Neck, Headache & Migraine Physiotherapy In Toronto

Neck, Headache & Migraine Physiotherapy

Migraine attacks and the neck are often related.  There is a link between the cervical spine (neck) and a sensitized brainstem (the commonly accepted condition associated with migraine).  If you have migraine attacks, persistent headaches, or a neck issue that just isn’t changing, come in for an assessment!


Headache & migraine physiotherapy treatments may be covered by your work or private insurance plans.

Click HERE to learn more from Keith about his approach to treating headache, migraine & complex neck issues. Book a free phone or in-person consultation with Keith if you have questions.


Conditions Treated

What is a cervicogenic headache?

Cervicogenic Headache is a headache originating from neck structure and is classified as a secondary headache. Cervicogenic headaches are usually caused by weakness of neck muscles or arthritis or lack of mobility of neck spinal joints or poor posture. Cervicogenic headaches are common after motor vehicle accident injuries or after injuries involving neck, upper back and head such as work related injuries.

Is my neck causing my headache?

Neck pain can sometimes contribute to headaches, especially tension headaches. If you’ve been experiencing discomfort or stiffness in your neck and it coincides with your headaches, it’s possible they’re connected. Poor posture, stress, muscle strain, or underlying issues like cervical spine problems could all be culprits. It might be worth consulting a healthcare professional to assess the situation, especially if the headaches persist or worsen.

Can Migraine headache be caused by neck problem?

Absolutely, neck problems can trigger migraine headaches. There’s a strong connection between the cervical spine (neck) and migraines. Issues like poor posture, muscle tension, or cervical spine abnormalities can contribute to migraines or tension-type headaches. This is referred to as cervicogenic headaches, where pain from the neck radiates and causes headaches.

The nerves in the neck are closely connected to the nerves that contribute to headaches, so problems like muscle tightness, joint dysfunction, or nerve irritation in the neck can lead to headaches. Addressing neck issues through physical therapy, posture correction, exercise, and sometimes medication can help manage or alleviate migraines triggered by neck problems. Consulting a healthcare professional can provide guidance tailored to your specific situation.

Do physiotherapists treat cervicogenic headaches?

Yes, physiotherapists often treat cervicogenic headaches. They specialize in assessing and treating musculoskeletal conditions, including issues related to the neck that may cause headaches. Physiotherapy for cervicogenic headaches typically involves a combination of techniques. The aim of physiotherapy in treating cervicogenic headaches is to address the underlying neck issues to reduce pain, improve function, and prevent recurrence. It’s essential to consult a healthcare professional to determine the specific cause of your headaches and receive appropriate treatment.

What causes Migraine?

Migraine pathology shows a sensitized brainstem.  This is in people with persistent migraine, even interictally (between migraine attacks).  This has been shown scientifically.  Some believe there is a genetic relationship as well, and there is a 3:1 dominance of migraine in women vs. men.  Migraine is a leading cause of disability in the world.  

But it is not treated homogeneously, there are many people still not receiving good care, that is, their symptoms are not controlled.  Research continues in the medical and physiotherapeutic fields, and is found in several scientific publications.

There are many common triggers for migraine (not to be confused with causes).  These include changes in the barometric pressure, ambient temperature, noise, bright lights, stress, lots of time at a computer, poor sleep, a relation to the menstrual cycle, physical exertion especially at the shoulders, cardiovascular exertion, some types of foods, alcohol, caffeine, certain perfumes or incense, and the list goes on.  

Migraine does often start before the person is 10 years of age, and can often evolve, and last for many decades of life.  Sometimes it pauses during pregnancy, sometimes it has started during pregnancy.  The triggers above can be exacerbating, people with migraine often live very carefully, trying not to trigger a migraine attack, or at least to keep the frequency of attacks lower.  You can see from the triggers above, that one can easily enter a vicious cycle of stress (often correlated with increased screen time)-poor sleep-altered diet and caffeine intake-less exercise.  

But it’s not as simple as keeping the above on track – often clients have a predisposition to persistent migraine by the structures of their upper neck.  

For more on this, please explore further down!

How can Physiotherapy help Migraine?

Physiotherapists with experience assessing and treating (and perhaps experiencing migraine) can help by being empathetic towards the person with migraine.  It is a lot to deal with, a truly emotionally challenging condition.  It’s not an injury, it’s a condition.  But have hope, it is a condition we can manage very well!  It’s important to know that there are support / information groups that can provide help:

Canadian Migraine Society– speak with Maya Carvalho, she heads it.  It is a Facebook group, Canada-wide, that is run by the clients themselves, it is, client centred.  Check them on Instagram as well for regular supportive messaging.

Migraine Canada– a non-profit organization, with medical and pharmaceutical ties, that can be a helpful place to peruse to find out the latest on pharmacological treatments.

Getting back to how Physiotherapy can help:

Yes, empathy is the starting point.  Then, an understanding of the pathophysiology, combined with your specific triggers and goals, can lead to a movement / posture / manual therapy program to help you improve your state.  The biggest part of the physical intervention is the examination and treatment of the cervical spine.  This is where training comes in, and experience.  The ability to check the joints and muscles of the neck, the movement, and skillfully examine the structures of the neck that are drivers of head and facial pain.  Treatment naturally follows, and the pressure applied should be gentle, relieving and productive in that sense.  Not a case where you need to aggressively pressurize the neck or a case where you have to get worse before you get better.

With regular follow up appointments, we track the metrics of your migraine (frequency, intensity, duration), response to medication, response to triggers, positioning of the joints of the neck and tension in the muscles, as well as concurrently guide you on secondary supports including posture, ergonomics, what exercises to do or not do and at what level, tips on how to improve sleep, diet, hydration and stress management, when appropriate.

What is the Watson Headache® Approach?

Named by and after Dean H. Watson, Ph.D, and APA titled Musculoskeletal Physiotherapist. Dr. Watson started the Watson Headache Institute, treating clients, and is an educator world-wide in his approach. His goal is to help those with migraine, wanting each client to have access to a skilled manual therapy examination to determine the relevancy of the cervical spine in their case and to have proper treatment.  

The Watson Headache® Approach is the only manual cervical approach scientifically validated to diminish the underlying disorder in migraine, a sensitized brainstem.  Please see www.watsonheadache.com for scientific references and videos and FAQ’s on the topic.

It has been taught to Physiotherapists, Chiropractors and Osteopaths and there are practitioners in over 25 countries.  Keith Fernandes is the only Watson Headache® Certified Practitioner currently in Canada.  He graduated with an honour’s degree in Kinesiology in 2000 from the University of Waterloo, and then earned a bachelor’s degree in Physiotherapy in 2005 at Queen’s University.  He studied in Spain, Italy, and Australia to develop his Watson Headache® Approach expertise. 

How many visits do I need for my headache or migraine treatments?

On assessment, which takes 1 hour, we determine the relevancy of the neck to your situation.  As described earlier, we analyze the metrics of your migraine, how it is affecting you, prior treatment with its response, review your medical history, and do some physical testing, to first ensure that you do not have signs that may indicate a need for medical assessment or a scan for example.  We are trained in seeing the signs of this.  Safety is paramount.

Trial treatments are done on day one, and then typically, 2 appointments the following week and then weekly appointments thereafter are advised.  1-2 visits can be enough to see a change in the neck and sometimes a response with the migraine.  4-5 sessions are needed to get a good sense of the efficacy of the Watson Headache® Approach with you.  

Often, there are further sessions, weekly or larger intervals, to help at the neck and see how you respond to triggers (for example the upcoming menstrual cycle, or the long plane trip, or the busy work week, etc.)  

Other sessions may include treatment of areas of the body that may be influencing the neck (the jaw, upper or lower back, shoulder) for example.  These are assessed and treated with a skill set that includes various treatments which may include exercise, acupuncture, manual therapy, cupping, and taping for example.

Often just 1-2 sessions is enough for the patient to get a good sense of if this approach is appropriate, and well-timed for them.  

How do you treat pinched nerves or disc issues at the neck?

This is a common reason for a Physiotherapy consultation.  Typically it is well treated and quickly.  The Mechanical Diagnosis and Therapy (M.D.T.) approach is used (see www.mckenziemdt.org for more information).  This is a post-graduate PT approach used world-wide.  

Disc pressure can lead to symptoms to the shoulder or bottom of the shoulder blade or chest, and “pinched nerves”, or impingement of nerves, can lead to symptoms down the arm to the hand.  

Addressed first by a comprehensive 1 hour assessment.  We examine lifestyle, posture, movements, strength as provided by the muscles supplied by the nerves of the neck, comparing both sides.

Treatment is non-invasive, involving postural change and certain neck or thorax movements (that we intend on seeing improvement on in the first visit).  Often there is manual therapy added as well to further assess and treat joints that need to be mobilized to release pressure on pain producing structures of the neck.  This is typically very well tolerated.  Note, I do not perform manipulations or high velocity thrust “cracking” of the neck joints.

To maintain benefits of in clinic treatment, I always address posture, showing you where it can be improved, to reduce what is often a causative factor for the pathology and pain.  Postural supports may be advised, options and details on what to get and where to get it, exercises, what to do and what not to do to facilitate a progressive and quick recovery.  I always follow the assessment with an email to you reviewing any exercises and advice.

With your consent, I fax my consultation and plan to any medical provider you have, to ensure continuity of care.  Follow up appointments are typically once per week.

I have been a credentialed provider of Mechanical Diagnosis and Treatment, from the McKenzie Institute Canada, since 2011.

Neck, Headache & Migraine Physiotherapy at Physiomobility in Toronto, the difference

The difference is in the training & collaborative approach to treatment.  Keith Fernandes is a registered physiotherapist who has exclusive interest in treating headaches & migraines originating from neck as well as complex neck related pain & radiation.

What Keith says about his approach to treating headache, migraine & complex neck related pain conditions:

“As a Physiotherapist, I have years of intentional work and study (including professional examination) on headache and migraine to provide warm, effective and efficient care.  It’s my exclusive professional focus!

✔️ A Watson Headache® Certified Practitioner

✔️ Credentialed in Mechanical Diagnosis and Therapy (M.D.T.), with the McKenzie Institute Canada

I have also earned certification in ergonomic analysis, am a student of diverse movement arts, and am a trained yoga teacher.  Acupuncture, cupping and postural analysis and correction are well-honed skills.  I take pride in helping people propitiously and believe that this is only possible when treating the correct area, with the appropriate intensity.  

I am an adjunct lecturer with the Department of Physical Therapy, at the University of Toronto and have mentored and managed students and healthcare practitioners for over 20 years.  I am also an assessor for the Quality Assurance program of the College of Physiotherapists of Ontario.

Our practitioners also work in collaboration when needed.  If your migraine situation involves a vestibular component that would benefit from Vestibular Rehabilitation Therapy, I will address this quickly and arrange for a consultation in-house.  I also integrate care with Registered Massage Therapists, Licensed Acupuncturist and Licensed Chiropractor, depending on your needs and preferences.”



Keith Fernandes, Registered Physiotherapist

Watson Headache® Certified Practitioner

Credentialled in Mechanical Diagnosis and Therapy

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Physiomobility continues to remain open and is not part of the lockdown. We continue to have rigorous disinfection policies and procedures in place to ensure the safety of our community and are open for patient in-person visits with all of our practitioners.

Virtual appointments are available and encouraged for those who are at a heightened risk of illness.

We remain focused on our quality of care & our continued commitment to helping our patients feel their best. For further assistance, you can contact us at 416-444-4800 during our opening hours. 

The Physiomobility Team