Headaches and Migraines

“Prior to seeing Nick for chronic migraine/cluster headaches, I have not had a headache free day in many years. The headaches began in 1998 because of a car crash in 1995. I saw and was treated by my family doctor, chiropractor, massage therapist, an anesthesiologist, & pain medicine physician and an amazing neurologist prior… The neurologist found I have numerous herniated discs in my neck causing the headaches. He put me on many medications and I had numerous RFA procedures but I still suffered from daily headaches and had 3 migraine headaches in month. After my first dry needling treatment, I had a headache free day!! After having just 2 months of treatments and adjustments, I am headache free on most days! It’s truly a miracle. I’m so happy to finally be off of almost all of the medications I needed to function and be headache free.”




  • These headaches typically feel like a dull ache in the back of the head and upper part of the neck. They are usually on one side, but they can switch sides.

  • There are several nerves that run up from the top part of your neck into the base of the skull. The Greater Occipital Nerve is a major one.

    • This nerve comes out of the second joint in your neck and runs up the back side of the head.

  • Tightness in the muscles and joints around the nerve will create inflammation and pain along its pathway.

  • If you have stiffness rotating your head left and right, have a pain distribution about the size of your hand on the base of your skull, you may be appropriate for physical therapy.


  • Migraine is a neuromuscular event in the brain.

  • Migraines often have a rams horn type pattern starting at the base of the skull wrapping up and around the temple to directly behind your eye. They are often accompanied by nausea, light sensitivity, and/or aura.

  • There are triggers that can increase your likelihood of getting a migraine.

  • Common triggers such as food, alcohol, smells, light, stress may impact sympathetic activity triggering a migraine.

  • Trigeminal irritation is major player in migraine threshold.

  • The trigeminal is a cranial nerve that controls the muscles that we chew with and provides sensation to the sinuses and face.

  • Jaw pain and “sinus pressure” accompanying you headaches = trigeminal irritation.

  • The trigeminal nerve has a contributing nucleus primarily at the second and third levels of the neck but can be from the first four joints in your neck. Inflammation and reduced movement at these areas can increase the sensitivity of the trigeminal nucleus which will increase the threshold for you to get a migraine.

PHYSICAL THERAPY treatment FOR cervicogenic and MIGRAINE headaches

  • Headache treatment includes manual therapy to improve the rotation of the first two joints in the neck.

  • Soft tissue techniques and Integrative Dry Needling to reduce the inflammation, muscle guarding, and improve blood flow around this nerve to reduce pain.

  • Exercise to strengthen postures and positions that will keep you from re-inflaming this area are all part of a standard physical therapy treatment.

  • With Migraines, our goal is not to cure the migraine but to help you reduce the triggers that set off your migraine symptoms.