Physiotherapy for Headaches in Perth

Physiotherapy is highly effective for specific headache types -- particularly cervicogenic headache (arising from the upper cervical spine) and tension-type headaches (driven by muscular trigger points and postural dysfunction). For these types, the evidence for physiotherapy is strong, with significant reductions in headache frequency, intensity, and duration achievable through manual therapy, exercise, and dry needling. Physiotherapy is not the primary treatment for migraines, cluster headaches, or medication-overuse headaches, though it may play a supporting role. Your physiotherapist will assess which type of headache you have and advise on whether physiotherapy is appropriate.

A cervicogenic headache is a headache that originates from structures in the upper cervical spine (C0-C2) -- joints, muscles, or nerves. It is estimated to account for 15-20% of chronic headaches and is frequently misdiagnosed as tension headache or migraine. Distinguishing features include: headache that starts at the base of the skull and spreads forward, pain reproducible by specific neck movements or sustained postures, usually one-sided and non-throbbing, associated with neck stiffness, and may involve shoulder or arm symptoms. It responds very well to upper cervical mobilisation and specific deep cervical flexor exercises. Diagnostic nerve blocks can confirm the diagnosis in complex cases.

For cervicogenic and tension headaches, an initial course of 6-8 sessions over 4-6 weeks typically produces significant improvement. Treatment frequency is usually weekly initially, then reduces as symptoms improve. Home exercise is an essential component -- the exercises you do between sessions are often more important than the treatment itself for achieving lasting outcomes. After an initial course, most patients are discharged with a home program and return for top-up sessions as needed rather than ongoing regular treatment.

Dry needling is an effective adjunct treatment for headaches driven by muscular trigger points, particularly in the suboccipital muscles (at the base of the skull), upper trapezius, sternocleidomastoid, and temporalis. These muscles commonly refer pain to the head in patterns that can mimic tension headache or even migraine. Research supports dry needling as part of a combined physiotherapy approach for reducing headache frequency. It is not a standalone treatment, but when combined with cervical mobilisation and exercise, it can accelerate results. Not all patients require needling -- your physiotherapist will recommend it when clinically indicated.