By Kenny Merlevede

Senior Physiotherapist, Founder and Director · Registered with the AHPRA (PHY0002060505)

Sports Rehabilitation · Musculoskeletal Problems · Sport Injuries · Neck pain, headaches, dizziness, jaw related neck pain

Kenny is a physiotherapist with over 18 years’ experience in musculoskeletal and sports rehabilitation. He has a focus on identifying the contributing factors behind pain and treating complex presentations including chronic spine pain, neck and headache disorders, jaw dysfunction, and persistent sports injuries. His approach combines manual therapy, dry needling, and active rehabilitation with strong emphasis on education and patient outcomes. He is also a GEMt dry needling teacher and demonstrator. As an endurance athlete with experience in marathons, Ironman, CrossFit, basketball, and ultra endurance events, he brings a performance athlete's perspective to rehabilitation and load management.

Read more about Kenny →

Last reviewed: 17 August 2026

Headaches and Migraines: Symptoms, Causes and Treatment

Headaches and migraines are common, often disabling conditions that range from tension-type headaches, felt as a tight band around the head, to migraines, which typically bring severe throbbing pain on one side, nausea and sensitivity to light or sound. Many headaches have a musculoskeletal component, meaning the neck, jaw or upper back contributes to the symptoms, and physiotherapy can help reduce their frequency and intensity alongside other treatments.

Fast facts

Common symptoms: Persistent or episodic head pain, neck stiffness, pain at the base of the skull, jaw soreness, sensitivity to light or sound, nausea (in migraine), morning headaches

Who it affects: Around 35% of Australians experience definite or probable migraine each year; tension-type headache is even more common, affects all ages, more common in women

Typical recovery: Frequency and intensity usually reduce over 6 to 12 weeks with combined manual therapy, exercise and trigger management, individual response varies

Outlook: Most headaches improve with treatment and self-management, chronic patterns benefit from identifying and addressing neck, posture, sleep and stress contributors

What are headaches and migraines?

Headaches are pain anywhere in the head, and they come in several types. Tension-type headaches feel like a tight band or pressure around the head, often linked to tight muscles in the neck and shoulders. Migraines are more severe, usually one-sided, throbbing, and often accompanied by nausea, vomiting, and sensitivity to light or sound, they can last hours to days and may be preceded by visual disturbances called aura. Cervicogenic headaches start in the neck, where a stiff or restricted joint refers pain into the head, typically one-sided and often felt at the base of the skull or behind the eyes. Medication-overuse headaches develop when regular painkillers are used too often, creating a rebound cycle.

The painful area, your head, is not always where the problem starts. The neck, jaw, posture, sleep position, stress and certain triggers like alcohol, dehydration or poor lighting can all feed into the headache pattern. Understanding which type you have, and what is driving it, is the first step to getting it under control.

What it feels like: symptoms and signs

The symptoms depend on the type of headache. Tension-type headaches usually feel like a dull ache or pressure on both sides of the head, sometimes described as a tight band. You might also notice stiffness or soreness in your neck and shoulders, and the pain tends to be worse at the end of a long day at the desk.

Migraines are different. The pain is typically severe and throbbing, often on one side of your head, and it can be bad enough to stop you in your tracks. You might feel nauseous or vomit, and light, noise or even smells can become unbearable. Some people see flashing lights, zigzag lines or blind spots before the headache starts, a warning sign called aura. A migraine can last anywhere from a few hours to three days, and afterwards you might feel drained or foggy for another day.

Cervicogenic headaches, the ones that start in the neck, often come with a clear pattern. The pain is usually one-sided, starts at the base of the skull or the upper neck, and can spread forward to your temple, forehead or behind your eye. You might notice it is worse when you turn your head, hold a position for too long, or first thing in the morning. There is often neck stiffness on the same side, and you might get shooting or numbing sensations down the neck when you move quickly.

If you wake up with a headache most mornings, or if the pain is always on the same side and linked to neck movement or posture, the neck is very likely involved.

What causes headaches and who is at risk

Headaches develop when the structures that sense pain in the head, neck or face become sensitised or overloaded. For tension-type headaches, the main drivers are tight muscles in the neck, shoulders and jaw, often from prolonged sitting, poor posture, stress or jaw clenching. When these muscles stay tight for long periods, they develop tender trigger points that refer pain into the head. Stress, anxiety and poor sleep make the nervous system more sensitive, lowering the threshold at which pain is felt.

Migraines have a stronger genetic and neurological component. They are thought to involve changes in brain activity and blood flow, and certain triggers, such as hormonal shifts, lack of sleep, dehydration, alcohol, bright lights, strong smells or specific foods, can set off an attack. Many people with migraines also have neck and jaw tension, and research shows that patients with migraine commonly present with reduced neck movement and tight muscles at the base of the skull, which can make the migraines worse or more frequent.

Cervicogenic headaches are caused by a problem in the upper cervical spine, typically a stiff or restricted joint at C1, C2 or C3, the top three segments of the neck. When a joint gets stuck, the muscles around it tighten to protect it, and over time this creates a pattern of restricted movement and referred pain into the head. Sleep position matters, sleeping with your arms tucked under your chest or your neck twisted can quietly aggravate the same structures we are trying to release in treatment. Desk work, looking down at a phone for hours, and previous neck injuries all increase the risk.

Medication-overuse headaches develop when you take painkillers, including over-the-counter ones, on more than 10 to 15 days per month for three months or longer. The medication stops working as well, and the headache returns as soon as it wears off, creating a cycle that is hard to break without guidance.

Women are more likely to experience migraines than men, partly due to hormonal factors. People with a family history of migraines, a history of neck or jaw problems, high stress levels, poor posture or a sedentary job are all at higher risk. According to a 2024 Australian survey, around 35% of adults experience definite or probable migraine in any given year, and around 8% have definite migraine, figures that highlight how common and disabling these conditions are.

How headaches and migraines are treated, and what recovery looks like

Treatment depends on the type of headache and what is driving it, but the goal is always the same: reduce the frequency and intensity of your headaches, identify and address the contributing factors, and give you the tools to manage flare-ups and prevent them from coming back. For most people, this is a combination of hands-on treatment, exercises, education and, where needed, medication or other medical input.

The first step is a thorough assessment. I check the cervical spine segment by segment, looking for restricted joints, muscle tightness and tender trigger points, and I assess how your neck moves in all directions. I also ask about your headache pattern, when it started, what makes it better or worse, your sleep position, stress levels, work set-up and any known triggers.

Hands-on treatment typically includes manual therapy to restore movement to stiff joints, soft tissue work to release tight muscles, and dry needling to target trigger points that refer pain into the head. The hands-on work is important, but it is only part of the picture.

I always give a home exercise programme alongside treatment, because headaches like this tend to relapse if the muscle tightness and posture that fed into the stuck segment are not addressed as well. The exercises might include gentle neck stretches, chin tucks to improve posture, strengthening for the deep neck flexors, and upper back mobility work. I also keep a close eye on compliance, at follow-up sessions I check the programme with the patient in the room rather than just asking if they have been doing it, because that is often the difference between steady improvement and a plateau.

What improvement looks like session to session is a reduction in muscle tightness, better range of motion, and, critically, a reduction in the sharp or shooting symptoms. Most people notice meaningful change over about 6 to 12 weeks, though some respond faster and others take longer depending on how long the problem has been there and how many contributing factors need addressing.

For migraines, the evidence supports a multimodal approach. A 2009 systematic review in the European Journal of Pain found that manual therapy and specific exercise reduced headache frequency by around 4 to 5 days per month and intensity by about 10 points on a 100-point scale in people with tension-type headache. The research on manual therapy for migraine is more cautious, a 2011 review in The Journal of Headache and Pain noted that massage therapy, physiotherapy and relaxation may reduce migraine frequency and disability, but the evidence base was small and methodologically limited. That does not mean these approaches do not work, it means the research is still catching up, and in practice I see people benefit when we address the neck and jaw contributors alongside their medical management.

Medication has a role, particularly for migraines. Acute treatments like triptans or anti-nausea medication can stop an attack, and preventive medications, including some blood pressure drugs, antidepressants or newer CGRP inhibitors, can reduce the frequency of attacks. Medication-overuse headaches require a structured withdrawal plan, usually supervised by a GP or neurologist, and the headache often gets worse before it gets better.

Trigger management is critical. Keeping a headache diary helps identify patterns: what you were doing, eating or feeling in the hours before the headache started. Common triggers include alcohol, dehydration, poor sleep, skipping meals, bright screens, stress and certain foods like aged cheese, chocolate or processed meats. Once you know your triggers, you can start to manage them.

Sleep position and work set-up matter more than most people realise. Sleeping with your neck twisted, your arms under your chest or a pillow that is too high or too flat can aggravate the same structures we are trying to release in treatment. I spend time with patients working out a better set-up: a supportive pillow that keeps the neck neutral, a desk and screen at the right height, regular breaks from sitting, and strategies to manage stress.

Recovery is not linear. Some people see steady improvement, others have setbacks, and some need ongoing maintenance sessions or a review every few months rather than a full discharge. The aim is to give you enough improvement and self-management strategies that you can space sessions out or stop, rather than creating dependence. After an initial block of treatment, usually 4 to 8 sessions over 6 to 12 weeks, we review your goals and decide together whether you need further sessions, a home programme, or simply a plan to come back if things flare up again.

Different approaches at Physio K

At Physio K we offer both physiotherapy and massage therapy for headaches, and the two approaches complement each other well. Physiotherapy focuses on identifying and treating the mechanical drivers of your headache: restricted joints in the neck, poor posture, muscle imbalances and movement patterns that overload the structures referring pain into your head. A physiotherapy session typically includes a detailed assessment of your cervical spine, hands-on joint mobilisation or manipulation to restore movement, dry needling to release trigger points, and a tailored exercise programme to address the underlying weakness or stiffness. The goal is to change the pattern that is causing the headache, not just settle the symptoms temporarily.

Massage therapy takes a broader, whole-body approach, working to release muscle tension through the neck, shoulders, upper back and jaw, and to calm the nervous system. A massage session might include deep tissue work, trigger point release, fascial techniques and relaxation strategies, and it can be particularly helpful when stress, poor sleep or muscle guarding are major contributors. Massage does not typically include joint mobilisation or a structured exercise programme, but massage can be an effective way to reduce the muscle tightness and nervous system sensitivity that feed into tension-type and cervicogenic headaches.

Many patients benefit from a combination: physiotherapy to address the joint restrictions and movement patterns, and massage to manage the broader muscle tension and stress load. Your practitioner will discuss which approach, or combination, is most likely to help based on your assessment findings and your goals.

What the research shows

The evidence for physiotherapy in headache management is strongest for tension-type and cervicogenic headaches. The 2009 systematic review by Verhagen and colleagues pooled data from several trials and found that people receiving manual therapy and exercise for tension-type headache had, on average, about 4 to 5 fewer headache days per month compared to those who received no treatment or usual care. Headache intensity dropped by around 10 points on a 100-point scale, and painkiller use fell by about 2 doses per month. Those are meaningful changes for someone whose headaches have been grinding them down for months or years.

For cervicogenic headaches, the rationale is even clearer. A 2006 study in the journal Headache found that patients with migraine commonly presented with reduced neck range of motion and myofascial trigger points, supporting the idea that addressing the cervical spine and surrounding muscles is a logical and worthwhile part of treatment.

The evidence for manual therapy in migraine is more cautious. Clinical guidelines, including those from the American Academy of Neurology and American Headache Society (2012), note that some non-pharmacological treatments, including certain physical therapies, may be beneficial as part of multimodal management, though they are considered adjuncts rather than stand-alone replacements for indicated medication.

In Australia, headache disorders are common and disabling. A 2020 study estimated that migraine affects around 8.5% of Australian adults aged 20 to 64 years and is associated with substantial health and productivity burden, including lost work days and reduced quality of life. The 2024 Australian Headache Epidemiology Data (AHEAD) survey reported that around 35% of Australians experience definite or probable migraine in any given year, and around 3.5% have medication-overuse headache, a figure that highlights how common the rebound cycle is and how important it is to review medication use as part of any headache management plan.

"The most common thing I see is that patients don't connect their headache to their neck at all," says Kenny Merlevede, Senior Physiotherapist and Director at Physio K. "They come in focused on the headache and migraines as the problem, when a lot of the time the driver is a stuck or restricted segment in the cervical spine, often with a clear side bias, and tight muscles like the scalenes, sub-occipital group, and upper traps feeding into it."

The take-home message from the research is that headaches, particularly tension-type and cervicogenic headaches, respond well to a combination of manual therapy, exercise, trigger management and education. For migraines, the evidence is less certain, but many people benefit from addressing the neck and jaw contributors alongside their medical management. The key is accurate diagnosis, a personalised plan, and realistic expectations: most people improve, but it takes time and consistent effort.

When to seek urgent help

Most headaches are not dangerous, but certain symptoms need urgent medical assessment. Seek help immediately if you experience a sudden, severe headache that feels like the worst headache of your life, particularly if it comes on in seconds or minutes (often described as a thunderclap headache). Other red flags include headache with a high fever, stiff neck, confusion, seizures, double vision, weakness, numbness or difficulty speaking, headache after a recent head injury, particularly if it is getting worse, a new headache in someone over 50, especially if it is persistent and associated with scalp tenderness or jaw pain when chewing (which may suggest giant cell arteritis), or a headache that changes with position, is worse when lying down or waking, or is accompanied by persistent vomiting, as these can suggest raised pressure in the skull.

If you have any of these symptoms, go to your GP or an emergency department straight away. Your clinician will screen for these warning signs at your first appointment and will refer you on promptly if anything does not fit a benign pattern.

Common questions

What if this is something serious and I need a scan, not physio?

Your clinician will screen for red-flag signs that suggest a more serious problem at your first appointment, and if anything does not fit a benign pattern, you will be referred to your GP or an emergency department urgently. Most headaches are not due to serious disease, but we never ignore worrying features. A normal scan is reassuring, but it does not mean physio will not find anything to treat, most tension-type and cervicogenic headaches do not show on scans because the problem lies in how the muscles, joints and nervous system are functioning, not in structural damage visible on imaging.

Is the treatment going to make my headaches worse?

It is common to feel a little sore or worked-on for a day or two after hands-on treatment or new exercises, but this usually settles quickly. Your programme is tailored to start at a level your body can tolerate and can be adjusted if symptoms flare. I show patients how to recognise normal post-treatment soreness versus warning signs that need review, and we adjust the plan if needed. Treatment is a mix of manual work and dry needling, built up gradually so your body can adapt.

I've tried so many things already, how is this any different?

This approach does not just chase pain, it looks carefully at the mechanical and lifestyle drivers of your headaches: neck stiffness, posture, jaw tension, sleep position, stress patterns and known triggers. The plan is personalised, progress is monitored, and you are given clear tools to use at home so you are not relying solely on passive treatment or medication. I also keep a close eye on compliance, I make a point of actually checking your home programme with you in the room rather than just asking if you have been doing it, because that is often the difference between steady improvement and a plateau.

Will I have to keep coming forever?

The aim is to give you enough improvement and self-management strategies that you can space sessions out or stop, rather than creating dependence. After an initial block of treatment, usually 4 to 8 sessions over 6 to 12 weeks, we review your goals and decide together whether you need further sessions, a review in a few months, or simply a home programme. Some people need ongoing maintenance or a check-in every few months, but most reach a point where they can manage independently with the tools they have learned.

This article was reviewed by Sebastian Oyarzo, a physiotherapy graduate currently completing his registration pathway with the Australian Physiotherapy Council (reference APP-0012627200), practising under supervision at Physio K. He holds a Bachelor's degree in Physiotherapy from Universidad Del Desarrollo and a Master's in Clinical Exercise Physiology from Universidad Mayor, with a focus on musculoskeletal physiotherapy, metabolic health, and preoperative rehabilitation. With eight years of clinical experience in Santiago at Clínica Dávila and Nutrimet, he developed experience managing obesity and metabolic syndrome through therapeutic exercise, surgical prehabilitation, and postoperative orthopaedic rehabilitation, alongside building a private practice treating sports injuries and joint trauma using manual therapy and evidence-based exercise prescription. His background also includes work with a national football selection team and gait analysis research at Macquarie University.

This article is for general information only and is not a substitute for personal medical advice. If you have concerns about your health, please consult a qualified clinician or your GP.