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Your Guide to Headache-Migraine

This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.


Headache-migraine are commonly diagnosed as tension headaches, menstrual migraine, cluster headaches, cervicogenic headaches, cyclic vomiting, and the list goes on. Recent research by leading physiotherapist Dean Watson now suggests that the numerous types of headachemigraine are actually a single disorder, caused by a SENSITISED BRAINSTEM.


The brainstem is small in size but extremely important as it connects the nerves from the main part of the brain to the rest of the body. The upper cervical region which consists of the first 3 vertebrae (C0-3) communicate with the brain via the brainstem. For the majority of headache-migraine sufferers, a dysfunction in the C0-3 region is the cause of the sensitised brainstem.

What Is A Sensitised Brainstem?

When the brainstem becomes sensitised, incoming information is magnified. A usually normal amount of information is experienced as an overload and thus produces pain. Some headache-migraine suffers often experience “triggers.” Triggers such as increases in hormones, certain foods and alcohol, stress, and poor posture can further magnify the dysfunction of the upper cervical spine and increase the sensitisation of the brainstem.

Is Your Headache Coming From Your Neck?

Your physio will be able to determine whether your headache-migraine is coming from your upper neck by reproducing the symptoms and seeing whether the symptoms change in real time. You will experience your typical headache as well as resolution of those symptoms within each session. This resolution of symptoms is the real time desensitisation of the brainstem. You will also learn techniques to self manage your headache-migraine as well as education on lifestyle changes to allow the body to naturally desensitise the brainstem.

Your journey to peak performance with Central Physio

Your physio has been extensively trained to thoroughly assess and diagnose your headache-migraine. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.

Phase 1: Eliminate Symptoms

Correcting any upper cervical dysfunction as well as desensitizing the brainstem is the first step to a life without headache. Your physio will utilise manual techniques and specific exercises to do this.

Phase 2: Restore Range of Motion

Often the ROM in your neck will be reduced due to decreased movement in you upper neck joints. You may notice this as difficulty turning your head to reverse the car. The first part of the treatment will be focused on restoring this movement.

Techniques your physio may use to increase ROM include joint mobilisations, specific muscle releases and heat. You will also have home exercises to do to keep you improving between sessions.

Phase 3: Restore Muscle Length

Often when you have the muscles around the neck that tighten up, they put increased stress on different levels of vertebrae. Tight muscles also make the job of other muscle harder and cause too much load on joints. Tight muscles may even change the way you move and cause a dysfunction in the upper cervical spine, further sensitising the brainstem. Therefore it is important to get your full muscle length back to stop all this from happening.

Phase 4: Re-educate movement patterns

Often if you work at a desk and or have a slouched posture, you will have changed the way you move your neck. This will be putting increased strain on areas that aren’t designed to handle the extra load and contribute to increased muscle tightness. If your movement patterns are not corrected then even if the muscles are stretched out, they may tighten up again due to the continued abnormal postures or movements.

Poor posture makes the stabilising muscles at the front of your neck and your upper back become weak, leading to continuation of poor posture and headaches. Now that your muscle length and movement patterns have been corrected it is important to strengthen these muscles to make sure you keep correct posture and minimise the risk of future problems.

Your physio will guide you through a graded exercise program to specifically strengthen your postural muscles. These exercises are light and don’t take very long, but you really have to focus on using the right muscles at the right times so you may find them hard at first. Many clients find that progressing to our Clinical Pilates or Exercise Physiology programs is ideal at this stage.

Phase 5: Sports/Ballistics and Advanced Strengthening

As you return to your normal activities and sport it is important to strengthen you in the positions required for these activities. It may be as simple as strengthening in the sitting position to allow you to work at a desk more comfortably, or adding in weights and more complex exercises if you play a specific sport.

Many clients find that seeing one of our Exercise PhysiologistsStrength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.

For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.