Headaches are a common source of pain and disability with total costs estimated over 30 billion dollars per year. Patients’ signs and symptoms help classify headaches into categories including migraine, tension type, cluster, and cervicogenic but some are found to be multifactorial in nature. Some of the most effective interventions for headache are provided by Physical Therapists including manual therapy and exercise. These combined treatments have been shown to be more cost and clinically effective than primary care management, exercise alone, and modalities in the short and long term. Specifically, a manual therapy and exercise approach has been shown to be 1/3 the cost of standard physical therapy and primary care management. A recent review of the evidence highlights the impact of these interventions on a patient’s quality of life.

Authors reviewed the available evidence on the impact of manual therapy on various headache types (Falsiroli Maistrello et al. Curr Pain Headache Rep. 2019). They included 7 randomized controlled trials in their systematic review and meta analysis. Consistent with previous research they found a significant impact of manual therapy, including spinal manipulation by Physical Therapists, immediately after treatment and at short and long term follow up. Authors concluded “manual therapy should be considered as an effective approach in improving quality of life” in patients with headache including tension and migraine.

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