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Headaches are a very common and painful condition, often interfering with work, school, and home duties. For many people, it becomes a normal part of their life. There are characteristics of headaches that are well understood but there are many aspects that are still a mystery. Many people will turn to medication for relief, while some people cope with the problem and learn to identify and avoid triggers. Can chiropractic and massage be a natural remedy to help headaches? Read on to learn more.

woman working on the computer with a headache

While there are many type of headaches that exist, the three most common and most researched with conservative treatment are tension, cervicogenic and migraine headaches.

Tension Headaches 

Most people have experienced a tension headache at some point in their life. They are characterized by mild to moderate pressing or tightening on both sides of the head. They can be triggered by a variety of things (usually stress), which leads extended periods of contraction of muscles in the head, neck and upper back. Contraction over long periods of time may lead to decreased blood flow and nutrient deficiencies, causing trigger points. This type of headache can be infrequent, frequent or chronic. 

Cervicogenic Headaches

As the name implies, the source of the headache stems from the neck due to muscle or joint irritation of the upper cervical spine. The pain is typically located on one side, and can be felt at the base of the skull, the forehead, or behind the eye. It may be exacerbated by neck movement or sustained awkward head positioning. Range of motion in the neck may be limited and there is usually neck or shoulder arm pain on the same side of the headache. Pressure over the upper neck on the same side of the headache will usually increase the symptoms as well. The headache can be moderate to severe and is usually non-throbbing and dull.

Migraine Headaches

Migraines are known to be one of the most severe and debilitating types of headache. Criteria for an average migraine includes at least two of the following characteristics: located on one side of the head, pulsating quality, moderate or severe pain intensity, aggravation by or avoidance of routine physical activity (e.g. walking or climbing stairs), nausea and/or vomiting, sensitivity to light, sound, touch and sometimes smells, blurred vision and lightheadedness. Though they are rare, auras may also occur before or during a migraine. Auras result in visual disturbances such as flashes of light or wavy vision, though they may also include disturbances in movement, speech or touching sensations. While the causes of migraines are not fully understood, genetics and environment may play a role. Common triggers are stress, physical exertion, hormonal changes, sensory stimuli, food and food additives. Like tension headaches, they can be infrequent, frequent or chronic. 

What does the research say about Chiropractic and Massage for headaches?

The research on chiropractic and massage therapy for headaches have not been nearly as extensive compared to neck or low back pain. Therefore a lot of the research is still mixed in its quality. However, there still have been some notable trends that have emerged over the years.


Research Findings for Tension Headaches

  • Chiropractic manipulation to the neck in addition to massage does not appears to be more effective than massage alone.

Research Findings for Cervicogenic Headaches:

  • Spinal manipulation or exercise therapy appear to be more effective than massage therapy, but it is unclear if the combination of spinal manipulation and exercise is more effective.

Research Findings for Migraine Headaches:

  • Spinal manipulation or massage may be as effective as prophylactic prescription medications.

  • It is unclear if exercise is beneficial for migraines, but sub-maximal exercise may be helpful.

What’s treatment like at Integrity Chiropractic for headaches?

Like the research, clinical results are not always consistent. Some patients respond very well to treatment while others do not at all. Therefore, our recommendation to patients is typically start with a trial therapy of 4-6 visits of either chiropractic and/or massage treatment over the course of 2-6 weeks. If there aren't any notable improvements within that time frame, then we do not suspect that further treatment will abate the symptoms and may recommend other options to you. As headaches tend to be life-long episodic or chronic conditions for most headache patients, and many of our patients are seeking to reduce or avoid medication, we work with you to establish a reasonable treatment frequency to manage the pain if you have benefit from treatment.

Our clinical observations tend to reflect what have seen in the research, so we highly recommend massage therapy for tension and migraine headaches as a first option as we see better results. Because cervicogenic headaches involve cervical joint structures, we recommend chiropractic treatment as a first option that will consist of spinal manipulation and/or exercise which has been supported by the research. We may also utilize soft-tissue work to the cervical spine depending on your presentation.


  • Bronfort G, Assendelft WJJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. Journal of Manipulative & Physiological Therapeutics. 2001;24(7):457-466. ​

  • Bryans R, Descarreaux M, Duranleau M, et al. Evidence-based guidelines for the chiropractic treatment of adults with headache. Journal Of Manipulative And Physiological Therapeutics. 2011;34(5):274-289.

  • Astin JA, Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia: An International Journal Of Headache. 2002;22(8):617-623.

  • Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. The Journal Of Headache And Pain. 2012;13(5):351-359.

  • Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. The Journal Of Headache And Pain. 2011;12(2):127-133.

  • Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy. 2010;18:3.

  • Moore CS, Sibbritt DW, Adams J. A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurology. 2017;17(1):61.

  • Racicki S, Gerwin S, DiClaudio S, Reinmann S, Donaldson M. Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of Manual & Manipulative Therapy (Maney Publishing). 2013;21(2):113-124.

  • Posadzki P, Ernst E. Review: Spinal manipulations for tension-type headaches: A systematic review of randomized controlled trials. Complementary Therapies in Medicine. 2012;20:232-239.

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