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Neurological Symptom

Headaches

Headaches affect virtually everyone at some point and are one of the most common reasons people seek medical and complementary healthcare. Tension headaches and migraines account for the vast majority of presentations. Understanding the type of headache you experience is key to finding the most effective treatment — and a range of therapies, from manual therapy to acupuncture to stress management, offer significant relief.

See therapies that may help

What is Headaches?

Headaches are classified as primary (where the headache itself is the condition — as in tension-type headache, migraine and cluster headache) or secondary (where headache is a symptom of another condition, such as infection, hypertension or medication overuse).

The two most common types are:

  • Tension-type headache — typically described as a dull, pressing pain on both sides of the head, often like a tight band. It is associated with stress, muscle tension and poor posture, and responds well to manual therapy and stress management.
  • Migraine — typically a unilateral, throbbing headache often accompanied by nausea, vomiting and light/sound sensitivity, lasting 4–72 hours. It is a neurological condition with specific triggers and treatments.

Medication overuse headache (MOH) is an important and often overlooked cause of chronic daily headache — overuse of painkillers (including OTC analgesics) for headache can paradoxically cause headaches to become more frequent.

Signs and symptoms

Headache features that help distinguish type:

  • Tension headache: bilateral, pressing or tightening quality, mild to moderate intensity, not worsened by routine activity, often associated with neck tension
  • Migraine: unilateral (often), pulsating quality, moderate to severe, worsened by physical activity, with nausea/vomiting or light/sound sensitivity; may be preceded by aura
  • Cervicogenic headache: originating from neck structures, typically unilateral, associated with neck pain and triggered by neck movement or sustained positions

Seek urgent medical attention if a headache is sudden and severe ("thunderclap"), follows head trauma, is accompanied by fever and stiff neck, or is associated with neurological symptoms such as weakness, visual changes, or confusion.

How therapy can help

Management depends on headache type:

  • Physiotherapy and osteopathy — highly effective for tension-type and cervicogenic headaches; manual therapy targeting the neck and upper back, combined with postural correction, produces significant reduction in frequency and severity
  • Acupuncture — NICE recommends acupuncture for chronic tension-type headache and migraine prevention. Good evidence across both types
  • Massage therapy — reduces muscle tension in the neck, scalp and jaw that drives tension headaches
  • Mindfulness and stress management — stress is the most common trigger for both tension headaches and migraines; reducing chronic stress activation reduces headache frequency
  • CBT — for chronic headache with significant disability and pain catastrophising, CBT addressing the psychological maintaining factors improves outcomes
  • Migraine-specific approaches — identifying and managing personal triggers, maintaining regular sleep and meal patterns, and biofeedback have evidence specifically for migraine prevention

Seeking help

For most headaches, a GP assessment to establish type and rule out secondary causes is a sensible starting point. A physiotherapist or osteopath is appropriate for tension-type and cervicogenic headaches. NICE recommends acupuncture as a preventive option for both migraine and tension-type headache, available through some NHS services.

Therapies that may help with Headaches

Showing 4 therapies linked to Headaches.

Therapy Evidence Notes
Biofeedback Practitioner
moderate

Tension-related headaches.
Psych-K Practitioner
moderate

Tension and cervicogenic headaches.
Rolfing Practitioner
moderate

Migraine and tension headaches.
Body Stress Release Practitioner
limited

Nervous system calming.

Frequently asked questions

What is the most effective treatment for tension headaches?

Manual therapy (physiotherapy, osteopathy or chiropractic) targeting the neck and upper back has the strongest evidence for tension-type headache, alongside stress management. Acupuncture is recommended by NICE. Addressing ergonomics and posture is important for those with desk-based occupations.

Can dehydration cause headaches?

Yes — dehydration is a well-established headache trigger, particularly for migraines. Maintaining adequate hydration (typically 1.5–2 litres of water daily) is one of the simplest preventive measures and is recommended for all headache types.

What is medication overuse headache?

Medication overuse headache (MOH) occurs when pain relief medication is taken too frequently — typically more than 10–15 days per month — for headache. Paradoxically, the very medication taken to relieve headache causes headaches to become more frequent and harder to treat. If you take painkillers for headache frequently, discuss MOH with your GP.

Can neck problems cause headaches?

Yes — cervicogenic headaches originate from structures in the cervical spine, particularly the upper neck. They are typically felt at the back of the head and/or behind the eye, and are associated with neck stiffness. Physiotherapy and osteopathy addressing the cervical spine are the most effective treatments.

How can I tell if my headache is a migraine?

Migraine is typically distinguished by at least two of: unilateral location, pulsating quality, moderate-to-severe intensity, worsening with physical activity; plus nausea/vomiting or photophobia/phonophobia. Migraines last 4–72 hours untreated. If you experience regular severe headaches, keeping a headache diary and discussing with a GP can help confirm the type.