Headache and Migraine Specialists

Headache &
Migraine Specialists

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Call us on 0844 264 0305

How Do We Work?

By involving both musculoskeletal and medical consultants specialising in headache and migraine we are able to provide a more comprehensive diagnosis and treatment strategy for our patients. Our unique approach has already provided significant or complete relief for over 80% of our patients.

Treatment Process

Screening for Serious Causes of Headache

BrainBefore our patients are examined they are required to participate in a simple screening process over the phone. This enables us to decide immediately what will be the most appropriate course of action for each individual. The vast majority of patients will then come straight away for a consultation with one of our specially trained headache physiotherapists. Around 5% are more appropriate for an immediate medical, rather than musculoskeletal, consultation and are offered a referral to a Consultant Neurologist conveniently located to where you live or simply advised to review things with your GP.

Very rarely are patients advised to go straight to A&E for immediate medical attention but this does happen which is why it is important that you complete this triage as early in the process as possible.

Musculoskeletal Examination & Treatment

ManipulationA specially trained headache and migraine physiotherapist will look at all aspects of your clinical and lifestyle issues. The aim is to marry how your headaches behave with various clinical tests that tell us whether or not your headache is coming, at least in part, from your neck. We are usually able to temporarily reproduce our patients’ head pain by stressing certain tissues in the neck and this is one of the key diagnostic criteria set by the International Headache Society (HIS) to differentiate cervicogenic headache from other types of head pain. This does not mean that you might not have migraine or tension type headache as well. Most headache sufferers have more than one type of headache which overlap each other.

For those patients with cervicogenic headaches, once the exact areas of neck dysfunction have been confirmed, carefully applied, gentle manipulation of any stiff spinal segments is used to ease the symptoms and most patients find that generally their pattern of headaches starts to change very quickly.

Training Your Spine to Work in a Normal Way Again

Postural Correction

As well as having stiff areas, patients often have some neck segments that are relatively flexible so that their habitual postures and general neck movements are then biased toward certain segments of the neck  causing uneven stress and strain. We often see people with headaches who are hypermobile (very loose joints) who are more susceptible to postural problems.

Teaching patients to hold their posture correctly and how to move the spine in a more efficient, ‘normal’ way rather than just through the path of least resistance or where gravity chooses, is vital in order that improvements in spinal health that are gained with manipulative therapy are then maintained.

Postural Re-education and Ergonomics


The majority of us have desk jobs and spend many hours a day sitting at computers in addition to the social and leisure time also spent sitting down and so our bodies are not doing what ‘mother nature’ intended for the vast majority of most days. It is fair to say that most of us pay little attention to how we hold ourselves and even if we do make an effort to improve posture it is not always done properly. If you add on sleeping time as well where perhaps the pillows we use do not fully support our necks properly, it is easy to imagine how our spinal posture is less than ideal for over 20 hours a day.

Referral for Medical Review

MRIIf on examination there are no relevant disorders to be found in your neck or upper back, treatment (beyond advice) would not necessarily be recommended and we would typically refer you back to your GP or sometimes to a Neurologist as appropriate. We work closely with a network of Consultant Neurologists so that the more serious medical aspects of various types of headaches are also assessed and managed effectively.

Medical examination involves a series of simple neurological tests designed to assess how well the major nerves in your brain are working as well as other standard measures such as taking blood pressure. Sometimes a GP or neurologist will recommend that patients have a brain scan but this is not so common as one might think.

Scans often shows up features that are completely harmless and so instead of giving reassurance they make the patient even more anxious. The general feeling amongst the doctors seems to be that it is best to not ‘over scan’ their patients but to rely on taking a thorough accurate history and undertaking a detailed clinical examination.

Your GP or neurologist will be able to advise you on the best medication to be taking and monitor and adjust this as they see fit according to your feedback on subsequent visits.

Warning: Please ensure that you have consulted a doctor regarding your headache or migraine. Most headaches and migraines are non-life threatening however it is advisable to seek the opinion of your GP or Neurologist if you develop sudden or severe symptoms, especially if these are different from previous attacks.

Screening for Serious Causes of Headaches. Musculoskeletal Examination & Treatment. Several Types of Headache May Overlap. Gentle manipulation of Stiff Spinal Segments can Change Headache Patterns. Posture Education & Ergonomics.

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Headache & Migraine Specialists, 49 Brookside, Hertford, Hertfordshire, SG13 7LJ
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