Headache complaints

  • Do you have a headache that you can’t get rid of?
  • Headache after a long day at work?
  • Are headache attacks succeeding each other faster and faster and you don’t know why?
  • Do you have migraines but also neck pain?
  • Do you have a headache after sleeping?

What is a headache?

Headache is a collective term for all the pain we feel from the back of our head to our forehead. These complaints can be accompanied by neck pain, shoulder pain, dizziness , nausea and even light or audio shyness.

Some people experience headaches and neck pain when standing up, while others experience them after a long day of working in front of a computer. Within manual therapy there is a specialized branch that deals with the investigation and treatment of headaches, dizziness and tinnitus complaints.

Significant progress has been made in recent years in identifying different types of headaches as well as treating them. Three common types of headaches that can be treated by the manual therapist are migraine, tension headache and cervicogenic headache.

How common are headaches?

Headache is a very frequent complaint, with an average annual prevalence of around 50% worldwide, making it the most common neurological disorder.

Because this complaint most often occurs in the most productive phase of life, the impact of headaches on quality of life is significant.

Vinding et al. (2007) Siberstein (2004) Stovner et al. (2007)

What is the difference between migraine, tension headache, and cervicogenic headache?

Headaches are, despite their common occurrence, a rather vague complaint. However, as mentioned before, we can distinguish between several different types. The following section briefly discusses four common headache types.


Migraine is a neurovascular disease. This means that the cause of the migraine lies in the brain.


  • Headache complaints are always one-sided and can occur alternately left or right
  • Pulsating headache that worsens with physical activity
  • Light shy and nausea
  • Consists of different phases
    • Prodrome phase: yawning, neck pain, all signs that a discharge is developing in the brain. Phase In which you are warned to take seizure medication
    • Aura: 20% of people experience tingling in the face or arm or half of the body
    • Headache phase: 6-12 hours of high intensity headache
    • Postdrome phase: no headache but listless. Can take a day

Tension headache

Tension headaches are a common type of headache in Western society. It is characterized by the onset of headaches just after a busy period, for example after a busy working day or at the end of the week after a busy week.

This type of headache is due to increased muscle tone of the neck and shoulder muscles.


  • Band-shaped pressing headache that is not pulsating of moderate intensity
  • May be sporadic or frequent
  • No nausea or dizziness
  • Not aggravated by physical activity

Cervicogenic headache

The literal translation is “headache through the neck”. This type of headache is accompanied by neck complaints in which the neck is the cause of the headache complaints. Research shows that >60% of headache sufferers also have complaints in the neck region. This type of headache is common after trauma (fall or accident) in the history.


  • Headaches associated with neck pain
  • If the neck pain improves, the headache symptoms improve
  • Headache is one-sided and always the same side
  • Shooting pain from the back of the head to just above the eyes

Medication overuse headache

This type of headache is a substance-induced headache. we can get these when

  • Paracetamol NSAID 15 days per month and multiple doses per day
  • Triptans (migraine medication) use more 10 days a month
  • Excessive use of caffeine more 5 doses per day

Multiple headache forms

You can have up to three types of headaches

During the interview, all characteristics are discussed with the patient and usually the patient also recognizes the different forms of headache

For example, migraine often occurs with a kind of tension headache


Patients with headaches seek refuge in a variety of treatments, which usually consist of medication, physiotherapy, stress management or acupuncture.

However, there is no strong evidence that these treatments are effective on their own. We know that for headache complaints, whatever form, the treatment is different for each patient. It is therefore recommended that headaches are treated multimodally. Recent research shows that manual therapy on top of conventional treatment is a good addition with proven effectiveness.

Manual therapeutic approach to headache complaints.

Within manual therapy there is a branch that is concerned with the research and treatment of headaches, dizziness and tinnitus complaints. Over the last few years there has been a significant evolution in the identification and treatment of different types of headaches.

In manual therapy, it is rationalized that neck pain is often present in headache patients (> 60%) and associated with pericranial tenderness in adults with migraine or tension headache. We also know that an incorrect position of the head in relation to the body and a reduced strength of the deep neck muscles play a major role in the maintenance of headache complaints.

Manual therapy can lead to a decrease in frequency and influence of headache complaints on activities and participation both in the short term and after 26 weeks (Castien et al. 2011). In addition, exercise therapy targeting the deep neck muscles has been shown to be beneficial.

The headache treatment at the manual therapist consists of finding out the headache type, looking for disorders in the neck/shoulder region that may be related to the headache symptoms. Provide information on possible triggers for the development of headaches and then map out an individual therapy trajectory. This is done by means of an extensive interview and physical examination.

The conclusion is that headache treatments should be multimodal. Manual therapy has proven effectiveness but will always be optimal in combination with other therapy. The manual therapist can refer the patient to the appropriate health professional if necessary.


René Castien, DAWN van der windt: Effectiveness of manual therapy in chronic muscle tension headache.   2011. General Practitioner Act 4(5): 244-7.
Stovner Li, Hagen K: The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27(3): 193-210. review.
Silberstein SD. Migraine. Lancet. 2004; 363(9406): 381-91. Review
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disroders, 3th edition (Beta version). cephalalgia. 2013; 33(9): 629-808. dog:10.1177/0333102413485658.

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