Headache Treatment: Causes, Symptoms & Evidence-Based Treatment
- Peter Petroff
- Jun 29
- 7 min read
Updated: 5 days ago
What is a headache?
A headache is pain or discomfort felt in the head, scalp, face, or upper neck. It is one of the most common health complaints and can range from a mild, short-lived ache to severe, disabling pain. Headaches are not a diagnosis themselves but rather a symptom that can arise from many different causes, including tension in the muscles, migraine, illness, problems involving the neck, medication use, or, less commonly, a more serious medical condition. Identifying the type of headache is the first step towards choosing the most appropriate treatment.
Different Types of Headaches
Infection-related headaches
These headaches commonly occur when you're unwell with an infection, such as a cold, the flu, or COVID-19. They often cause a dull, widespread ache across the head and may be accompanied by symptoms such as fever, fatigue, or body aches.
Caffeine or withdrawal headaches
If you've recently cut back on caffeine or significantly changed your diet, you may develop a withdrawal headache. These headaches often feel like a throbbing or pulsating pain on both sides of the head and usually improve once your body adjusts.
Tension-type headaches
Tension headaches are the most common type of headache. They typically feel like a constant pressure or tight band around the forehead or the back of the head. Unlike migraines, they usually aren't made worse by everyday physical activity.
Cluster headaches
Cluster headaches cause sudden episodes of severe pain, usually around one eye. The pain is often described as sharp, stabbing, or burning and may be accompanied by a watery eye, a blocked or runny nose, or redness on the affected side of the face. Although very painful, they are relatively uncommon.
Migraines
Migraines are more than just a bad headache. They usually cause moderate to severe throbbing pain, often on one side of the head, and may be accompanied by nausea, sensitivity to light and sound, or visual disturbances known as an aura. Many people find they need to rest in a quiet, dark room until the migraine passes.
Cervicogenic headaches
A cervicogenic headache is a headache that originates from structures in the neck. The pain is usually felt on one side of the head and may begin in the neck before spreading towards the forehead, temple, or behind the eye. Neck stiffness and pain with neck movements are common features.
TMJ-related headaches
Problems with the jaw joint (temporomandibular joint, or TMJ) or the surrounding muscles can cause headaches, often around the temples, cheeks, or in front of the ears. Jaw clicking, soreness, or pain while chewing may also be present.
As you can see there are many different types of headaches, and this list is not exhaustive. See this link for a more exhaustive list. It is important to have your headache properly assessed to ensure that you receive appropriate treatment.
Is Your Headache Neck Related?
As an osteopath, when assessing someone's headaches, the first priority is to screen for serious symptoms that might warrant urgent medical referral. If that is cleared, then I aim to assess the structures in the next to determine whether hands-on treatment can be effective.
The most common type of headache I see in practice are "cervicogenic headaches", as mentioned above, these headaches stem from issues in the joints or muscles in the neck and often respond well to osteopathic care.
It is important to note that many people likely have combination headaches, where both cervicogenic headaches and migraines are contributing to their discomfort. In these instances, management needs to be holistic and not solely focused on hands-on treatment.
Clues that may suggest your headache is coming from your neck rather than a true migraine include:
Cervicogenic | Migraine | |
Where the pain starts | Neck, base of skull, can spread into the head | Often around the temple, forehead or behind one eye |
Quality | A dull ache or steady pain | A throbbing or pulsating |
Neck pain | Usually the primary complaint | Can occur before, during or after a migraine |
Neck movement | Usually uncomfortable | Can also be uncomfortable, but unlikely to trigger or aggravate the headache |
Light and sound sensitivity | Very common | Uncommon but possible |
Nausea | Uncommon but possible | Common |
Duration | Varies, usually lasts until the neck settles | 4-72 hours on average |
Aura symptoms | Not present | About 25% of migraine sufferers experience an aura* |
*An aura refers to visual changes such as zig-zags, pins & needles, difficulty speaking and other neurological symptoms before an attack.
When Should You Seek Urgent Medical Attention?
Most headaches are not caused by a serious medical condition. However, if your headache is sudden, severe, different from your usual headaches, or is accompanied by symptoms such as weakness, confusion, fever, vision changes, or difficulty speaking, seek urgent medical attention immediately.
Treatment Options Available
Medication
If you experience frequent migraines, your GP or neurologist may recommend a medication to help reduce how often they occur. These medications are preventative, meaning they are taken regularly to reduce the frequency and severity of migraines rather than treating an attack once it has started.
Some of the more commonly prescribed medications include:
Topiramate
Originally developed to treat epilepsy, topiramate can also help reduce the frequency of migraines by calming overactive nerve activity in the brain.
Propranolol
A beta-blocker commonly used to treat high blood pressure and certain heart conditions. It can also help prevent migraines in some people by reducing the sensitivity of the nervous system.
Amitriptyline
An antidepressant that is often prescribed in much lower doses for migraine prevention. It may help by altering how pain signals are processed within the nervous system.
Candesartan
A medication commonly used for high blood pressure that has also been shown to reduce migraine frequency in some people.
OnabotulinumtoxinA (Botox)
For people with chronic migraine (15 or more headache days per month), Botox injections into specific muscles around the head and neck may reduce the frequency and severity of migraines by decreasing pain signalling from overactive nerves.
CGRP monoclonal antibodies
These are newer migraine-specific medications, including:
Erenumab (Aimovig)
Fremanezumab (Ajovy)
Galcanezumab (Emgality)
Eptinezumab (Vyepti)
They work by blocking the activity of calcitonin gene-related peptide (CGRP), a protein involved in triggering migraine attacks. They are usually prescribed by a neurologist for people whose migraines have not responded well to other preventative medications.
What does the research say?
A 2023 systematic review of 12 randomised controlled trials found that several preventative medications reduced the number of monthly headache and migraine days in people with chronic migraine. The newer CGRP medications generally showed the greatest benefit, although improvements were modest, and the best medication varies from person to person.
Exercise
Exercise is increasingly recognised as an important part of migraine management. Regular physical activity may help reduce the number of migraine attacks, lessen their severity, and improve quality of life.
Current research suggests that the following forms of exercise may be beneficial:
Moderate-intensity aerobic exercise (e.g. brisk walking, cycling, swimming)
Higher-intensity aerobic exercise
Yoga
Rather than searching for the "perfect" exercise program, focus on choosing an activity you enjoy and can perform consistently. Building up gradually is important, particularly if exercise has previously triggered your migraines.
Lifestyle Changes That May Help Reduce Migraines
Medication and hands-on treatment are only part of the picture. Research suggests that healthy lifestyle habits can play an important role in reducing the frequency and severity of migraine attacks. While lifestyle changes won't eliminate migraines altogether, they are inexpensive, accessible, and can complement other treatments.
A simple way to remember the key lifestyle factors is the SNAPS framework.
S – Smoking & Alcohol
Smoking and alcohol can trigger migraines in some people. If you smoke, quitting is beneficial for your overall health, while limiting alcohol intake—particularly if you notice it triggers your migraines—may help reduce attacks.
N – Nutrition & Hydration
Eat regular, balanced meals and avoid skipping meals, especially breakfast. Stay well hydrated throughout the day, and keep your caffeine intake consistent, as both excessive caffeine and sudden caffeine withdrawal can trigger headaches.
A – Activity
Regular exercise has been shown to reduce migraine frequency, improve sleep, lower stress, and improve quality of life. Aim for at least 150 minutes of moderate-intensity physical activity each week, building up gradually if you're just getting started.
P – Psychological Wellbeing
Stress is one of the most commonly reported migraine triggers. Techniques such as mindfulness, relaxation exercises, deep breathing, counselling, or cognitive behavioural therapy (CBT) may help reduce the impact of stress and improve migraine control.
S – Sleep
Aim for a regular sleep routine by going to bed and waking at consistent times each day. Keeping your bedroom cool, dark, and quiet, and limiting screen time before bed, may also improve sleep quality and reduce migraine frequency.
No single lifestyle change works for everyone, but together these habits can form an important part of a comprehensive migraine management plan alongside appropriate medical care and exercise.
Role of Osteopathy
Osteopathy may play a role in the management of certain headaches, particularly those arising from the neck (cervicogenic headaches) or where neck pain and stiffness contribute to symptoms.
Following a thorough assessment, an osteopath may use a combination of:
Education about your condition and contributing factors.
Exercise prescription to improve neck strength, mobility, and endurance.
Manual therapy, including soft tissue techniques and joint mobilisation where appropriate.
Advice on posture, workstation ergonomics, sleep position, and activity modification.
Lifestyle strategies to help reduce common headache triggers.
It's important to recognise that not all headaches originate from the neck. For example, migraines are a neurological condition and often require a multidisciplinary approach involving your GP or neurologist. While some people with migraine experience associated neck pain that may benefit from osteopathic treatment, manual therapy is generally used to address the accompanying musculoskeletal dysfunction rather than the underlying migraine itself.
The most effective management plan is often one that combines appropriate medical care, regular exercise, healthy lifestyle habits, and hands-on treatment when indicated.
Key Take Away
There is no one-size-fits-all solution to headaches. The most effective headache treatment begins with an accurate diagnosis and is tailored to the individual. Whether your headaches are related to migraine, the neck, tension, or another cause, a combination of education, exercise, healthy lifestyle habits, appropriate medical care, and, where indicated, osteopathic treatment can help reduce their impact and get you back to doing the things you enjoy.
How I Can Help - Headache Treatment In Yarraville
Headaches can have many different causes, which is why a thorough assessment is so important. During your consultation, I'll take the time to understand your symptoms, explain my findings in plain English, and work with you to develop a management plan that's tailored to your needs and goals.
If you're ready to take the next step, you can book an appointment online today.
