Gentle physiotherapy treatment around the head

Headache Treatment in Cologne Esch

Professional physiotherapy for tension headaches and migraines at Martinusstraße 53

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A dull pressure like a band that is too tight around the head, plus a stiff neck: this is how many people describe their tension-type headache. In others, the pain pulls forward from the back of the head on one side. This page explains both forms, names the warning signs and shows what physiotherapy at Praxis Pirnay in Cologne-Esch can do about them – and where its limits lie.

Understanding tension-type headache and headache from the neck

Tension-type headache is considered the most common form of headache. It usually presses on both sides, is mild to moderate and does not get worse with walking or climbing stairs. Nausea is usually absent. Why it occurs is not fully understood. A combination of increased muscle tension in the head and neck and a pain processing that has become more sensitive is suspected.

Cervicogenic headache has a different source: it originates in the cervical spine, above all in the upper vertebral joints and the muscles around them. The nerves of this region converge in the upper cervical spinal cord with fibers of the trigeminal nerve, the nerve for the face and forehead. That is why people often feel the pain in the forehead, the temple or behind the eye. Typical features: always the same side, onset in the neck, worsening with certain head positions.

Both forms can exist side by side, and both have to be told apart from migraine. That classification is made by the doctor. In physiotherapy, we carry out an assessment: how mobile the cervical spine is, which muscles are tender to pressure and which postures bring on the headache.

What favors these headaches

Constant tension in neck and shoulders

If muscles stay tense for hours, they become tender to pressure. This sensitivity at the neck, temples and chewing muscles is often found in tension-type headache.

Upper cervical spine

Irritated or poorly mobile joints between the back of the head and the first neck vertebrae can transfer pain into the head. They are the source in cervicogenic headache.

Head positions held for a long time

Driving, reading in bed, handicrafts or working overhead: if you hold your head in one position for a long time, you load the short neck muscles one-sidedly.

Stress and inner tension

Under pressure, many people raise their shoulders without noticing. Worries and too little sleep can also lower the pain threshold.

Too little counterbalance

Without regular exercise, neck and shoulder muscles lose endurance. They then tire earlier even in everyday postures.

How the two forms feel

Tension-type headache

• Dull, pressing or pulling, not throbbing
• Usually on both sides, like a band or helmet
• Mild to moderate, everyday life remains possible
• No increase when climbing stairs
• Often hardened, tender neck muscles

Headache from the neck (cervicogenic)

• On one side, without switching sides
• Begins in the neck or at the back of the head
• Pulls to the forehead, temple or eye
• Can be brought on by turning the head or by pressure on the upper neck

More typical of migraine

• Pulsating, severe pain
• Nausea or vomiting
• Light and noise are barely tolerated
• Any movement makes it worse

Warning signs: when a headache must first be checked by a doctor

Most headaches are harmless. Some signs, however, point to a serious cause and must be examined by a doctor before any physiotherapy. For the first three points, please call the emergency number 112 immediately. The others belong without delay, if possible on the same day, in a doctor’s office or an emergency department.

Headache that starts suddenly and is the worst you have ever experienced (thunderclap headache).
Headache or sudden neck pain with paralysis, numbness, problems with speech, swallowing or vision, dizziness, a drooping corner of the mouth, confusion or a seizure.
Headache with high fever and a stiff neck, possibly with drowsiness or a skin rash.
Headache after a fall, an accident or a blow to the head, even if it only begins after days or even later – especially when taking blood thinners.
Headache occurring for the first time from around age 50, above all with pain when chewing, a tender temple or vision problems.
Headache that steadily increases, changes markedly, shoots in when coughing or straining, or appears newly in pregnancy, with cancer or with a weakened immune system.

Physiotherapy for tension-type and neck-related headache

Which therapy you receive is stated on the prescription from your doctor (Heilmittelverordnung). If the headache is connected with the neck, the combination of hands-on treatment and active exercises has proven its worth.

Manual therapy

We examine the joints of the upper cervical spine and mobilize them with calm, measured techniques. If pressure at one spot brings on your familiar headache, that is a pointer to the source and the starting point of treatment.

Physiotherapy exercises (Krankengymnastik)

You practice activating the deep neck muscles that hold the head above the spine, and you strengthen the muscles between the shoulder blades. This active part is meant to maintain what has been achieved beyond the series.

Classical massage

For tension-type headache, we work on hardened cords in the neck, the shoulder girdle and at the edge of the back of the head. Many people find this soothing. For lasting improvement, exercises are needed in addition.

Heat with fango (mud packs) or hot air

Heat before treatment loosens the muscles at the neck and shoulders and makes the techniques more pleasant. It is prescribed as a supplement and does not replace the active part of the therapy.

How your treatment in Cologne-Esch works

1
Conversation and assessment
You describe where, how often and during which activities the headache occurs. Then we check mobility of the cervical spine, muscle tension and posture.
2
Setting goals
Together we note what should change, for example fewer headache days or being able to turn your head more freely when backing up the car.
3
Treating and practicing
In the following appointments, we combine techniques at the neck with exercises. You continue two or three of them at home; they are the most important building block between appointments.
4
End of the series
At the end of the prescription, we compare your status with the initial assessment. Whether a further prescription makes sense is decided by your doctor.

What you can do yourself for neck and head

These simple measures are harmless for tension-type and neck-related headache without warning signs. If the pain increases while you do them, stop and mention it at your next appointment.

Tuck the chin

Sit upright and push your chin straight back, as if you wanted to make a double chin. Hold briefly, release, repeat a few times. This relieves the upper cervical spine and fits into any break.

Warmth on the neck

A warm cherry-pit pillow or a hot-water bottle wrapped in a towel relaxes the muscles. A quarter of an hour is enough. Please do not apply it to bare skin or while asleep.

Build endurance

Brisk walking or cycling on several days of the week is recommended for frequent tension-type headache. Begin with an amount that you can keep up well.

Painkillers with care

Take painkillers only after consulting a doctor or pharmacist and not on many days a month. Note the days you take them so that you keep track.

Your appointment at Praxis Pirnay in Cologne-Esch

The practice is at Martinusstraße 53 in the north of Cologne and is also easy to reach from Pesch and Auweiler. The bus stop “Esch Schulstraße” is a few minutes’ walk away. By car, you come via the A57, exit Köln-Chorweiler, or via the A1, exit Köln-Bocklemünd. Parking spaces are right in front of the practice.

Bring your insurance card and prescription, as well as any doctors’ letters or imaging of the cervical spine. A top with a wide neckline or a tank top makes it easier to examine the neck and shoulders. If you have noted down your headache days, please bring the notes.

You can make an appointment by phone or via the appointment form on this website. We speak German, English and Spanish; Turkish is also possible at the reception desk. We plan more time for the first appointment because the assessment is part of it.

Opening hours: Mon 7:00–20:00, Tue 8:00–19:50, Wed 8:00–19:30, Thu 7:00–19:50, Fri 7:00–15:30

Questions about tension-type and neck-related headache

How can I tell whether my headache comes from the neck?

Pointers are a pain that is always on one side, begins in the neck and can be brought on by head movements or pressure on the upper neck. Often turning the head to one side is restricted. This can only be assessed reliably in an examination; the diagnosis is made by a doctor.

Do I need an MRI of the cervical spine before physiotherapy?

As a rule, no. For typical tension-type headache without warning signs, the medical diagnosis usually does without imaging. Whether imaging of the cervical spine is necessary in your case is decided by the doctor’s office. If you already have images or reports, bring them to the first appointment.

Which prescription do I need, and what do I pay myself?

People with statutory health insurance need a prescription that specifies the therapy. They pay the statutory co-payment unless they are exempt. Those with private health insurance clarify reimbursement with their insurer in advance, because it depends on the plan. The practice bills all statutory and private health insurers.

Is massage alone enough against tension-type headache?

Usually not in the long run. Massage can loosen tense muscles and is often experienced as pleasant, but on its own the effect rarely lasts long. A combination with exercises, regular endurance exercise and relaxation makes more sense.

Should I rest my neck when I have a headache?

No, rest does not usually help with these forms of headache. Calm movement within the range that causes little discomfort keeps joints and muscles supple. Avoid jerky movements and strong overextension of the head. A cervical collar is only appropriate on a doctor’s orders.

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0221 - 7099885