Headaches and Migraine
Headaches are very common and can have many different causes. The International Classification of Headache Disorders (ICHD) is the global standard used by doctors and healthcare professionals to classify headache conditions.
Understanding your headache type helps guide appropriate treatment and identify when further medical assessment is needed. As physiotherapists we ask screening questions to be sure that your headache is one that is amenable to physiotherapy. If it is we will assess the structures that can contribute to headache to find the source and then proceed onto to treatment. If your headache is not one that can be managed by physiotherapy we help refer you to the correct profession.
1. Primary Headache Disorders
Primary headaches are conditions in their own right and are not caused by another disease or injury. We have only included migraine and tension type here as they are the most common there are other types of primary headache like Cluster headache and TACS.
Migraine
Migraine is a neurological condition, not “just a bad headache”. There is an aspect of sensitisation (the nervous system becoming very sensitive to headache and head pain) that can lead to other physical structures becoming sore and tight and also contributing to headache.
Common features:
Moderate to severe head pain
Often one-sided, but can be both
Throbbing or pulsating pain
Nausea and/or vomiting
Sensitivity to light, sound, or smells
May be preceded by visual or sensory changes (called an aura)
Migraines may be:
With aura
Without aura
Chronic (occurring 15 or more days per month)
Tension-Type Headache
This is the most common headache type.
Common features:
Mild to moderate pain
Pressure, tightness, or “band-like” feeling around the head
Usually affects both sides
Not usually associated with nausea or vomiting
2. Secondary Headache Disorders
Secondary headaches are caused by something else. Treating the underlying cause is essential.
Examples include headaches due to:
Head or neck injury
Infection
Sinus disease
High or low blood pressure
Medication overuse
Disorders of the neck, jaw, or nervous system
⚠️ Urgent medical review is needed if headaches:
Start suddenly and are extremely severe
Are associated with fever, confusion, fainting, weakness, or vision changes
Are new or worsening over time
Begin after head or neck trauma
Start for the first time after age 50
Cervicogenic (neck related) Headache
In the ICHD, cervicogenic headache is classified as a secondary headache.
It is caused by structures in the neck (cervical spine) and may co exist with other headaches.
Common features:
Pain starts in the neck and spreads to the head
Usually one-sided
Triggered or worsened by neck movement or sustained posture
Reduced neck movement
Neck pain or stiffness is present
Management often involves physiotherapy and medical collaboration.
These are physio bread and butter. We got this!
Headache Attributed to Temporomandibular (Jaw) Disorders
The ICHD recognises headaches caused by disorders of the jaw and facial structures.
Common features:
Pain in the temples, face, or around the ears
Jaw pain, clicking, clenching, or grinding
Worse with chewing, talking, or yawning
May coexist with neck pain or other headache types
Treatment focuses on addressing the jaw and contributing factors. Again this is our jam! If it’s coming from the neck or jaw we are the right people to have a look.
Why Classification Matters
Many people experience more than one headache type at the same time. Correct classification helps to:
Identify the underlying cause
Guide appropriate treatment
Avoid unnecessary or ineffective therapies
Recognise when referral to a doctor or specialist is needed
How Physiotherapy May Help
For certain headache types—particularly cervicogenic headaches and headaches related to the neck or jaw—physiotherapy can:
Improve neck and jaw movement
Reduce muscle tension
Address posture and movement habits
Support self-management strategies
Physiotherapy is often used alongside medical care, especially for migraine and complex headache disorders. It is essential that we work together to get the best results.