Headaches are extremely common, and most of us have experienced them at numerous times in our lives.  Headaches are often fleeting, mild, or inconsequential and require no significant medical attention.  But sometimes they are long-lasting or frequent, intense, and life-altering. These types of headaches require some form of medical attention and diagnosis.

A good physical therapist can help to determine the source(s) of your tension headache by performing a thorough examination and making a plan to address it.  This plan may include corrective exercise to stretch or strengthen muscles, ergonomic assessment of your workplace or home environment, hands-on manual therapy (soft tissue or instrument-assisted soft tissue mobilization, joint mobilization, trigger point dry needling, myofascial release, cupping, etc.), or modalities (Class IV laser, heat, ice, electrical stimulation, cold laser, or ultrasound).  If PT alone does not provide adequate relief of your tension headache, massage therapy may be suggested.

In the event your headache does not present as a tension headache, your therapist or medical provider will work to accurately diagnose and develop a plan.  This may include a referral to your primary care physician, neurologist, optometrist, or dentist.  Another common type of headache is a post-traumatic or concussion-induced headache.  Here at Rebound, we have therapists who specialize in concussion management to address these symptoms and speed recovery.

Contact us today to get started on a treatment plan to improve your quality of life!


*Check out our Concussion Management and Ergonimics pages to learn more about treatment options.*


Types of Headaches


Primary headaches (stable pattern over many months or years)

  • Long-standing history
  • Family history of similar headaches
  • Normal physical exam
  • Headaches consistently triggered by:
    • Hormonal cycle
    • Specific foods
    • Specific sensory input
    • Weather changes


  • Infrequent: minutes to 7 days, less than 12 episodes per year
  • Frequent: minutes to 7 days, 1-14 episodes per month
  • Chronic: hours or continuous, may be accompanied by mild nausea, average 15 episodes per month
  • “Tight” sensation around head, typically front or back of the head, mostly constant in nature
  • Symptoms may overlap with migraine-type headaches
  • Cervical muscle tension, often with trigger points in upper trap, levator, sub-occipitals
  • Contributing factors: poor posture, poor ergonomics, cervicogenic conditions, stress, anxiety, depression


  • Usually begin on one side of the head as pulsing, throbbing pain and may shift sides or affect whole head
  • May last 4 hours to 3 days
  • May be sensitive to light, sound, smell, and physical movement/activity
  • Affects 12% of U.S. population, women 3x more than men, has hereditary component
  • Other symptoms: Nausea/vomiting, sweating/chills, pallor, dizziness, blurred vision, loss of appetite, tender scalp, fatigue; in rare cases, diarrhea or fever
  • May be preceded by fatigue, mood changes, increased thirst, food cravings, or neck stiffness/pain
  • Triggers may be stress, too much caffeine or caffeine withdrawal, hypersensitivity or over-stimulation with respect to light/foods/smells/noises, overexertion, missing meals, medications
  • May be accompanied by an aura (disturbed or distorted vision)
  • Co-morbid with obesity


  • Occur in clusters, or cyclical patterns, excruciating pain
  • Sudden onset, may last 15 minutes to 3 hours, then disappears suddenly but causes exertion/fatigue
  • Often awake at night with pain around one eye or one side of the head
  • Cluster periods can last weeks or months, followed by remission for months or years
  • May have eye redness, eye swelling, tearing, runny/stuffy nose, or sweating on the affected side
  • May be accompanied by migraine-type symptoms, including sensitivity to light, etc.
  • More common in men ages 20-50, smokers, or hereditary


Secondary headaches (caused by another condition)

  • First or worst headache of your life.
  • Abrupt onset of headache without any warning or build-up.
  • Fundamental change in the pattern of recurrent headaches
  • Headache beginning at unusual ages.
  • ≤5 years old.
  • ≥50 years old.
  • The presence of cancer, HIV, pregnancy.
  • Abnormal physical exam.
  • Headache onset:
    • with seizure or syncope
    • with exertion, sex or Valsalva (squeezing)


  • Pain, pressure, fullness in the face and head
  • Worsens with bending forward or lying down
  • Stuffy nose
  • Fatigue


  • Occur quickly after intense physical activity due rapid increase in blood flow to the skull
  • Important to warm-up prior to increasing intensity of exercise, monitor
  • Can be a warning sign/symptom of something more sinister (see “Other Secondary Headaches” below)


  • Myth: Induced by working or being treated at Rebound Sports & Physical Therapy
  • Medication-induced, typically overuse of OTC pain medications


  • Typically females and due to menstruation, birth control, or pregnancy


  • Pulsating
  • Worse with activity
  • Usually occurs on both sides of the head
  • May be accompanied by changes in vision, N&T, chest pain, nose bleeds, or SOB

Caffeine, other stimulants

  • Occurs due to withdrawal


  • Occur after a head injury
  • May feel similar to tension or migraine headache
  • May last 6-12 months

Other secondary headaches

  • Pressure from tight-fitting head gear
  • Thunderclap
    • Striking, sudden onset
    • Peak within 60 seconds
    • May be accompanied by nausea or vomiting, altered mental state, fever, seizure, or other neurologic/systemic S&S
    • May be a sign of brain aneurysm, subarachnoid hemorrhage, CSF leak, infection such as encephalitis or meningitis, ischemic stroke, hypertensive crisis

Jared Smiddy, PT, MSPT



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