I’ve had a ton of clients who have suffered from migraine’s. For the most part, I see those migraine’s get better using the strategies below. But, I’ve never seen a migraine sufferer not have at least one of these characteristics:
Forward head posture. I won’t get into the deep science, but suffice to say that every half inch your head is forward, the greater the stress is on the cervical spine. (1) Forward head posture is associated with greater tension-type headaches (which will usually contribute to a migraine).
Trigger points. Most of us have trigger points in our neck. In my experience, most who suffer from migraine’s have major trigger points in the neck area. This is backed up by a lot of studies which shows that individuals who have tension-based headaches will have worse trigger points than the rest of us. (2)
Non-neutral shoulder position. There is some evidence to support that higher tension in the upper traps (and potentially other muscles) is a contributor to tension-based headaches. (3) In my experience, this is reflected with elevated or depressed shoulders.
Flexed torso posture in daily life. You could have perfect neutral head posture, but if you are leaned over, you are over-stressing your neck big-time.
Now that I’ve harped on all my migraine-suffering clients, let’s get to what works. I’m surprised that more docs don't refer out to physical therapists for migraine’s, because the research shows physical methods work just as well as medications (if not better in some cases). I'd argue the physical means will at least have a chance to prevent future headaches. (4)
1. Get out of forward head posture by using the stick test. If you're reading this, you very likely have some degree of forward head posture. Here's how to really tell.
Place a broom stick on your back where the stick touches your butt, mid-back, and see if it touches your head. If it touches your head and you're not trying to touch your head to the stick, congratulations, you don't have a forward head posture. if you have to bring your head back at all, you have forward head posture.
Here's an overall good tutorial on neck position.
If this feels like you are constantly trying to avoid someone punching you in the face, that’s good. It should feel like that at first.
Over time, it will get easier, but you need to be really conscious of this. You may also need to work on extending or straightening your thoracic spine if you are rounded too much. Some clients just hate me when I am constantly putting the stick on their back and showing them their head is forward. If you’re overweight or obese, the stick may not be appropriate for you, but the back edge of your ear should bisect the middle of your shoulder.
2. Get a massage. My business partner, Matt Williamson is a master at identifying a ton of muscular, joint-based, and whole body patterns that tie into stuff like headaches. Before any training session, I’ll typically have clients roll with a softball on their necks against the wall. Often times, this will allow clients to stretch the neck muscles without them being aggravated.
3. Get your shoulders neutral. If you have depressed shoulders, you need to get them elevated, and this could mean doing shrugs. If you have elevated shoulders, you may need to focus on doing scapula depression work which is effectively, a reverse-shrug. Both ways relieve tension on the muscles, but you have to know which position you are in first. If you’re not sure, send me a pic, and ask.
4. When sitting, sit vertically. This sounds easy, but it is not. Realistically, you’ll likely need to move some cushions around to make it actually comfortable, potentially have your computer or book higher, and possibly reposition your legs. If you can’t be vertical or near vertical, you should have some head support.
I recommend patience with these evidence-based strategies. You likely won’t notice an immediate improvement, but overtime, you hopefully will see some major improvement with your headaches.
1. Cailliet R. Soft Tissue Pain and Disability. Philadelphia: FA Davis Co.,1977
2. Abboud J, Marchand AA, Sorra K, Descarreaux M. Musculoskeletal physical outcome measures in individuals with tension-type headache: a scoping review. Cephalalgia. 2013 Dec;33(16):1319-36. doi: 10.1177/0333102413492913. Epub 2013 Jun 26. Review. PubMed PMID: 23804285.
3. Bendtsen L, Ashina S, Moore A, Steiner TJ. Muscles and their role in episodic tension-type headache: implications for treatment.Eur J Pain. 2016 Feb;20(2):166-75. doi: 10.1002/ejp.748. Epub 2015 Jul 6. Review. PubMed PMID: 26147739.
4. Biondi DM. Physical treatments for headache: a structured review. Headache. 2005 Jun;45(6):738-46. Review. PubMed PMID: 15953306.
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