises, some of which you may be able to do at home.

Reducing headaches. Your physical therapist will assess your headaches’ different possible causes and use specific treatments and exercises to reduce and eliminate them. Treatment may include stretches, strength and motion exercises, eye exercises, hands-on techniques like specialized massage, and the use of technologies such as electrical stimulation.

Returning to regular activity or sport. As symptoms ease and you can regain your normal strength and endurance without signs of returning, your physical therapist will help you gradually add normal activities back into your daily routine. Your physical therapist will help you avoid overloading the brain and nervous system as you increase your activity level. Overloading the brain during activity after a concussion interferes with the brain tissue’s healing and can cause symptoms to return. Your physical therapist will help you return to your everyday life and sports activities as quickly and safely as possible while allowing your brain to heal properly.

How to Relieve Chronic Headache Pain

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