Physiotherapist Specialised in Headache, Facial and Orofacial Pain
The majority of headaches (around 80%) can benefit from specialised physiotherapy treatment. Some improve completely, while others improve partially with only physiotherapy when treatment is individually tailored. The headaches we treat include migraine with and without aura, tension-type headache, cervicogenic headache, headache related to temporomandibular disorders (TMD), and some trigeminal autonomic headaches.
Types of Headache
There are several types of headache, classified as either primary or secondary. Physiotherapy can help with the following types of headache:
Tension-type headache
Migraine with and without aura
Trigeminal autonomic headaches
Cervicogenic headache
Headache attributed to a TMD
How do we help you?
We carry out a comprehensive clinical interview, assessing your case in depth, followed by a physical examination to determine whether your condition is suitable for physiotherapy treatment.
Assessment of your headache history
Specific headache questionnaires
Quantitative and qualitative analysis of mastication
Cervical spine assessment
Examination of the jaw and temporomandibular joint (TMJ)
Assessment of the potential benefits of physiotherapy
Headache Treatment
The most effective non-pharmacological therapeutic approaches for the treatment of headache and migraine will be used, always adapted to your individual case and taking into account all the findings from the assessment.
Exercise prescribed for headaches and migraines
Manual therapy for the cervical spine and jaw
Cervical and jaw exercises
Self-management strategies for home
Ergonomics and posture
Book Your Appointment
Determining whether your headache is likely to benefit from physiotherapy usually requires only one or a few sessions. If physiotherapy is appropriate for your case, we will follow a specialised treatment plan.
The average treatment consists of 5–6 sessions, although significant improvements may already be noticed after the first appointment.
Most Common Diagnoses Related to Headache, Facial and Orofacial Pain
Migraine
Migraine is a type of headache that affects a large proportion of the world’s population, occurring in approximately 20% of women and 10% of men. Migraine may occur with or without aura, and in both cases specialised physiotherapy can help reduce, and in some cases even eliminate, migraine attacks.
Migraine Symptoms
Migraine headache usually fulfils 2 of the following 4 criteria:
Pain located on one side of the head
Moderate to severe intensity
Pulsating or throbbing pain
Pain worsens during routine physical activity (walking, climbing stairs)
Migraine Aura
Migraine aura is defined as an altered perception of sensory stimuli, such as vision or sound, or motor functions such as speech, which may appear up to 60 minutes before the migraine attack.
Photophobia (light sensitivity)
Phonophobia (sound sensitivity)
Difficulty speaking or performing other movements
Nausea or vomiting
How do we help you?
A clinical interview is carried out to confirm the diagnosis of migraine, and time is dedicated to understanding your individual case. The cervical spine is examined to assess its possible involvement, and an individualised treatment plan is proposed.
Confirmation of the diagnosis
Analysis and understanding of your case
Cervical spine examination
Individualised treatment plan
Migraine Treatment
Migraine treatment is based on three fundamental pillars. Firstly, manual therapy techniques are applied to the cervical spine. Secondly, an exercise programme tailored to your condition is prescribed, which may include different exercise modalities. Finally, practical strategies are provided to help you manage migraine attacks when they occur.
Cervical manual therapy
Cervical exercises
Aerobic exercise
Home recommendations and exercises
Overcoming migraine requires collaboration between the physiotherapist and the patient. Assessment and treatment may require several sessions. Every migraine responds differently to treatment, so treatment goals should be agreed upon during the consultation. The benefits of treatment should begin to appear within days or weeks. For this reason, we recommend completing several treatment sessions during which we will use every available therapeutic resource to help your migraines disappear.
Tension-Type Headache
Tension-type headache is the most common cause of headache (around 40% of headache cases). Like migraine, MRI scans and other imaging tests do not identify any cause that explains the pain. The most widely accepted theory is the sensitisation of certain body regions such as the cervical spine, the jaw or the central nervous system, which is why specialised physiotherapy plays a key role in its treatment.
Symptoms of Tension-Type Headache
In tension-type headache, there is no aura, and the headache generally has the following characteristics:
Bilateral location
Pressing or tightening pain (non-pulsating)
Mild to moderate intensity
Not aggravated by routine physical activity (walking, climbing stairs)
How do we help you?
We carry out an interview to confirm the diagnosis of tension-type headache and better understand your particular case. When appropriate, we complement it with specific questionnaires that help us gather more information. We assess the cervical region, the jaw and your overall physical condition in order to propose a personalised treatment.
Clinical interview
Specific headache questionnaires
Cervical and jaw assessment
General physical condition assessment
Treatment for Tension-Type Headache
Treatment consists of exercise, with aerobic exercise having proven to be the most effective. The treatment is complemented with manual therapy, massage and other exercises if necessary. Finally, guidance and home exercises are provided.
Individualised aerobic exercise
Cervical spine and jaw exercises
Virtual reality exercise
Massage and manual therapy
Home advice and exercises
Book an Appointment
Getting rid of tension-type headache is faster than you may think. If physiotherapy can help you, improvements should be seen within weeks. That is why we recommend a treatment programme consisting of several sessions, during which we will use every available resource to help your tension-type headache disappear.
Book Appointment
Trigeminal Autonomic Headaches
Headaches affecting the sensory nerves of the face are known as trigeminal autonomic headaches, the best-known being trigeminal neuralgia, although there are others. The role of specialised physiotherapy in orofacial neuropathic pain is becoming increasingly important.
Symptoms
Nerve involvement causes pain and other very characteristic symptoms that allow it to be diagnosed as neuropathic pain and, within this category, to establish a differential diagnosis between different types of orofacial and craniofacial neuralgias.
Unilateral pain described as electric, stabbing, throbbing or pressing
Moderate, severe or very severe intensity
Daily pain attacks lasting from 2 minutes to several days
Associated autonomic symptoms: tearing, nasal congestion, eyelid swelling, sweating, etc., accompanied by a feeling of restlessness or agitation
Disability
Orofacial neuropathic pain can be highly disabling, with spontaneous episodes of pain unrelated to daily activities. However, in some cases certain activities are limited or prevented by the pain, for example:
Touching or drying your face
Speaking
Chewing, eating, drinking or swallowing
Washing your face or brushing your teeth
Shaving
Blowing your nose
Yawning
Washing your hair
Others
Types of Neuropathic Pain
Trigeminal neuralgia
Glossopharyngeal neuralgia
Eagle syndrome
Cluster headache
Paroxysmal hemicrania
SUNCT/SUNA (Short-lasting Unilateral Neuralgiform Headache Attacks with Cranial Autonomic Symptoms)
Hemicrania continua
How do we help you?
First of all, by providing reliable, evidence-based information about orofacial neuropathic pain: what it is, how long it lasts and how it can be treated. We assess the condition of the nerve and propose an individualised physiotherapy treatment plan.
Differential diagnosis of the type of neuropathic pain
Quantitative clinical assessment of nerve status
Detailed explanation of the prognosis
Physiotherapy treatment plan coordinated with neurology
Treatment
Neuropathic pain requires a complex physiotherapy approach. Physiotherapy enhances the effects of drug treatment while reducing its side effects. It also decreases the level of stimulation needed to trigger pain, in other words, it desensitises the nerve. The strategies used include:
Aerobic exercise
Manual therapy
Heat therapy, electrotherapy (TENS)
Other case-specific stimuli
Book an Appointment
The prognosis of orofacial neuropathic pain depends on each individual case, and because it is a relatively uncommon condition, it is not advisable to begin with a fixed treatment programme of a specific number of sessions, as it is impossible to predict how each patient will respond. For this reason, we recommend starting with an initial assessment session, after which decisions are made regarding the most appropriate treatment plan.
Cervicogenic Headache
Cervicogenic headache is a type of secondary headache. The headache originates from disorders or injuries affecting the cervical spine. Specialised physiotherapy is the most effective treatment for this type of headache, which is often underdiagnosed because it can coexist with migraine or tension-type headache.
Symptoms
The symptoms of cervicogenic headache are similar to those experienced by patients with neck pain. Some are clearly associated with neck pain, while others are not commonly linked to it, despite there being a relationship:
Neck pain or a history of neck pain or whiplash injury
Neck stiffness or restricted movement
Dizziness and unsteadiness
Blurred vision, difficulty concentrating
How do we help you?
First, we carry out a thorough assessment of your case through a detailed interview and an extensive physical examination. We use questionnaires, perform clinical tests and gather all the necessary information so that you receive the most appropriate treatment.
Clinical interview and cervical-specific questionnaires
Assessment of cervical strength, coordination and mobility
Treatment focused on reducing both headache and neck pain
Treatment
Cervicogenic headache is treated using manual and instrument-assisted techniques to reduce pain. In addition, a cervical exercise programme is introduced, including strength, coordination, flexibility and other exercises.
Manual therapy and massage
Strength, flexibility and cervical stretching exercises, among others
Aerobic exercise
Virtual reality exercise
Book an Appointment
Recovering from cervicogenic headache requires a comprehensive treatment approach using the appropriate therapeutic tools. Implementing the programme takes several sessions, but improvements are usually noticed quickly.
Headache Attributed to the TMJ
Headache attributed to the TMJ is a headache that is triggered or worsened by a jaw problem. In particular, disorders of the temporomandibular joint (TMJ) can cause this type of headache or aggravate other headaches such as migraine or tension-type headache. Specialised physiotherapy is the most effective treatment for this type of headache.
Symptoms
The symptoms of headache attributed to the TMJ appear together with jaw pain or after chewing, and are accompanied by other jaw-related symptoms such as:
Unilateral or bilateral TMJ pain
Associated bruxism
Jaw stiffness or restricted mouth opening
Fatigue while chewing or difficulty chewing hard or tough foods
How do we help you?
First of all, we carry out a thorough assessment of your case. When evaluating your headache, we analyse whether the jaw is involved, especially if bruxism is present. If this is the case, we perform a more in-depth assessment of the temporomandibular joint and propose an appropriate treatment to improve this region.
Clinical interview and differential diagnosis of bruxism
Muscle and TMJ assessment
Chewing and jaw mobility tests
Specific jaw treatment
Treatment
Headache attributed to the TMJ is treated using manual and instrument-assisted techniques to reduce pain. In addition, a programme of jaw exercises will be introduced to improve jaw function, including bruxism treatment when necessary.
Manual therapy and TMJ massage
Jaw exercises
Chewing training
Bruxism treatment
Book an Appointment
Treating headache associated with the TMJ requires implementing an exercise programme together with several sessions of manual therapy. The effects of treatment may be noticeable immediately after the first session or within a few weeks.
Further Information About Headaches
Headache is the second most common cause of pain worldwide. In many cases it is constant, while in others headache episodes occur on more than 15 days per month. This generates high levels of disability, psychological distress and emotional burden. Specialised physiotherapy successfully treats headaches through manual therapy and exercise.
Headache is considered a disorder of the nervous system because its origin may be related to an identifiable pathology, that is, a clearly defined medical condition. This is known as a secondary headache. It is called secondary because there is an underlying disease or pathology that explains the headache. In general, the specialist in headaches is the neurologist. For a first episode of headache, this is the appropriate healthcare professional to consult, especially if one or more of the following conditions are present:
- Being over 50 years old and experiencing your first headache or migraine episode.
- Sudden onset of headache or migraine (thunderclap headache)
- A significant worsening of your usual headache or migraine
- A personal history of cancer or HIV
- Headache + fever + neck stiffness + redness
In all of the above situations, you should attend the emergency department before visiting a specialised physiotherapist, as treatment cannot be considered safe until causes such as infections, tumours, arterial inflammation or other serious conditions have been ruled out.
If you experience recurrent or chronic headaches or migraines, there is no problem in consulting a specialised physiotherapist. In fact, physiotherapy is strongly recommended for headaches and migraines in these situations.
Most headaches are not caused by an underlying disease or pathology and are diagnosed based on their clinical history and presentation. These are known as primary headaches and account for the majority of cases:
- Tension-type headache
- Migraine with or without aura
- Trigeminal autonomic headaches
Primary headaches have no specific diagnostic tests that clearly define the condition. Imaging tests and blood tests are negative or do not explain the headache. Diagnosis is made based on the clinical history, that is, the way the headache presents itself.
In consultation with a specialist, this diagnosis is made through the patient’s account and the clinical interview. It may be complemented by clinical tests, imaging or laboratory tests, although when these are requested, they are generally used to rule out the presence of a specific pathology.
Secondary headaches, on the other hand, are those in which the headache is caused by a pathology or dysfunction elsewhere in the body. Among secondary headaches, there are two types that can be successfully treated with physiotherapy. Although they are not the only ones, they are the most common and are often diagnosed during a physiotherapy assessment:
- Cervicogenic headache
- Headache attributed to a temporomandibular disorder
Cervicogenic headache is a headache caused by a disorder affecting the cervical spine. In general, this type of headache is often overlooked in medical diagnosis, despite being much more common than usually thought. During the physiotherapy assessment, the relationship between neck pain or dysfunction and the headache is established through the patient’s clinical history and a specialised physical examination.
Likewise, headaches may be secondary to a temporomandibular disorder, the best-known being dysfunction of the temporomandibular joint (TMJ). Just as with the cervical spine, jaw disorders can cause headaches or worsen other headache types such as migraine or tension-type headache. Diagnosis is made through an assessment of the TMJ and the chewing muscles, together with chewing function tests.
Physiotherapy treatment for headaches includes manual therapy and exercises for the cervical spine or the TMJ whenever these regions are involved in the headache. For primary headaches such as migraine, tension-type headache and trigeminal neuralgias, high-intensity aerobic exercise is recommended, as it has demonstrated superior effects compared with continuous moderate-intensity aerobic exercise. This type of exercise must be prescribed accurately and specifically according to strict safety criteria and should be supervised by the appropriate healthcare professional during the first sessions.
In many cases, time is also dedicated to explaining the mechanisms through which the headache or migraine has developed, and patients are given additional tasks to practise in their daily lives. This is because research over recent years has shown that understanding migraine and pain helps patients improve their symptoms, gain better control over them, reduce the disability they cause and, in some cases, even eliminate them.
