If you live with migraine, you already know it is not “just a headache”. Attacks can flatten a day or a week. Most people who walk into a Physiotherapy room with migraine have already seen their GP, tried a few medications, and now want to know what else can help between attacks. The honest answer is that Physiotherapy is one piece of the puzzle, not all of it, and the piece it covers is often missed.
01 · The condition
What is a migraine, and how is it different from a headache?
Migraine is a neurological condition, not a one-off headache. An attack usually involves moderate to severe pain on one side of the head, often throbbing, often made worse by movement, light, or noise. Many people also get nausea, visual changes, or unusual sensations in the hours before the pain starts. Around 1.7 million Australians live with migraine, and women are affected at more than twice the rate of men (AIHW, 2025).
A tension-type headache is different. It tends to be a steady, pressing pain on both sides of the head, without the nausea or visual changes, and it usually does not get worse with normal movement. The two can overlap, and many people who get migraine also get tension headaches between attacks.
There is also a third pattern, cervicogenic headache, where the pain actually starts in the neck and refers up into the head. The plan for each of these is different, which is why an early assessment matters more than a guess.
02 · The triggers
What tends to set off a migraine attack
Most migraine attacks have triggers, and most people have more than one. The common ones are stress (often the come-down from stress, not the stress itself), poor or irregular sleep, skipped meals, dehydration, hormonal shifts around the menstrual cycle, certain foods and drinks, weather changes, and sustained postures at a screen or steering wheel.
The neck connection is the one most often missed. A 2022 systematic review and meta-analysis (Al-Khazali et al, 2022) found that around 77 percent of people with migraine also have neck pain, compared with about 23 percent of people without headaches. That makes neck pain roughly twelve times more common in people with migraine than in the general population. It does not mean the neck causes every migraine. It does mean that the muscles, joints, and movement habits around the upper neck are involved in the system that produces an attack, and that they can often be changed.
A 2024 updated review of the cervical musculoskeletal evidence found patterns in migraine including forward head posture, reduced neck rotation, and reduced strength and endurance of the deep neck flexor muscles (Pensri et al, 2024). The certainty of the evidence is very low, but the pattern is consistent enough to be worth assessing.
03 · The plan
How Physiotherapy can help with migraine
Physiotherapy does not replace your GP, and it does not replace migraine-specific medication. What it can do is work on the neck, posture, and movement drivers that show up in the research, alongside the plan you already have.
A first appointment usually looks at the upper neck, the joints and muscles that move it, the position you hold your head in at work, your sleep position, and the activities that seem to make attacks worse or better. From there, the plan pulls together a few different threads.
Hands-on therapy. Manual therapy, gentle joint mobilisation, and soft-tissue work to the upper neck and shoulders can reduce neck symptoms during and between attacks. A 2023 systematic review and meta-analysis of physical therapy in chronic migraine found that, across the small but growing pool of randomised trials, these approaches show promise for headache frequency, intensity, disability, and quality of life (Onan et al, 2023). The wording is deliberately careful: the evidence is real, but it is not a guarantee.
Targeted exercise. Aerobic exercise has the most consistent evidence, and combined with medication it has reduced attack frequency, duration, and intensity in trials (Onan et al, 2023). Work on the deep neck flexors and thoracic spine mobility targets the specific impairments the cervical research identifies. Exercise also helps sleep, stress, and mood, the three migraine triggers that come up most often.
Posture and ergonomics. Sustained forward head posture, poor desk setup, and stomach sleeping are common contributors. Small changes to monitor height, keyboard position, and the pillow you sleep on can reduce the load on the upper neck across a whole day.
Education and pacing. A short course of Physiotherapy is also a chance to map your own triggers, plan around them, and build a routine for the early-warning signs. People who understand their pattern tend to manage attacks more confidently and reach for the rescue plan earlier.
The Physiotherapy team at Optimum Health Solutions works closely with your GP and, when helpful, our Exercise Physiology team and our Hydrotherapy service. You can read more on the Physiotherapy page, and our clinicians are introduced on the Meet our team page.
04 · The home plan
Self-management you can start at home
Most of the work in migraine management happens outside the clinic. The plan below is general guidance, not personalised advice, and it sits alongside whatever your GP has set up.
Track the pattern. Write down the date, the time, what came before the attack, what you had eaten and drunk, how you had slept, and any neck or shoulder tension in the lead-up. A 30-day record almost always finds patterns you would otherwise miss.
Build a steady week. Aim for similar sleep and wake times, regular meals, and steady hydration. Migraine tends to be sensitive to rapid changes, including the come-down from a stressful week.
Move most days. A short walk, a gentle ride, or any low-intensity aerobic work, most days of the week, is one of the most consistently helpful inputs.
Reset the neck regularly. If your work involves sitting at a screen, set a reminder to stand and move every 30 to 45 minutes. Long stretches of sustained neck flexion are a common trigger for upper-neck symptoms.
05 · The next step
When to see a Physiotherapist or GP
If you have a confirmed migraine diagnosis from your GP and you want help with the neck, posture, and movement drivers, a Physiotherapist is a reasonable next step. You do not need a referral. Most people see better results when they get the assessment in early, before they have stopped doing the things they enjoy.
If you have not yet had a diagnosis, see your GP first. Some headaches need investigation that sits outside the Physiotherapy scope, and an accurate diagnosis is what makes the rest of the plan work. The peak Australian patient organisation, Migraine and Headache Australia, is a useful starting point for general information and trigger guidance.
Optimum Health Solutions has Physiotherapy at fourteen clinics across New South Wales and Tasmania, including Blacktown, Liverpool, and Croydon Park. You can book a Physiotherapy appointment or, if you are a GP or other referrer, send a referral through the referrers hub.
Migraine is the most common neurological condition in Australia. Around 1.7 million Australians live with it, and most of them also have neck pain.
