Headache Relief

Headache treatment questions, answered

These are the practical questions people in North Palm Beach ask us about headaches, from what we treat to what helps between visits. For the longer explanation of how a stiff neck turns into head pain, read The Headache That Starts in Your Neck.

Which headaches do you treat?

Headaches that come from the neck. That means cervicogenic headaches, which are driven by the joints and tissues at the top of the spine, and tension-type headaches, which tend to feel like a tight band around the head. It also means headaches after whiplash or a concussion, once a physician has seen you, and the jaw and posture habits that feed head pain. Plenty of people have a mix of these. The evaluation sorts out how much of yours is coming from the neck before anything is treated.

Do you treat migraines?

Migraine itself, along with its diagnosis and any medication for it, stays with your physician. Our part is the neck, when it is one of the things that sets a migraine off: stiff joints at the top of the spine, tight muscles running from the shoulders into the base of the skull, and long hours held in one position. Tell us what your doctor has diagnosed and what you take. We treat the part that belongs to us and leave your medication plan exactly as your physician set it.

How can I tell if my headache is coming from my neck?

On your own, you can only collect clues. A headache that starts at the base of the skull or on one side, builds through the afternoon, gets worse after a desk day or a long drive on I-95, and eases when you stand up and move makes the neck a suspect, especially with a stiff neck or sore shoulders alongside. Our headache article sets those patterns out in a table. The evaluation is where we check them. If neck pain is the bigger complaint, start with our neck pain treatment page.

What happens at my first visit?

Plan on about an hour, one-on-one with your therapist. We start with your story: when the headaches come, which side, what you were doing beforehand and what helps. Then we watch how your neck moves and measure motion, strength and the positions that bring the pain on. Treatment usually begins the same day. On Episode 10 of Pain 2 Power, Dr. Dave Kashuba, Ph.D., OTR, described the clinic this way: “we try to take each person individually and figure out a game plan for them.” The first visit page covers what to bring.

What does treatment involve?

Usually two parts. First, skilled manual therapy: your therapist finds the stiff or irritable joints at the top of the neck and uses gentle techniques to restore how they move, while easing the muscles guarding around them. Second, the reasons the tension keeps rebuilding. That means strengthening for the deep neck flexors and upper back, plus coaching on your desk setup and the way you sleep. If your jaw is part of the picture, we look at that too. The plan changes as you respond.

What can I do between visits?

Your home program, done the way you were shown. Two staples of our neck programs are on the home exercises page: scapular retractions and shoulder shrugs, three sets of ten, because both work against the forward head posture that keeps the upper neck loaded. The everyday movement list matters just as much. Put the phone down, get up and walk, and stretch before the day starts. Dave is plain about the goal. On Episode 8 he said, “I do everything I can to let people not ever come to see me.”

How many visits will I need?

It depends on what is driving the headaches and how long you have had them. After your evaluation your therapist proposes a visit frequency and honest milestones, then reassesses as you go, so you are never attending sessions you don't need. When the neck is the driver, treating it can reduce how often the headaches come and how hard they hit. Jot down when each headache starts and what you were doing beforehand. A few weeks of those notes lets you and your therapist compare instead of guess.

When does a headache need a doctor first?

Some headaches are emergencies. A sudden, severe headache that feels like the worst of your life needs urgent medical care, and so does one with fever, confusion, vision loss, weakness, numbness or trouble speaking, or one that follows a significant blow to the head. A headache that is new, or different from your usual pattern, should be checked by a physician before therapy. The same goes after a car accident or a concussion: a physician first, and in Florida within 14 days of a crash if personal injury protection is going to pay. Our car accident rehab page explains that rule.

Do I need a referral, and will insurance cover it?

In most cases Florida's direct access law lets you begin a physical therapy evaluation without a physician referral. Some plans still require one for coverage, and Medicare requires a physician to certify your plan of care. Before your first visit our front desk verifies your Medicare or commercial benefits and tells you what your plan needs. After a car accident, physical therapy is follow-up care on your physician's referral. Our 2026 Medicare guide explains deductibles and coinsurance.