Headaches and Migraines

Most headaches do not start in your head. They start in the muscles and joints of the neck and upper back, and they respond to treatment aimed there.

If your headache builds through the day rather than arriving all at once, sits at the base of the skull, follows a long stretch at a desk or a bad night's sleep, or comes with a stiff neck, there is a reasonable chance your neck is part of the picture.

At Advanced Physio Plus we work out where your headache is coming from before we treat it. If the neck and upper back are involved, physiotherapy has something useful to offer. If they are not, we will say so and point you to the right person.

What it feels like

• Pain that starts at the base of the skull and spreads forward over one side of the head
• A tight band around the forehead and temples
• Headache that worsens through the working day and eases at the weekend
• Neck stiffness, or pain turning your head to one side
• Tender, ropey muscles across the top of the shoulders and base of the skull
• Jaw tightness or clenching alongside the headache
• Headaches that began after a car accident or a fall

Where headaches come from

Tension type headache. The most common kind. A dull, pressing band across both sides of the head, often building through the day. Frequently linked to sustained postures, stress and jaw clenching.

Cervicogenic headache. A headache referred from the joints, discs and muscles of the upper neck. Usually one sided, usually the same side every time, and often reproducible by pressing on the neck or by holding a position. Closely related to neck pain.

Migraine. A neurological condition, not a muscle problem. Typically throbbing, often one sided, and often with nausea, or sensitivity to light and sound. Many people who get migraines also carry neck and shoulder tension, and the two can feed each other.

Headache after a collision or a knock to the head. Common after whiplash. Worth assessing properly, because the neck is often involved and often overlooked.

How physiotherapy helps

Where the neck and upper back are contributing, treatment is aimed at them directly. That usually means hands on work to the stiff segments of the upper neck, soft tissue and trigger point treatment through the neck, shoulders and jaw muscles, and exercise to build endurance in the deep neck muscles that hold your head up through a long day.

Alongside that we look at the things feeding the problem: how your workstation is set up, how you sleep, how long you hold one position, and how you breathe when you are under pressure.

On migraine, we want to be straight with you. Physiotherapy does not treat migraine itself. What it can address is the neck and shoulder contribution that sits alongside migraine for many people, and the separate neck driven headaches that often get labelled migraine. Migraine is usually managed with your family doctor or a neurologist, and we are happy to work alongside them.

Your first appointment

Twenty minutes with Nikolay Zagrebailov, Registered Physiotherapist and Registered Massage Therapist. He asks when your headaches happen and what they feel like, watches how you move, examines the neck, jaw and upper back, and tells you what he thinks is driving them.

If physiotherapy is appropriate, he writes the treatment plan and our physiotherapist assistants deliver it. If something else is going on, he will tell you that instead.

No doctor's referral is needed in Ontario. Most workplace health plans include physiotherapy and we handle the paperwork and billing based on your plan.

What we use

• Manual therapy and joint mobilisation through the upper neck
• Trigger point therapy and massage therapy for the neck, shoulders and jaw
• Dry needling into the muscles referring pain into the head
• Spine traction where disc or nerve irritation is part of the problem
• BioFlex laser therapy and the Super Inductive System for pain and muscle tension
• Exercise and rehabilitation for deep neck and shoulder blade control

When to see a doctor first

Some headaches need medical assessment rather than physiotherapy. See a doctor or go to an emergency department if you have:

• A sudden, severe headache that peaks within seconds and is the worst you have had
• Headache after a head injury with vomiting, drowsiness or confusion
• Headache with fever and a stiff neck
• A new headache pattern after the age of 50
• Headache with weakness, numbness, slurred speech or loss of vision
• Headache that wakes you from sleep or is clearly worse lying flat
• Headache in pregnancy with swelling or visual changes

Book an appointment

Advanced Physio Plus, 102 – 2600 Skymark Avenue, Building 3, Mississauga, Ontario L4W 5B2.

Call 647 998 4727 or book online. No referral needed. Direct billing to most extended health plans, to auto insurers after a collision, and to WSIB for approved workplace claims.