The Benefits and Drawbacks of Physical Therapy for Migraine Relief

There’s limited research on physical therapy and migraine, but it may help with neck pain and stress linked to episodes.

Knowing your options for managing migraine can be empowering and lead to informed decision making. Some options might be non-pharmaceutical, complementary, and alternative approaches.

One of those options may be physical therapy (PT).

While research on physical therapy and migraine is limited, some experts suggest it might assist with migraine management, including reducing triggers, pain, and frequency.

Here’s what you need to know when including PT in your migraine treatment plan, what to expect at appointments, and when you might see results.

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Can physical therapy help with migraine?

Scientists are still learning more about what causes migraine, why specific people get migraine episodes, and ways to manage the condition. However, physical therapy may be a viable option for some.

“I am an advocate for knowing all of the options for the management of a condition, having them described in detail, and having the person going through the experience make an educated decision on what option is best for them,” says Landon Uetz, DPT, a physical therapist who works with people with migraine.

How can physical therapy help people with migraine? It’s mostly about sensitivity to tension.

“Migraine can sensitize the nerves around the neck and shoulders, leading to many people with migraine [experiencing] tight, achy muscles in those areas,” says Liza Smirnoff, MD, a clinical assistant professor of neurology.

This can lead to avoidance of using or stretching those muscles, resulting in worsened symptoms or more frequent attacks.

Smirnoff says that physical therapy’s ability to relieve tension in these muscles can also help someone begin exercising them again, potentially lowering the chances of a migraine attack.

A 2023 research review suggests that physical therapy and rehabilitation might:

• improve headache symptoms and intensity
• reduce the number of headache days experienced per month
• boost a person’s quality of life

The authors called for more research on the efficacy, best duration, and safety of physical therapy for chronic migraine.

Authors of a 2019 review of research also pointed out the lack of research and data consistency surrounding the use of physical therapy for migraine. However, they noted that physical therapy may include manual and exercise therapies and education to reduce pain, sensitivity, and balance issues.

They stressed the need for a physical examination and customized treatment plan for each individual.

Benefits of physical therapy for migraine

There may be benefits as well as drawbacks to adding physical therapy to your migraine toolkit.

Potential benefits of physical therapy for migraine include:

• reduced neck tension
• stress relief
• reduced reliance on medication
• a preventive approach

Neck pain

“One of the most common symptoms associated with migraine is neck pain, which could occur a few hours before a migraine episode as a prodromal symptom,” says Medhat Mikhael, MD, a pain management specialist.

The prodromal stage of migraine is the phase right before an episode.

Smirnoff agrees. These areas “can often feel tense and tight as though you’ve just done an intensive gym workout,” Smirnoff says.

This is due to a small part of the brain known as the trigeminocervical complex (TCC) becoming hyperactive. This activates the occipital nerves in the base of the head, neck, and upper shoulders.

Physical therapy can help reduce this tension and pain.

Mental tension and stress

Physical therapy may also help reduce mental tension, which is a common migraine trigger.

“Physical therapists often provide patients with stress-reduction and relaxation techniques, giving them the tools and knowledge to address migraines themselves,” says Leon Barkodar, MD, a neurologist.

A physical therapist may use:

• relaxation techniques
• stretching exercises
• application of ice and heat
• massage

These strategies “can moderate the symptoms and make it much less intense,” Mikhael says. ”It may help prevent a full-blown migraine episode.”

Again, more research is needed, specifically on people with migraine.

But a 2020 study not specific to people with migraine suggests that physical therapy and yoga were more effective than education about back pain in lowering perceived stress.

A 2022 research article called for more mindfulness-based techniques like meditation in physical therapy, saying it would allow practitioners to care for a person’s “mind and body.”

Reduced reliance on medication

Medication certainly has its place in preventing and treating migraine symptoms. However, Uetz says physical therapy might reduce a person’s reliance on medications.

This could be beneficial for some people with migraine, especially those who experience side effects. As a result, you may require fewer doctor’s visits.

Prevention

Physical therapy may offer a preventive rather than reactive or abortive approach to migraine.

“The best option is always prevention,” Mikhael says. Understanding triggers and risk factors, like stress, and avoiding or treating them can help prevent and reduce attacks.

The downsides to physical therapy for migraine

Pain and issues with touch are at the center of potential cons of physical therapy for migraine.

Treatment may not be possible during episodes

Some physical therapy modalities may be uncomfortable during an acute migraine episode.

“[Most] people with migraine won’t be able to do any PT or have a therapist touch them during an episode, and they [may] prefer to be left alone in a dark, quiet room,” Mikhael says.

Symptom flares

Another drawback for some may be that symptoms get worse before you see improvement.

“Sometimes, when physical therapy or exercise is started, it can activate the very sensitive nerves of the neck and shoulders, and persons with migraine can experience more pain in the short term,” Smirnoff says.

It’s important to work with a physical therapist who is well-versed in treating symptoms of migraine so they can ensure a slow and steady start.

What to expect when trying physical therapy for migraine

Knowing what to expect — including the timeframe for results — can help you feel more prepared and in control of your health. However, these factors will vary from person to person.

Appointments

The first appointment may take longer and serve as an introductory session.

“The first visit is largely spent getting to know you as a human being, as well as your opportunity to learn about me as a person and as a therapist,” Uetz says. “Knowing the complexity of migraine and pain in general, the relationship and rapport built on day one is huge.”

On your first visit, you may:

• answer questions about goals, like what you want to get back to enjoying, as well as your family, work, and lifestyle
• undergo an assessment so the therapist can test your strength and observe your movement
• collaborate on an action plan based on the above
• learn gentle exercises you can do at home
• learn calming and soothing techniques, like massage or joint mobilization

Future appointments will involve follow-up about how the treatment plan is working.

“There will likely be a quick reassessment to guide upcoming treatment, and then the time will be used to address some of the areas that the therapist feels … will assist in the improvement of migraine symptoms,” Uetz says.

Between appointments

What a person does between appointments can also affect improvements.

“It’s so important to keep up with the exercises taught in physical therapy between appointments,” Smirnoff says. “The regular activity will also help reduce the likelihood of migraine and can complement traditional medical therapies.”

The standard advice for migraine prevention applies.

“Avoid stress, lack of sleep, and all the triggers, and take … preventive and abortive migraine medications as prescribed,” Mikhael says.

Results timeline

There’s no precise timeframe for expecting results because everyone with migraine is different.

“Some individuals may feel relief in symptoms as early as that day, and others could stretch weeks to months,” Uetz says.

Multiple factors affect results, including:

• sleep
• stress
• family life
• hydration
• nutrition
• lifestyle
• outlook

“Having a positive impact on as many of those as you can will provide the best chance to experience early results,” says Uetz.

Smirnoff recommends giving physical therapy at least 8 to 12 weeks, though she says you will hopefully begin to see some improvements more quickly.

“Results happen as the muscles of the head, neck, and shoulders become stronger and more relaxed, which typically starts to happen after 3 to 4 treatments,” Smirnoff says.

When physical therapy doesn’t pan out

Smirnoff says physical therapy isn’t the best fit for everyone. However, it may be worth speaking to another physical therapist if you’re not seeing results or are unsatisfied with your current PT.

“It’s also important to remember that results do not happen right away, and it may take time to see improvements,” she says. “If a full 8 to 12-[week] course of PT does not result in improvements, it’s important to talk to your doctor about other strategies for improving your migraine.”

Uetz agrees with the advice to be patient and seek a second opinion. He also suggests assessing lifestyle factors like sleep and stress.

However, like Smirnoff, he points out that PT isn’t a magic solution.

“It would be naïve of us as physical therapists to think that everyone will have a 100% success rate with PT,” he says. “Specialists like neurologists are here for a reason, and in situations where symptoms don’t resolve, you may be a candidate for additional testing and another set of eyes on you with a specialist visit. This is where medication management or additional imaging could come into play.”

Takeaway

There’s currently limited data to support the use of physical therapy for migraine, but some recent research suggests it might help.

Experts say reducing muscle tension, especially around the neck and shoulders, might lower migraine frequency or prevent it altogether. Physical therapy may also reduce mental stress, a common migraine trigger.

If you don’t see results within 12 weeks, you may want to seek a different physical therapist, assess your lifestyle factors, and try other management strategies with the support of a doctor.