During our migraine clinics we get asked many questions by patients, who are seeking an improved understanding of their chronic migraine condition. We believe that better education of patients leads to improved outcomes. We have therefore decided to publish, in a series, our responses to their most frequent queries.

‘What do you think of Physical Treatments (Physiotherapy, Chiropractic, Osteopathic, Massage therapy) for my Migraines?’

A topic that we are frequently asked to comment on is the use of physical treatments for migraine headaches.

As migraine is commonly accompanied by neck pain or other symptoms, physiotherapy and other physical treatments are often provided.

In 2005, a literature review was undertaken of clinical studies, systemic reviews, and case series, that assessed the treatment of headache or migraine with chiropractic, osteopathic, physiotherapy or massage interventions. It was titled ‘Physical Treatments for Headaches: A Structured Review’

The authors noted that evidence is lacking regarding the efficacy of these treatments in reducing headache frequency, intensity, duration and disability, and that further studies of improved quality were needed.


In the absence of clear evidence about their place in treatment, the authors felt that the use of physical treatments should complement, and not replace, better validated forms of therapy.

Validated forms of therapies have been subject to randomized controlled trials and have shown a significant reduction in the number of headache and migraine free days, as well as migraine severity.

With the exception of high velocity chiropractic manipulation of the neck, physical therapy treatments are unlikely to be dangerous, although they are often expensive, and may result in lost treatment opportunities by providing treatment which is lacking in clear evidence and is potentially ineffective.

Note: information on this site is not a substitute for professional medical advice


Physical Treatments for Headaches: A Structured Review’ David M Biondi, Headache 2005;45:738-746