How do headache-specialised physiotherapists treat patients with migraine,tension-type,cervicogenic or temporomandibular-associated headaches – an online survey of the IHS Physiotherapy Special Interest Group

Abstract

Background

Headaches are commonly treated by physiotherapists, despite differing clinical recommendations and a lack of international guidelines to support consistent practice.

Objective

To provide an overview of treatment approaches used internationally by physiotherapists for patients with migraine, tension-type headache (TTH), cervicogenic headache (CgH) and headache attributed to temporomandibular disorders (TMD) to support the development of a minimum curriculum as part of the objectives of the Physiotherapy Special Interest Group (SIG) of the International Headache Society (IHS).

Methods

A cross-sectional online English language survey was developed and included questions on demographics treatment approaches for four headache types, and referral practices. Physiotherapists treating headache patients were recruited through the IHS Physiotherapy SIG network.

Results

Of 116 respondents, 76 physiotherapists completed all mandatory questions. Participants were trained in 26 countries and practiced in 24 countries across six continents. Migraine and TTH were the most frequently treated headache types, followed by CgH and TMD-related headache. Regardless of headache type, education, manual therapy, and exercise were commonly used. There was less use of body–mind approaches, electrotherapy and invasive techniques. Self-referral was the most common pathway into physiotherapy.

Conclusion

Physiotherapists with a special interest in headache worldwide treat a variety of headaches using, most frequently, education, manual therapy, and exercise. These findings support the need for an international curriculum to cover this spectrum of headaches and support the need for future guideline development for physiotherapy in headache care.

Keywords

survey headache migraine management physiotherapy

Background

The International Classification of Headache Disorders¹ lists more than 220 different headache types. They are divided into primary headache disorders such as migraine and tension-type headache and secondary headache disorders, indicating that they are a symptom of another condition. These include headaches from cervical or temporomandibular joint disorders, both of which are typical indications for physiotherapy treatment to address the musculoskeletal associates of these headaches.²

There are practice guidelines for the different primary headaches. Physiotherapy management is recommended for tension-type headache.^3,4 The International Headache Society (IHS) practice guideline for migraine only covers pharmacological treatment.⁵ Nevertheless, many patients with migraine access physiotherapy management directly or are referred to physiotherapists.^6,7 The treatment they receive is influenced by the physiotherapist's expertise in managing neck pain, a common accompaniment of migraine and by methods advocated in the literature to reduce pain sensitivity such as exercises and manual therapy approaches.⁸ Aerobic and relaxation exercises might also be included into the overall management.⁹

April 2025 marked the inaugural event of a Special Interest Group (SIG) in Physiotherapy, established within the IHS. One goal of the SIG is the development of an international curriculum towards having consistency in physiotherapy education internationally.^10,11 This curriculum could compliment the already published IHS curriculum for headache-specialised neurologists. As a step towards this aim, an understanding of the interventions physiotherapists use in the management of various headache types is needed. This applies especially to migraine for which there are no guidelines, and where the literature presents a variety of approaches.^12,13 The formation of the SIG presented the opportunity to capture the current nature, internationally, of physiotherapy treatment for patients with different types of headaches.

The purpose of this study in this first step was therefore to gain an international overview of interventions, headache-specific treatment approaches and referral pathways currently used by physiotherapists with a special interest in managing patients with different headache types.

Methods

A cross-sectional online survey was developed using the online platform LimeSurvey (Supplemental material). The University of Luebeck's ethical committee agreed to all procedures (AZ 2025-271). The reporting of this survey follows the CROSS Checklist.¹⁴ The survey was pre-registered at the open science framework platform (https://osf.io/8mgyk; registration doi 10.17605/OSF.IO/RZVD7).

Survey design

The survey focused on headaches expected to be commonly treated by physiotherapists. These included cervicogenic headache, headaches associated with temporomandibular disorders (TMD), migraine and tension-type headache.

The survey consisted of three sections. The first collected demographic information – country of origin, academic training and knowledge about headaches (seven questions). In the second section, participants were asked which treatment approaches they commonly used for each of migraine, tension-type headache, cervicogenic headache and TMD (48 questions). The third section focused on their practices of referral from and to other health professionals (five questions). All questions contained response options and allowed for multiple answers. Participants were able to move forward and backward between pages and to leave questions unanswered. The survey language was English.

The questionnaire was pre-tested by the authors and their teams. This resulted in a reduction of items, removal of ambiguously phrased questions to ensure a clearer structure.

Participants/recruitment

Physiotherapists treating patients with headaches were eligible to participate. A filtering question at the beginning of the survey ‘Are you treating patients with headaches’ closed the survey for those responding with ‘no’. There is no recommended sample size for this type of survey, however, to capture the international perspective, participants from a minimum of 20 countries from ideally all continents were considered a representative target population.

Survey administration

All physiotherapists who provided their email address for the purpose of the survey, during the inaugural SIG meeting in April 2025 (n = 125), were invited to contribute. Participation was anonymous. Informed consent was obtained by entering the first survey page after reading the information text on the starting page. The survey was accessible for a period of 3 months ending on 16 October 2025.

Data analysis

Questions with categorical response options were analysed descriptively by counting the responses to the categories provided (e.g. very often, often, sometimes, rarely and never). To indicate the relative number of responses for each category, the total number of responses was divided by the number of participants answering all mandatory questions. For the open-ended question ‘how does your treatment approach vary for the different headache types’, most participants (81.4%) provided a generic, in principle answer. Hence, after thoroughly reviewing the responses, it was decided to simply comment on whether clinicians varied treatments for different headache types and on what principle. The statistical software Jamovi (Version 2.7.7) was used.

Results

Participants

Of the 125 SIG meeting attendees providing their email addresses, 116 (92.8%) participants accessed and 76 (60.8%) fully completed all mandatory questions of the survey. Based on these 76 responses, participants were trained as physiotherapists in 26 countries (Supplemental Figure A) and were currently practising in 24 countries on six continents (3 (4%) participants in Asia, 6 (8%) in North America, 45 (59%) in Europe, 4 (5%) in Africa, 8 (11%) in South America and 10 (13%) in Australia). Highest qualifications were a PhD 19 (25%), Master's degree 34 (44%), Bachelor's degree 16 (21%) and 7 (10%) had other qualifications, for example, a Diploma. Thirty-one participants had undertaken postgraduate academic training (e.g. Master's degrees) which included some training in headache management and 45 participants had participated in professional development courses specialising in headache assessment and treatment.

Seventy-two (95%) participants claimed to be familiar with applying the diagnostic criteria for headache types according to the International Classification of Headache diagnoses. When asked which headache types were treated in their clinical practice, participant responses of ‘often’ or ‘very often’ were 55 (73%) for migraine, 54 (71%) for tension-type headache, 46 (60%) for cervicogenic headache and 20 (40%) for TMD. Additionally, 23 (30%) of participants stated they often treated post-traumatic headaches and 27 (35%) whiplash-associated headaches. Fifty-five respondents (72%) added that rarely or sometimes other headache types are treated, but these were not further specified.

Treatment approaches used for the different headache types

Subsequent questions focused on determining the treatment approaches participants used for managing patients with the most common headache types (cervicogenic headaches, migraine, tension-type headaches and TMD). Figure 1(a)–(d) present an overview of the treatment approaches to each headache type. Table 1 presents a breakdown of the interventions provided within each treatment approach. The greatest variety of responses across headache types was observed for the types of exercises participants prescribe (Figure 2(a)–(d)).

Table 1.

Treatment approaches used by participants.

Treatment approach	Headache type
	CgH	TMD	Migraine	TTH
Education	68 (89%)	62 (82%)	74 (97%)	75 (99%)
Headache education	63 (83%)	58 (76%)	72 (95%)	71 (93%)
Pain neuroscience education	51 (67%)	50 (66%)	62 (82%)	66 (87%)
Lifestyle education	58 (76%)	56 (74%)	71 (93%)	73 (96%)
Self-management strategies	66 (87%)	60 (79%)	71 (93%)	71 (93%)
Posture and ergonomic advice	57 (75%)	40 (53%)	45 (59%)	57 (75%)
Other *This included: medication-overuse headache; the relationship of migraine and the neck; acute and prophylactic medication	2 (3%)	7 (9%)	15 (20%)*	4 (5%)
Manual therapy	71 (93%)	62 (82%)	63 (83%)	69 (91%)
Low-velocity mobilizations	52 (68%)	46 (61%)	42 (55%)	43 (57%)
High-velocity thrust techniques	27 (36%)	11 (14%)	15 /(20%)	18 (24%)
Sustained mobilisation techniques	56 (74%)	35 (46%)	47 (62%)	47 (62%)
Mobilisation with movement	60 (79%)	48 (63%)	43 (57%)	45 (59%)
Soft tissue techniques	55 (72%)	56 (74%)	56 (74%)	63 (83%)
Massage	26 (34%)	28 (37%)	20 (26%)	29 (38%)
Self-mobilisation techniques	56 (74%)	46 (61%)	46 (61%)	48 (63%)
Neural mobilisation techniques	25 (33%)	11 (14%)	23 (30%)	27 (36%)
Other	5 (7%)	5 (7%)	8 (11%)	5 (7%)
Exercise	71 (93%)	63 (83%)	71 (93%)	75 (99%)
Moderate aerobic continuous exercise	38 (50%)	30 (39%)	55 (72%)	56 (74%)
High intensity interval training	8 (11%)	12 (16%)	13 (17%)	22 (29%)
Low load cervical motor control training	53 (70%)	35 (46%)	45 (59%)	44 (58%)
Strength and endurance training – neck/shoulder	63 (83%)	29 (38%)	57 (75%)	52 (82%)
Stretching for neck/shoulder	46 (61%)	25 (33%)	42 (55%)	51 (67%)
Jaw exercises	15 (20%)	58 (76%)	54 (32%)	22 (29%)
Vestibular training	13 (17%)	4 (5%)	21 (28%)	7 (9%)
Balance training	15 (20%)	6 (8%)	26 (34%)	11 (14%)
Cervical sensorimotor exercises	51 (67%)	24 (32%)	36 (47%)	34 (45%)
Breathing techniques	27 (36%)	33 (43%)	43 (57%)	44 (58%)
Other	6 (8%)	3 (4%)	6 (8%)	7 (9%)
Electrotherapy, modulation and other more invasive techniques	11 (14%)	9 (12%)	10 (13%)	12 (16%)
Laser therapy	2 (3%)	2 (3%)	2 (3%)	2 (3%)
Dry needling	6 (8%)	6 (8%)	5 (7%)	7 (9%)
Acupuncture	3 (4%)	2 (3%)	2 (3%)	4 (5%)
Transcranial direct current stimulation	2 (3%)	1 (1%)	1 (1%)	1 (1%)
Transcutaneous electrical nerve stimulation	3 (4%)	3 (4%)	5 (7%)	5 (7%)
Other	1 (1%)	2 (3%)	1 (1%)	2 (3%)
Body–mind approaches	27 (36%)	27 (36%)	36 (47%)	37 (49%)
Mindfulness, meditation	19 (25%)	22 (29%)	29 (38%)	29 (38%)
Progressive muscle relaxation	17 (22%)	16 (21%)	21 (28%)	22 (29%)
Biofeedback relaxation	9 (12%)	10 (13%)	13 (17%)	14 (18%)
Yoga, Tai-Chi and others	10 (13%)	10 (13%)	18 (24%)	20 (26%)
Other	1 (1%)	0 (0%)	2 (3%)	2 (3%)

The treatment categories are in bold with the techniques within that category listed below. The absolute numbers and percentages indicate the numbers of physiotherapists using this approach in relationship to all survey participants (n=76).

CgH: cervicogenic headache; TMD: headache attributed to temporomandibular disorders; TTH: tension-type headache.

How treatment approaches vary for different headache types

Seventy respondents answered this open-ended question. Sixty of the 70 indicated that they varied their approach to different headache types. Twelve provided explicit answers such as ‘In TMD and CgH, the approach is more “local”, on joints and muscles. In migraine and TTH, there is more emphasis on general education and pain neuroscience education, “local” techniques are supplementary’. The remaining 48 participants responded with more in principle statements such as ‘A thorough interview and physical assessment influencing clinical reasoning and decision on the contributing factors of the headache picture guides my treatment approach’. Eight of the remaining 10 participants, focused on treatment of the upper cervical spine for all headaches. Two participants described their approach to one headache type only.

Referral patterns

Most patients attended physiotherapy on a self-referral basis (Figure 3). General practitioners (GP), neurologists and other physiotherapists were the most common sources of referral (Figure 3). Physiotherapists most often referred patients to neurologists, followed by psychologists/psychiatrists and general practitioners (Figure 4).

Discussion

Seventy-six physiotherapists with a special interest in the management of patients with different headache types provided information on their treatment approaches and referral pathways and represented 26 countries. Most had an advanced level of education as well as attending postgraduate professional development courses in headaches, as could be expected from physiotherapists associated with a special interest group physiotherapy within the IHS. Regardless of headache type, education, manual therapy and exercise were the most used interventions. Body–mind approaches were used to a moderate extent, while electrotherapy was rarely applied.

Interestingly, migraine (73%) was the most frequently treated headache type by these physiotherapists with a special interest in headache, followed by tension-type headache (71%) and cervicogenic headache (60%). This is a surprising result considering that physical therapies are guideline-recommended interventions for cervicogenic headache¹⁵ but not guideline-recommended interventions for migraine and only tentatively recommended in guidelines for tension-type headache.³ An explanation for this occurrence might be the commonly reported neck pain associated with migraine attacks¹⁶ and the significant association of cervical disability with migraine frequency.¹⁷ Patients frequently express a wish to reduce medication using non-pharmacological alternatives.¹⁸ There is a long history of using neck manipulation for migraine, with the first contemporary RCT being conducted some 50 years ago.¹⁹ However, based on current knowledge of migraine pathophysiology, neck pain itself cannot be regarded as a causal factor.²⁰ An ongoing scientific debate deliberates whether nociception arising from musculoskeletal structures potentially contributes to migraine frequency and severity,^17,21,22 and there is an increasing body of research by physiotherapists in primary headache types investigating this issue.^23–26 The frequency with which migraine and tension-type headache are treated may be also reflect that some of our participants work in highly specialised tertiary headache settings, since physiotherapy is not always accessible to patients with primary headaches.⁷

Manual therapy was used by most respondents in the management of all headache types (Table 1) which likely reflects the high incidence of neck pain in our headaches of interest.²⁷ Traditionally, manual therapy is used in the treatment of joint pain and dysfunction but it might also serve as a pain modulating intervention.²⁸ Unfortunately, we did not capture the rationale for its use in this survey. While there is evidence of benefit for cervicogenic headache,^29,30 the evidence for cervical manual therapy for other headache types is more uncertain. A recent systematic review revealed low-level evidence that cervical manipulation may reduce headache days and pain intensity in migraine.³¹ For tension-type headache, the evidence of effectiveness for soft tissue and manual therapy remains limited.³² This limited responsiveness to cervical manual therapies may be explained by recent research which suggests that a cervical musculoskeletal cause of neck pain may be present in only 30% to 40% of people with tension-type headache and migraine, respectively.^24,26

Exercise likewise was commonly used in management, but there was greater differentiation in exercise types used for the different headaches (Table 1 and Figure 2). Aerobic training and strength training were predominant for migraine and tension-type headache which accords with the evidence of benefit for these headaches.^13,33 Low load cervical motor control and strength training were predominant in the management of persons with cervicogenic headache, which is in accord with the evidence for therapeutic exercise for cervical musculoskeletal disorders.³⁴ Of interest cervical motor control training was frequently employed in the management of persons with migraine but not so common in the management of those with tension-type headache. This raises the question of whether our cohort of physiotherapists find that the neck pain in migraine is more frequently associated with cervical musculoskeletal dysfunction than it is in tension-type headache. It could be a factor of consumer selection for management of neck pain, as the survey revealed that many of the patients seen by physiotherapists are self-referred.

Jaw exercise was dominant in the management of patients with temporomandibular disorder (TMD), and often in combination with other exercise, especially cervical motor control training. Nevertheless, jaw exercise was prescribed for approximately one-third of patients with the other headache types (Table 1). This practice may reflect the reciprocal influence that has been demonstrated between cervicogenic headache and temporomandibular dysfunctions.³⁵ Likewise, a recent systematic review demonstrated that temporomandibular disorders are a frequent co-morbidity in patients with migraine and tension-type headache.³⁶ These distinct diagnoses could occur concomitantly and overlap to a great extent due to their multiple interactions, for example pain in the muscles of face may be not TMD but the result of migraine sensitisation.³⁷ Also, there is anatomical overlap in the pain perceived in these conditions. Considering the pathophysiology and the clinical presentation of some headache types and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify.³⁸

Education was widely used across all headache types, especially migraine and tension-type headache. Some evidence exists for different types of education in migraine^25,39,40 but not for the other headache types. Similarly, there is some evidence supporting the use of body–mind approaches in migraine,^40,41 but not other headaches. Therefore, evidence for such interventions closely reflect the responses from this survey. Overall, the responses suggest that physiotherapists frequently adopt a multimodal approach which has a strengthening evidence base.^33,42

When asked to explain different approaches for different headache types, most physiotherapists reported that this decision was based on their clinical reasoning following a thorough assessment. However, responses were biased towards manual therapy for the neck, which might be directed at potential joint dysfunctions but might also serve as a pain modulating intervention.²⁸ Unfortunately, this was not explained in more detail in the responses.

As this was an international survey aiming to reflect headache physiotherapy practice worldwide, it must be acknowledged that physiotherapy is regulated by different governments and subject to varying restrictions. Fifty-six of the 76 participants who completed the entire survey, reported that they often or very often see patients who self-refer to physiotherapy. This is not possible in countries such as Germany or Austria and is restricted to self-paying patients or private insurance schemes in other countries, including the United Kingdom and Switzerland.

Limitations

Several limitations must be acknowledged, many related to the use of an online survey methodology. These include incomplete representation of all countries in which physiotherapy is provided for patients with headache, as well as imbalanced participant numbers across countries. Therefore, the results can only provide an impression of current physiotherapy practice in headache care, for example, some countries such as Germany, do not allow physiotherapists to perform dry needling or high velocity thrust techniques, hence the distribution of countries with their government regulation might have influenced results.

As with all surveys, participation was voluntary, and individuals with a special interest or strong opinion on the topic are more likely to respond. In this case, this was anticipated and intentional, as the survey was initiated by a physiotherapy special interest group under the umbrella of the IHS. The purpose was to summarise headache care approaches to support the subsequent development of undergraduate and postgraduate curricula. It must be acknowledged that the results of this survey do not reflect standard headache care provided by all physiotherapists.

Conclusions

Physiotherapists with a special interest in headache treat a broad spectrum of headaches including migraine, tension-type headache, cervicogenic headache and headaches associated with TMDs. As physiotherapy is more commonly aligned with cervicogenic headache, this finding supports the need for an international curriculum for undergraduate and postgraduate education across at least, this spectrum of headaches. In common, education, manual therapy and various forms of exercise were commonly used across all headache types. This finding supports the need for further research into indications and effectiveness for such management methods and guideline development for physiotherapy in headache care.

Article highlights

Seventy-six SIG-registered physiotherapists practicing as headache experts in 24 countries, provided insights into their approaches for cervicogenic headaches, migraine, tension-type headaches and TMD.

Regardless of headache type, education, manual therapy and exercise were used. There was little distinction reported regarding the approaches for the different headache types.

Self-referral was the most common pathway into physiotherapy.

Supplemental Material

sj-docx-1-rep-10.1177_25158163261469090 - Supplemental material for How do headache-specialised physiotherapists treat patients with migraine, tension-type, cervicogenic or temporomandibular-associated headaches – an online survey of the IHS Physiotherapy Special Interest Group

Supplemental material, sj-docx-1-rep-10.1177_25158163261469090 for How do headache-specialised physiotherapists treat patients with migraine, tension-type, cervicogenic or temporomandibular-associated headaches – an online survey of the IHS Physiotherapy Special Interest Group by Kerstin Luedtke, Gwendolen Jull, Debora Bevilaqua-Grossi and Zhiqi Liang in Cephalalgia Reports

Supplemental Material

sj-pdf-2-rep-10.1177_25158163261469090 - Supplemental material for How do headache-specialised physiotherapists treat patients with migraine, tension-type, cervicogenic or temporomandibular-associated headaches – an online survey of the IHS Physiotherapy Special Interest Group

Supplemental material, sj-pdf-2-rep-10.1177_25158163261469090 for How do headache-specialised physiotherapists treat patients with migraine, tension-type, cervicogenic or temporomandibular-associated headaches – an online survey of the IHS Physiotherapy Special Interest Group by Kerstin Luedtke, Gwendolen Jull, Debora Bevilaqua-Grossi and Zhiqi Liang in Cephalalgia Reports

Footnotes

Acknowledgements

We thank the International Headache Society for supporting the Special Interest Group Physiotherapy.

ORCID iDs

Kerstin Luedtke

Gwendolen Jull

Zhiqi Liang

Ethical considerations

The University of Luebeck's ethical committee agreed to all procedures (AZ 2025-271).

Consent to participate

Participants were informed on the first page of the survey about the purpose and the format of the project. The were also aware that they could withdraw at anytime and that participation was anonymous. The last sentence informed participants that by opening the next page they consented to study participation.

Consent for publication

All authors agree to publish with Cephalgia Reports.

Author contributions

KL analysed the data and wrote the first draft of the manuscript. All authors developed the concept for the project, participated in survey design and development of the questions. All authors contributed to the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data is available from the authors upon reasonable request.

Open practices

Pre-print server: doi 10.17605/OSF.IO/RZVD7

Supplemental material

Supplemental material for this article is available online.

References

Headache Classification Committee of the International Headache Society (IHS). The International classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1–211.

Becher

Lozano-López

Castro-Carletti

EM de

, et al. Effectiveness of therapeutic exercise for the management of cervicogenic headache: a systematic review. Musculoskelet Sci Pract 2023; 66: 102822.

Bendtsen

Evers

Linde

, et al. EFNS guideline on the treatment of tension-type headache – report of an EFNS task force. Eur J Neurol 2010; 17: 1318–1325.

Diener

H-C

Gaul

Kropp

. Therapie der Migräneattacke und Prophylaxe der Migräne: entwicklungsstufe: s1. Nervenheilkunde 2018; 37: 689–715.

Puledda

Sacco

Diener

H-C

, et al. International Headache Society global practice recommendations for the acute pharmacological treatment of migraine. Cephalalgia 2024; 44: 3331024241252666.

Carvalho

Quinn

Luedtke

. Migraine patients’ experiences with and expectations from physiotherapy. Musculoskelet Sci Pract 2023; 66: 102803.

Tedeschi

Pillastrini

Pierangeli

, et al. Is physiotherapy in migraines known to sufferers? A cross-sectional study. Neurol Sci 2024; 45: 1669–1674.

Amons

Castien

De Hertogh

, et al. Efficacy of cervical physical therapy on pain sensitivity in patients with migraine compared to no treatment, sham treatment or usual medical care: a systematic review and meta-analysis. J Man Manip Ther 2026: 1–13. doi: 10.1080/10669817.2026.2614009

La Touche

Fierro-Marrero

Sánchez-Ruíz

, et al. Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline. J Headache Pain 2023; 24: 68.

10.

Jull

Luedtke

Bevilaqua-Grossi

, et al. A physical therapy specialist interest group in the International Headache Society be in on its creation!. J Man Manip Ther 2025; 33: 73–74.

11.

Luedtke

Liang

Bevilaqua-Grossi

, et al. The International Headache Society welcomes a physiotherapy special interest group. Musculoskelet Sci Pract 2025; 76: 103281.

12.

Beier

Callesen

Carlsen

, et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education in migraine treatment. A systematic review and meta-analysis. Cephalalgia 2021; 42: 63–72.

13.

Woldeamanuel

Oliveira

ABD

. What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. J Headache Pain 2022; 23: 134.

14.

Sharma

Minh Duc

Luu Lam Thang

, et al. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med 2021; 36: 3179–3187.

15.

Côté

Shearer

, et al. Non-pharmacological management of persistent headaches associated with neck pain: a clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain 2019; 23: 1051–1070.

16.

Al-Khazali

Al-Sayegh

Younis

, et al. Systematic review and meta-analysis of Neck Disability Index and Numeric Pain Rating Scale in patients with migraine and tension-type headache. Cephalalgia 2024; 44: 3331024241274266.

17.

Florencio

Chaves

Carvalho

, et al. Neck pain disability is related to the frequency of migraine attacks: a cross-sectional study. Headache 2014; 54: 1203–1210.

18.

Gaul

Eismann

Schmidt

, et al. Use of complementary and alternative medicine in patients suffering from primary headache disorders. Cephalalgia 2009; 29: 1069–1078.

19.

Parker

Tupling

Pryor

. A controlled trial of cervical manipulation of migraine. Aust N Z J Med 1978; 8: 589–593.

20.

Goadsby

Holland

. An update: pathophysiology of migraine. Neurol Clin 2019; 37: 651–671.

21.

Bragatto

Bevilaqua-Grossi

Benatto

, et al. Is the presence of neck pain associated with more severe clinical presentation in patients with migraine? A cross-sectional study. Cephalalgia 2019; 39: 1500–1508.

22.

Ford

Calhoun

Kahn

, et al. Predictors of disability in migraineurs referred to a tertiary clinic: neck pain, headache characteristics, and coping behaviors. Headache 2008; 48: 523–528.

23.

Bevilaqua-Grossi

Pinheiro-Araujo

Carvalho

, et al. Neck pain repercussions in migraine – the role of physiotherapy. Musculoskelet Sci Pract 2023; 66: 102786.

24.

Liang

Thomas

Jull

, et al. Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction. Headache 2021; 61: 882–894.

25.

Meise

Carvalho

Thiel

, et al. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: a randomized controlled trial. Cephalalgia 2023; 43: 3331024221144781.

26.

Pensri

Liang

Treleaven

, et al. Cervical musculoskeletal function is variable in tension-type headache: a cluster analysis. Headache 2026; 66: 1548–1562.

27.

Ashina

Bendtsen

Lyngberg

, et al. Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia 2015; 35: 211–219.

28.

Vigotsky

Bruhns

. The role of descending modulation in manual therapy and its analgesic implications: a narrative review. Pain Res Treat 2015; 2015: 292805.

29.

Jull

Trott

Potter

, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002; 27: 1835–1843. discussion 1843.

30.

Satpute

Bedekar

Hall

. Mulligan manual therapy added to exercise improves headache frequency, intensity and disability more than exercise alone in people with cervicogenic headache: a randomised trial. J Physiother 2024; 70: 224–233.

31.

Rist

Hernandez

Bernstein

, et al. The impact of spinal manipulation on migraine pain and disability: a systematic review and meta-analysis. Headache 2019; 59: 532–542.

32.

Lozano López

Mesa Jiménez

de la Hoz Aizpurúa

, et al. Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. Neurologia 2016; 31: 357–369.

33.

Varangot-Reille

Suso-Martí

Romero-Palau

, et al. Effects of different therapeutic exercise modalities on migraine or tension-type headache: a systematic review and meta-analysis with a replicability analysis. J Pain 2022; 23: 1099–1122.

34.

Dirito

Abichandani

Jadhakhan

, et al. The effects of exercise on neuromuscular function in people with chronic neck pain: a systematic review and meta-analysis. PLoS ONE 2024; 19: e0315817.

35.

von Piekartz

Lüdtke

. Effect of treatment of temporomandibular disorders (TMD) in patients with cervicogenic headache: a single-blind, randomized controlled study. Cranio 2011; 29: 43–56.

36.

Bizzarri

Manfredini

Koutris

, et al. Temporomandibular disorders in migraine and tension-type headache patients: a systematic review with meta-analysis. J Oral Facial Pain Headache 2024; 38: 11–24.

37.

Bevilaqua-Grossi

Lipton

Napchan

, et al. Temporomandibular disorders and cutaneous allodynia are associated in individuals with migraine. Cephalalgia 2010; 30: 425–432.

38.

Costa

Y-M

Porporatti

A-L

Calderon

P-S

, et al.

Can palpation-induced muscle pain pattern contribute to the differential diagnosis among temporomandibular disorders, primary headaches phenotypes and possible bruxism?

Med Oral Patol Oral Cir Bucal 2016; 21: e59–e65.

39.

Kindelan-Calvo

Gil-Martínez

Paris-Alemany

, et al. Effectiveness of therapeutic patient education for adults with migraine. A systematic review and meta-analysis of randomized controlled trials. Pain Med 2014; 15: 1619–1636.

40.

Meise

Schwarz

Luedtke

. Effectiveness of patient education and cognitive behavioural treatment as a non-pharmacological intervention for migraine in adults – a systematic review. SN Compr Clin Med 2022; 4: 197.

41.

Xie

Zhang

Guo

. Multilevel network meta-analysis of non-pharmacological interventions for migraine: focusing on the dose-effect of physical exercise and its moderators. Clin J Pain. 2026; 42. DOI: 10.1097/AJP.0000000000001351.

42.

Repiso-Guardeño

Moreno-Morales

Armenta-Pendón

, et al. Physical therapy in tension-type headache: a systematic review of randomized controlled trials. Int J Environ Res Public Health; 2023; 20. DOI: 10.3390/ijerph20054466.

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