Primary headache disorders are often accompanied by
neck pain or other symptoms referable to neck muscles. Therefore,
physical therapy and other physical treatments are commonly prescribed for
headache management. A medical literature review was completed in order to gather information regarding the efficacy of selected physical modalities in the treatment of primary and
cervicogenic headache disorders. After analyzing the collected data, expert opinions were developed regarding the utility and efficacy of selected physical modalities in the management of primary and
cervicogenic headaches. Based on this review, the following four expert opinions are presented:
physical therapy is more effective than
massage therapy or acupuncture for the treatment of
tension-type headache and appears to be most beneficial for patients with a high frequency of
headache attacks.
Physical therapy is most effective for the treatment of
migraine when combined with other treatments such as thermal
biofeedback, relaxation training and exercise.
Chiropractic manipulation demonstrated a trend towards benefit in the treatment of
tension-type headache, but evidence is weak.
Chiropractic manipulation is probably more effective in the treatment of
tension-type headache than it is in the treatment of
migraine. In general, strong evidence is lacking regarding the efficacy of these treatments in reducing
headache frequency, intensity, duration and disability in many commonly encountered clinical situations. Many of the published case series and controlled studies are of low quality. Physical treatments are unlikely to pose a significant risk, with the exception of high velocity
chiropractic manipulation of the neck. Consideration must be given to financial costs and lost treatment opportunity by prescribing potentially ineffective treatment. In the absence of clear evidence regarding their role in treatment, physicians and patients are advised to make cautious and individualized judgments about the utility of physical treatments for
headache management. In most cases, the use of physical modalities should
complement rather than replace better validated forms of
therapy. The evidence base to determine the safety and efficacy of physical treatments in the management of
headache disorders would be substantially improved by using standard scientific rigor in the development and conduct of future clinical studies.