One of the reported causes of both migraine and tension headache is cervical muscle tension and spinal joint abnormalities in the neck. When considering treatment for headaches, whether it’s a tension-type or migraine, there are many choices available to the patient. The question is, which of the many options offer the best benefit?

One study compared the effectiveness of physical therapy (PT) to that of relaxation and thermal biofeedback (RTB). Both groups were treated using one of these approaches, and if at least a 50% improvement was not achieved, the other form of treatment was then utilized. Results were calculated at 3-, 6-, and 12-month timeframes. The PT group was treated with standard physical therapy approaches that included:

• Posture correction for alignment of head and spine.
• Cervical range of motion for neck and shoulders.
• Isometric strengthening of the neck.
• Flare-up management techniques.
• Active self-mobilization of the spine.
• Whole body stretching.

The goal was to target muscular abnormalities and those in this group were to perform the above twice per day for 30 min. Members of the RTB group were instructed in relaxation and thermal biofeedback (RTB) treatment that focused on muscle relaxation, breathing exercises, and the use of a thermal feedback device that determines when the subject’s temperature changes telling them if they are successfully relaxing. The participants were to practice at home and utilized audiotapes for relaxation and monitor success with the portable biofeedback unit.

Using the PT approaches, only 13% reported a successful outcome compared with 51% in the RTB group. In the follow-up at 3, 6 and 12 months, both groups reported continued benefit. When the subjects reported less than 50% benefit with either method, they were given the other treatment option, and the PT approach achieved a 47% success rate and the RTB 50% with these patients. These findings suggest that treatments that focus on muscle tension reduction (such as the RTB group) might result in a better outcome compared to only addressing posture, range of motion, and flexibility. However, as illustrated in the follow-up group, PT did have a positive beneficial effect. An important point: the subjects in the RTB group demonstrated the ability to reduce migraine pain and the associated disability by using a self-applied form of care. When teaching the patient to self-manage their condition by instruction and training, the greater the likelihood for a successful outcome.

Chiropractic focuses on many self-management training procedures including (but not limited to) the training of the use of ice vs. heat, exercises, proper methods of bending and lifting, as well as improving posture and muscle strength. The use and instruction of relaxation is also a commonly recommended form of care, which this study found to be most beneficial.