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  • Writer's pictureSam Kelokates

Why Do I Get a Headache After Physical Therapy?

Updated: Feb 19

Have you ever left a physical therapy session feeling the start of a headache or a migraine?

If so, you're not alone. Many people ask me "Why do I get a headache after physical therapy?" and "Can physical therapy cause migraines?"

These are important questions, especially for those of you who are already dealing with frequent headaches or migraine attacks.

female physical therapist performing hands-on examination of female patient sitting in chair. Hands on neck

At Kelos Physical Therapy in Philadelphia, PA, I specialize in treating headache and migraine disorders. I understand how tough it can be to manage these conditions.

That's why we want to share some insights into why you might experience headaches after physical therapy and what can be done about it.

The goal of this blog is to dig into the reasons why headaches or migraine attacks might happen after your PT sessions.

We'll look at common causes and offer some tips on how to work with your physical therapist to manage or even prevent these headaches.

Our aim is to help you feel better, not just during your therapy sessions but long after you leave our clinic.


Can Physical Therapy Cause Migraine?

When you come to Kelos Physical Therapy, you might be seeking relief for your headaches or migraine disorder. So, it might seem a bit confusing, or even frustrating, to find that sometimes, physical therapy sessions can lead to a headache or trigger a migraine.

Let's talk about why this happens and what's going on behind the scenes.

First off, it's important to know that while physical therapy is aimed at helping you feel better, some of the interventions we use can inadvertently trigger headache attacks in certain individuals.

This isn't just something we've noticed in practice. It's also been backed up by research.

For example, a study by Carvalho et al. in 2020 found that people with migraine were more likely to report neck pain and migraine attacks after undergoing a neck muscle endurance test.

Specifically, those who experienced neck pain that spread to the head during a manual examination were more likely to suffer from migraine attacks compared to those who didn't experience such pain.

So, what's the connection between physical therapy and headaches? It often comes down to the stimulation of the upper cervical spine.

The upper part of your spine is a sensitive area, and for those with headache disorders, stimulating this area can inadvertently activate what's known as the trigeminocervical nucleus—a key player in the onset of migraine attacks.

The trigeminocervical nucleus is a region in your brainstem that becomes activated during a migraine attack. When we work on the muscles and joints in your neck, the intention is to treat impairments found during the initial examination.

However, for individuals with migraine disorders, this well-intentioned stimulation can sometimes send signals to the trigeminocervical nucleus, triggering a migraine attack.

Understanding this connection is crucial, not just for us as physical therapists but for you as a patient.

At Kelos Physical Therapy, I'm not just about applying treatments aimlessly. It's about applying the right treatments with a deep understanding of how your body might respond.

That's why we always start with a thorough evaluation and keep a close eye on how you're feeling and responding to treatments throughout your journey.

Common Reasons for Headaches after Physical Therapy Sessions

Physical therapy is a journey towards better health and fewer headaches, but sometimes, it can come with unexpected twists, like a headache after a session.

There are a few reasons this might happen, and understanding them can help us navigate through and minimize their occurrence.

The Natural Occurrence of Migraine

Migraine is a complex condition characterized by its unpredictability. Sometimes, a migraine might seem to strike out of the blue, and it can feel like it's coinciding with your physical therapy sessions just by chance.

It's important to remember that migraines have their own rhythm, influenced by a wide range of factors including stress, diet, sleep patterns, and even changes in the weather.

So, while it might seem like your PT session is the trigger, it could also be that a migraine was on its way regardless of your therapy activities.

Recognizing this unpredictability is a key step in managing migraine effectively.

Stress-Induced Migraines from Physical Therapy

Physical therapy involves challenging your body to heal and adapt, which can sometimes be stressful. This stress isn't just physical.

It can also be psychological, especially if you're anxious about pain or eager to see improvements. Stress, both physical and emotional, is a well-known trigger for migraine.

The effort of engaging in PT, the focus on areas of pain or dysfunction, and even the journey to and from the clinic can add up to a significant amount of stress, potentially leading to a migraine.

Specific PT Interventions as Triggers

Certain interventions used in physical therapy, particularly those involving the neck and head areas, are known to provoke headaches in some people. This is especially true for techniques that stimulate the upper cervical spine.

As mentioned earlier, this area is closely linked to the trigeminocervical nucleus, a key player in the migraine process. Manual therapies, neck exercises, and even some forms of mobilization can, in rare cases, act as a trigger for migraine.

It's not that these interventions are harmful; rather, for individuals with sensitivities, they can inadvertently kickstart the migraine process.

At Kelos Physical Therapy, I'm keenly aware of these potential triggers. That's why I tailor my approach for each individual, taking into account your specific migraine triggers and vulnerabilities.

My goal is to provide physical therapy that helps you have fewer headaches without inadvertently causing discomfort or pain.

Identifying Your Migraine Triggers and Managing Risk

Navigating physical therapy while managing migraine requires understanding and collaboration. It's all about identifying what triggers your attacks and finding ways to minimize these triggers during your therapy sessions.

Here’s how we can work together at Kelos Physical Therapy to make this process as smooth as possible.

Working Together to Identify Triggers

Communication is the cornerstone of effective migraine management in physical therapy. We encourage you to be open and detailed about your migraine history and triggers.

Here are a few tips on how we can work together to identify these triggers:

Share Detailed Information: Let us know about your migraine triggers, frequency, and any patterns you've noticed. For example, if certain neck movements or stress levels have previously triggered a headache, sharing these details can be incredibly helpful.

Feedback During Sessions: Provide immediate feedback during your therapy sessions. If a particular exercise or manual therapy technique makes you feel uncomfortable or seems to provoke headache symptoms, let us know right away.

Monitor Symptoms: Keep a diary of your migraine attacks, especially in relation to your physical therapy sessions. This can help us both see patterns and make necessary adjustments.

Strategies to Reduce Headache Risk

Once we have a better understanding of your triggers, we can implement strategies to reduce the risk of triggering a migraine during your therapy sessions. Here are some strategies we might use:

Tailored Treatment Plans: Based on your triggers, we can adjust our treatment plan. This might mean modifying certain exercises, using alternative therapy techniques, or adjusting the intensity and duration of sessions.

Relaxation Techniques: Stress can be a significant trigger for migraine. We might incorporate relaxation techniques before and after sessions, such as deep breathing, guided imagery, or even short meditation exercises, to help manage stress levels.

Gradual Progression: Instead of jumping into intensive therapy, we may start slowly and gradually increase the intensity of your exercises. This approach can help your body adapt without overwhelming it, potentially reducing the risk of triggering a migraine.

Environmental Adjustments: Sometimes, the clinic environment can contribute to migraines. If bright lights or certain sounds are triggers for you, let me know. I can make adjustments to create a more comfortable therapy environment. I often have the lights off in my office!

At Kelos Physical Therapy, I'm committed to providing a therapy experience that not only addresses your physical needs but also carefully considers your migraine management.

By working together to identify your triggers and implementing strategies to minimize risks, we can create a more effective and comfortable path to more headache-free days.

Your well-being is my top priority, and through collaboration and tailored care, we can tackle the challenges of migraine together.

Effective Communication for Better Outcomes

In physical therapy for headache disorders, communication isn't just helpful, it's essential.

The more we know about how you're responding to treatment, the better I can tailor our approach to fit your needs.

The Importance of Speaking Up

It's understandable to have concerns about voicing discomfort or pain during therapy sessions. You might worry about complaining or disrupting the flow of treatment.

However, I view your feedback as a valuable tool that enables me to provide you with the best care possible.

Here's why your input is crucial:

Identifying Headache Triggers: Your insights help us pinpoint specific activities or interventions that might be contributing to headaches post-PT. This information is vital for customizing your therapy to avoid these triggers.

Enhancing Your Comfort: Letting us know when something isn't feeling right allows us to make immediate adjustments, whether it's modifying a technique on the spot or finding a more comfortable position for you.

Building Trust: Open communication fosters a stronger therapist-patient relationship. Knowing that your concerns are heard and addressed can make your therapy sessions a more positive and productive experience.

Adjusting Your Treatment Plan

Your feedback is a key component in developing a successful treatment plan. Here's how we use your input to make necessary adjustments:

Modifying Techniques: If certain exercises or manual therapies are consistent headache triggers, we can modify these techniques or explore alternative therapies that provide the same benefits without the risk of triggering a migraine.

Pacing the Therapy: Based on your feedback, we may adjust the pace of your therapy sessions. If a slower approach helps manage your migraine risk, I'm happy to accommodate that.

Conversely, if you're responding well, we can gradually increase the intensity at a comfortable rate.

Incorporating Preventive Measures: Alongside modifications, we can introduce preventive measures such as warm-up exercises, relaxation techniques, or hydration tips before and after sessions to help mitigate the risk of headaches.

Holistic Approach: Sometimes, adjusting your treatment plan might also mean looking beyond physical therapy itself. We can discuss lifestyle adjustments or refer you to other specialists if we think it could help manage your migraine triggers more effectively.

The goal is to ensure that your treatment not only aids in your rehabilitation but also respects and accommodates your needs due to migraine. I want to create a therapy plan that aligns with your health goals, maximizes benefits, and minimizes discomfort.

The Kelos Approach to Headache Physical Therapy

My approach is not just about responding to headaches when they occur. It's about preventing them from happening in the first place. Here's how we stay ahead of the game.

Tailored Approach to Therapy

Every patient is unique, and so is their experience with migraine and headache. That's why a one-size-fits-all approach doesn't work. From the moment you walk into the clinic, I'm focused on creating a therapy plan that's as individual as you are. This includes:

  • Thorough Initial Assessment: Before starting treatment, we conduct a comprehensive evaluation to understand your medical history, migraine triggers, and specific goals. This assessment is crucial for crafting a personalized therapy plan.

  • Customized Treatment Plans: Your therapy plan is designed to address your specific needs, taking into account your migraine history. We choose exercises, manual therapies, and other interventions with a mindfulness of avoiding known triggers.

Continuous Assessment

Your body's response to therapy can change over time, and so can the factors influencing your migraine. Continuous assessment allows us to monitor these changes and adapt your treatment plan accordingly. This includes:

  • Regular Check-ins: Each session is an opportunity for us to check in with you about how you're feeling, any headaches you've experienced, and your overall progress. These check-ins help us gauge the effectiveness of the treatment and make adjustments as needed.

  • Feedback Loops: I encourage open communication and see feedback as a valuable part of your treatment. Your insights into what works and what doesn't are integral to fine-tuning your therapy plan.

Willingness to Adjust Strategies

Flexibility is key in physical therapy, especially for patients managing migraine. We're always ready to adjust our strategies to ensure the best outcomes for you. This might involve:

  • Modifying Interventions: If an exercise or technique proves to be a potential trigger, we're prepared to modify it or find an alternative that achieves the same therapeutic goals without risking a migraine.

  • Incorporating New Techniques: As we learn more about your condition and response to treatment, we might introduce new techniques that can further enhance your therapy experience and minimize the risk of headaches.

  • Collaborative Care: Sometimes, the best approach to managing migraine involves working with other healthcare professionals. We're open to collaborating with your doctors, neurologists, or other specialists to ensure a comprehensive approach to your health.

At Kelos Physical Therapy, I'm not just treating symptoms. I'm treating people. My proactive, patient-centered approach means I'm always assessing, adapting, and adjusting to ensure that your physical therapy journey supports your overall wellbeing, including your battle with migraines.

If you're ready to take a proactive step towards managing your migraine alongside with physical therapy, I invite you to book a consultation at Kelos Physical Therapy for a personalized assessment.

About Me:

Hi, my name is Sam Kelokates, PT, DPT. I am a licensed physical therapist and owner of Kelos Physical Therapy, located in Philadelphia, PA. I specialize in the non-pharmacological management of headache and migraine disorders.


This blog post is for informational purposes only and should not replace professional medical advice or treatment. Always consult with a qualified healthcare provider for personalized guidance and recommendations.

**I may earn commissions for purchases made through the links in this post**

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