Evidence-Based Care at Vantage Point in Bondi Junction
Physiotherapy for Headache and Migraine
Many headaches have a contributor we can assess and treat: the upper neck, the jaw, or a nervous system that has become sensitised. We find out what is driving yours, explain our reasoning, and build a plan around the research and around you.
- APA Musculoskeletal Physiotherapists
- Our physiotherapists are trained in the Watson Headache® Approach
- No referral needed
- Private health rebates on the spot
Headache profiles
Which best describes your headaches?
Headaches present in distinct ways, and each profile points to different drivers and a different starting point for treatment. Select the one closest to yours.
Headaches Triggered by Neck Influences
Headaches that start at the base of the skull or in the neck, usually on one side, and build with neck movement, sustained postures or long periods at a screen.
You might notice
- Headache starting at the base of the skull
- Usually on one side, sometimes spreading behind the eye
- Brought on or eased by neck movement or position
What is usually happening
The top three neck nerves meet the nerve that supplies the head and face in a region of the brainstem called the trigeminocervical nucleus. That shared wiring is why an irritated upper neck joint can be felt as a headache at the temple or behind the eye.
Common causes
Cervicogenic headache
Headache referred from the upper three neck joints, and one of the headache types with the strongest physiotherapy evidence. In a randomised trial, manual therapy and exercise reduced headache frequency and intensity, with effects maintained at 12 months (Jull et al., 2002).
Neck involvement in other headaches
The upper neck can also feed into migraine and tension-type headache without being the only cause, so we test it in every headache assessment.
What we look at in your assessment
The flexion-rotation test, which identified upper neck related headache with 91% sensitivity and 90% specificity in a blinded study (Ogince et al., 2007), and upper cervical assessment using the Watson Headache® Approach to test whether the upper neck reproduces and eases your familiar headache, plus deep neck flexor control.
How treatment usually starts
Manual therapy to the upper neck joints, deep neck flexor and upper back exercise, and adjustments to the loads that build your headaches.
Related services
Pressure-Like Headaches Around the Head
A band-like pressure or tightness across the forehead, temples or back of the head, usually on both sides, that builds through the day rather than striking suddenly.
You might notice
- Tightness or pressure on both sides of the head
- Tender muscles in the neck, shoulders or scalp
- Worse with stress, poor sleep or long days at a screen
What is usually happening
Tension-type headache is the most common headache worldwide. Increased tenderness in the muscles around the head and neck is a consistent finding, and when headaches become frequent, the nervous system's pain processing can become more sensitive. That is why sleep, stress and workload matter as much as the neck itself.
Common causes
Episodic tension-type headache
Headaches on fewer than 15 days a month, often linked to stress, sleep and workload.
Chronic tension-type headache
Headaches on 15 or more days a month for more than three months. In this group, a physiotherapist-led manual therapy programme reduced headache days more than usual GP care at both 8 and 26 weeks (Castien et al., 2011).
What we look at in your assessment
Neck and shoulder movement, muscle tenderness and endurance, the flexion-rotation test to check whether the upper neck is also involved, and a look at sleep, stress and workload.
How treatment usually starts
Manual therapy and soft tissue work to settle sensitive muscles, graded neck and upper back exercise, and practical strategies for workload, sleep and stress.
Related services
Migraine with Neck Involvement
Recurrent, often one-sided headaches with nausea or sensitivity to light and sound, sometimes with visual aura, where neck pain or stiffness comes before or during attacks.
You might notice
- Neck pain or stiffness before or during a migraine
- Nausea or sensitivity to light, sound or smell
- Attacks lasting hours to days, with or without aura
What is usually happening
Migraine is a neurological condition, so the neck is rarely its cause. But neck pain is one of the most common migraine symptoms, reported more often than nausea (Calhoun et al., 2010), because the neck and head share the trigeminocervical pathway. A sensitive neck can lower the threshold for attacks, and attacks can sensitise the neck.
Common causes
Migraine with or without aura
A neurological headache disorder managed by your GP or neurologist. Physiotherapy complements medical care rather than replacing it.
Neck pain associated with migraine
Where the neck acts as a trigger or amplifier, treating it may help. Regular aerobic exercise has also been shown to reduce migraine frequency, comparably to relaxation training or preventive medication in one trial (Varkey et al., 2011).
What we look at in your assessment
Your headache history and diary, screening for features that need medical review, neck movement and the flexion-rotation test, and upper cervical assessment to see whether the neck reproduces any part of your symptoms.
How treatment usually starts
Gentle upper neck treatment where it is contributing, a graded aerobic exercise plan, and coordination with your GP or neurologist. A sudden, severe headache unlike any before needs urgent medical care first.
Related services
Headaches Linked to the Jaw
Headaches at the temples or around the ear that come with jaw aching, clicking or tightness, often worse after clenching, chewing or a stressful day.
You might notice
- Temple headaches with jaw ache or tiredness
- Clicking, locking or limited jaw opening
- Clenching or grinding, especially at night
What is usually happening
The chewing muscles, the jaw joint and the upper neck all feed into the trigeminal system. Sustained clenching loads the temporalis muscle, which can refer pain to the temple, and jaw disorders and headache commonly occur together. The international headache classification recognises headache attributed to temporomandibular disorder as its own diagnosis.
Common causes
Headache attributed to TMD
Temple or ear-area headache that changes with jaw movement or clenching, often alongside jaw pain.
Clenching and grinding (bruxism)
Daytime and night-time clenching loads the jaw and neck muscles. We work alongside your dentist where a splint is involved.
What we look at in your assessment
Jaw opening and movement, the chewing muscles, whether jaw movement or pressure reproduces your headache, and the upper neck, since the two are often involved together.
How treatment usually starts
Jaw and neck manual therapy, retraining of opening and chewing patterns, and strategies for daytime clenching, coordinated with your dentist.
Related services
Headaches with Dizziness or Vertigo
Dizziness, vertigo or unsteadiness that comes with headaches, or episodes of dizziness in someone with a history of migraine, even without a headache at the time.
You might notice
- Dizziness or vertigo during or between headaches
- Motion sensitivity, such as feeling worse in busy places
- Sensitivity to light or sound during dizzy spells
What is usually happening
Vestibular migraine is a migraine disorder in which the brain's processing of balance information is affected, rather than the inner ear itself. It has defined diagnostic criteria (Lempert et al., 2022) and is a common cause of recurrent vertigo. Neck-related dizziness and BPPV can look similar, so careful testing matters.
Common causes
Vestibular migraine
Episodes of vertigo or dizziness linked to migraine, managed alongside your GP or neurologist, with vestibular rehabilitation for ongoing motion sensitivity.
Neck-related dizziness
Unsteadiness that tracks neck pain or stiffness, which can coexist with headache. Our neck pain page explains this profile in more detail.
What we look at in your assessment
Positional testing to rule out BPPV, eye movement and balance testing, joint position sense and smooth pursuit neck torsion testing, and your headache and dizziness history.
How treatment usually starts
Vestibular rehabilitation for motion sensitivity and balance, neck treatment where it contributes, and coordination with your GP or neurologist on migraine management.
Related services
Headaches After a Head Knock or Car Accident
Headaches that began after a concussion, fall, sporting knock or car accident, sometimes with neck pain, dizziness or fogginess.
You might notice
- Headache that started after the injury
- Neck pain or stiffness alongside the headache
- Fogginess, fatigue or symptoms worse with screens or exercise
What is usually happening
Headache is the most common symptom after concussion, and the same forces often strain the upper neck, so post-traumatic headache can come from the brain, the neck or both. The international consensus statement on concussion in sport (Patricios et al., 2023) recommends neck and vestibular rehabilitation when dizziness, neck pain or headaches persist for more than 10 days.
Common causes
Post-traumatic headache
Headache developing within seven days of a head injury. It settles for most people but persists for some, and a coordinated plan helps when it does.
Whiplash-related headache
Headache driven by injury to the upper neck joints and muscles after a car accident. We accept CTP claims.
What we look at in your assessment
Concussion symptom screening, a cervical spine examination including the flexion-rotation test, eye movement and vestibular testing, and exercise tolerance testing where appropriate.
How treatment usually starts
A graded return to activity, neck rehabilitation, and eye movement and balance exercises, coordinated with your doctor. If symptoms are worsening after a head injury, see a doctor urgently first.
Related services
Our approach
Four principles behind every assessment
Headaches can involve the neck, jaw, nervous system and balance systems at once. These are the standards we hold ourselves to when making sense of yours.
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Advanced Clinical Training
Led by APA Musculoskeletal Physiotherapists, a title held by fewer than 5% of physiotherapists in Australia, with our physiotherapists also trained in the Watson Headache® Approach.
Why it matters: master's-level training and peer-assessed clinical reasoning, which counts most when headaches are complex or have not responded to previous treatment.
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Experience Beyond the Clinic
Our team brings more than 30 years of combined clinical experience across semi-professional AFL, rugby union, basketball, swimming and triathlon, and we are proud sponsors of Dunbar Rovers Football Club and Maccabi Basketball Club.
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Backed by Evidence
We test upper neck involvement with the flexion-rotation test and the Watson Headache® Approach, and use VALD DynaMo strength testing where relevant, so your progress is tracked in numbers. Where research supports a claim on this page, we name it.
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Connected Care
Neck, jaw, vestibular and tinnitus care sit alongside our headache care, and we work with your GP, neurologist, dentist and other specialists when your care needs it.
Your recovery journey
A Confident Recovery Comes from a Clear Management Plan
Some people move through this in two weeks, others take twelve or more. You move to the next stage when you reach its goal, not after a set number of sessions, and visits usually spread out as you become more independent. Everyone recovers differently, so timeframes and outcomes vary.
Why combine hands-on care with exercise? For cervicogenic headache, a randomised trial found manual therapy and exercise together reduced headache frequency and intensity, with effects maintained at 12 months (Jull et al., 2002).
Stage 1: Your First Visit
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A
Initial Consult
We start with your story: when your headaches began, how often they occur, what triggers and eases them, and screening questions to rule out anything that needs a doctor first. A headache diary beforehand helps.
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B
Assessment and Treatment
A thorough examination of the neck, jaw and nervous system, including the flexion-rotation test and the Watson Headache® Approach, followed by treatment where it will help from day one.
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C
Management Plan
We explain what is driving your headaches and how long recovery typically takes for a presentation like yours, then give you a written plan with clear goals.
Goal: A clear diagnosis and plan
Subsequent sessions
Over the following weeks, you move through each stage as you reach its goal.
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2
Stage 2
Settle
Manual therapy to the upper neck and jaw, and changes to the loads that build your headaches, to calm a sensitised system.
Goal: Headaches easing and less easily triggered
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3
Stage 3
Restore
Rebuild upper neck movement and deep neck flexor control, tracked with pressure biofeedback so you can see your progress.
Goal: Improved neck movement and control
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4
Stage 4
Strengthen
Progressive neck and upper back strength and graded aerobic exercise, with a return to full work, screen and training loads.
Goal: Returning to your usual work, screens and training
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5
Stage 5
Self-Management
Visits taper as you take over, with a maintenance routine and a written flare-up plan so you know exactly what to do if headaches return.
Goal: Managing independently, with a plan for flare-ups
Fees and funding
Consultations and Rebates
All consultations are 45 minutes, whether it is your first visit or a follow-up, so there is time to assess, treat and explain at every session.
Book a Headache AssessmentWays to claim
- Private health: rebates claimed on the spot with HICAPS
- Medicare: rebates with a GP referral
- Workers compensation: fees set by SIRA
- CTP: fees set by SIRA
Common questions
Can physiotherapy help migraines?
Physiotherapy does not cure migraine, which is a neurological condition managed by your GP or neurologist. It can help where the neck is a trigger or amplifier, and one trial found regular aerobic exercise reduced migraine frequency about as much as relaxation training or preventive medication (Varkey et al., 2011). We assess whether your neck is involved and coordinate with your doctor.
How do I know if my headache is coming from my neck?
Clues include headaches that start at the base of the skull, sit mainly on one side, and change with neck movement or sustained postures. The clearest sign is when examining the upper neck reproduces your familiar headache and then eases it, which is what our assessment tests.
When should I see a doctor about a headache?
See a doctor urgently for a sudden, severe headache unlike any before, a headache with fever and neck stiffness, new weakness, numbness, confusion or speech changes, or a headache that is worsening after a head injury. A new headache pattern after 50, or one that is steadily changing, also needs medical review.
Do I need a scan for my headaches?
Usually not. Most headaches are diagnosed from your history and examination, and scans rarely change management unless there are specific warning signs. Your GP or specialist decides when imaging is needed.
What is the Watson Headache® Approach?
It is an assessment and treatment method developed by Australian physiotherapist Dean Watson, which examines whether the upper neck is reproducing and maintaining your headache. Our physiotherapists have completed training in the approach and use it alongside other clinical tests.
Should I keep a headache diary?
Yes. Recording when headaches start, how long they last, what you were doing and what helped gives us a clear picture of your pattern, and lets us track change objectively over your care.
Can screen time or my desk setup cause headaches?
Rarely on their own. Long periods in any position load the neck and jaw, and eye strain and stress add to it. Regular breaks, a stronger neck and attention to sleep and workload tend to do more than a perfect setup.
How many sessions will I need?
It depends on your headache type, how long you have had it and what is driving it. We give you an estimate at your first visit and review it as you progress through each stage.
Do I need a referral?
No. You only need a GP referral to claim a Medicare rebate. Workers compensation and CTP claims need a claim number, and fees are set by SIRA.
How soon can I get an appointment?
You can book online at any time and see live availability for each physiotherapist. If you cannot find a time that suits, call us on (02) 8528 2985 and we will do our best to fit you in. We are open Monday to Thursday 8am to 6pm, and Friday 8am to 5pm.
What research is this page based on?
The studies, diagnostic criteria and consensus statements referenced on this page are listed below.
- Calhoun AH, Ford S, Millen C, Finkel AG, Truong Y, Nie Y. The prevalence of neck pain in migraine. Headache. 2010;50(8):1273–1277.
- Castien RF, van der Windt DAWM, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: a pragmatic, randomised, clinical trial. Cephalalgia. 2011;31(2):133–143.
- Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835–1843.
- Lempert T, Olesen J, Furman J, et al. Vestibular migraine: diagnostic criteria. J Vestib Res. 2022;32(1):1–6.
- Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther. 2007;12(3):256–262.
- Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695–711.
- Varkey E, Cider Å, Carlsson J, Linde M. Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls. Cephalalgia. 2011;31(14):1428–1438.
Clinically reviewed by David Cohen and Zachary Ehrenfeld, APA Titled Musculoskeletal Physiotherapists and Directors of Vantage Point Physiotherapy. Last reviewed October 2026.
