Many women experience headaches that seem to follow a pattern: often appearing right before or during their period, as well as around ovulation time. These are known as menstrual migraines or hormonal headaches (HA), and they’re more common than you might think.
While hormones are a key trigger, there’s often much more going on beneath the surface, and physiotherapy can play an important role in managing them.
While medication is often part of migraine management, physiotherapy can play a powerful role too, especially through targeted treatment approaches such as the Watson Headache® Approach.
What Are Menstrual or Hormonal Headaches?
Menstrual migraines are headaches linked to fluctuations in oestrogen and progesterone levels, particularly the drop in oestrogen that occurs in the days leading up to menstruation. These hormonal shifts can affect the brainstem and pain sensitivity, leading to migraine-type headaches.
Typical symptoms include:
- Throbbing or stabbing-like, one-sided head pain, typically presenting behind or around one eye/ unilateral
- Sensitivity to light and sound (Phono or Photophobia)
- Nausea or vomiting
- Neck or shoulder tension
- Fatigue, dizziness, or brain fog
- Visual disturbances
These headaches can last anywhere from a few hours to several days, making everyday life and exercise routines difficult.
The Neck–Headache Connection
Recent research has shown that the upper neck (cervical spine) plays a significant role in many types of headaches, including hormonal migraines. The nerves from the upper cervical spine (especially C1–C3) communicate closely with the trigeminal nucleus, the same brainstem area involved in migraine pain. If the neck joints or muscles are stiff or irritated, they can heighten sensitivity in this shared pathway, making it easier for hormonal changes to trigger a migraine.
How the Watson Headache® Approach Helps
Developed by Australian physiotherapist Dean Watson, the Watson Headache® Approach is a specific, manual therapy technique that aims to:
- Identify if your upper cervical spine is contributing to your migraine
- Reproduce and then relieve your headache symptoms during assessment
- Restore normal movement and function in the neck
- Reduce sensitivity in the brainstem (the “headache control centre”)
During treatment, your physiotherapist gently tests and mobilises specific neck segments while monitoring your symptoms. If your headache or familiar symptoms are reproduced and then eased, it confirms the neck’s involvement.
Over time, restoring normal cervical function can reduce the frequency, intensity, and severity of migraine episodes, even when hormones fluctuate.
What to Expect in a Physiotherapy Session
At your first appointment, your physiotherapist will take a detailed history, including when your migraines occur, any hormonal patterns, and your neck or posture concerns.
Assessment includes:
- Posture and movement analysis
- Palpation of the upper cervical joints
- Testing for reproduction and easing of familiar symptoms
Treatment may include:
- The Watson Headache® Approach
- Gentle manual therapy and soft tissue techniques
- Postural retraining
- Exercises to restore neck strength and mobility
- Education on headache management and triggers
A Holistic Approach to Migraine Management
While hormones may be the trigger, addressing the neck’s contribution to migraine sensitivity can help reduce the overall load on your system. Combined with good sleep, hydration, stress management, and medical guidance, physiotherapy provides a non-invasive and effective way to help manage hormonal migraines.
If you experience migraines that worsen around your menstrual cycle or hormonal changes, one of our HNJ physiotherapists trained in the Watson Headache® Approach can assess whether your neck is contributing to your migraines and help you find lasting relief. Book an appointment today.
Lisa Eisfeld is a trained physiotherapist from Germany. She has also studied advanced Manual therapy and finished her Osteopathy Diploma in 2018 at the School for Manual Medicine Berlin. Lisa has also attained her Watson Headache Institute Level 1 Foundation and Level 2 Consolidation courses. Read more about Lisa.