Physical Therapy in Headache Care: Insights From an Exploratory Cross-Sectional Survey of Healthcare Professionals Publisher



Onan D ; Kodounis M ; Gelener P ; Waliszewska Prosol M ; Ekizoglu E ; Raffaelli B ; Oliveira A B D ; Puledda F ; Castaldo M ; Gil Gouveia R ; Mavridis T ; Versijpt J ; Gonzalez Martinez A ; Deligianni C Show All Authors
Source: Cephalalgia Reports Published:2026

Abstract

Background: The role of physical therapy (PT) in headache management is increasingly recognized, yet its use varies across professionals and countries, and remains poorly characterized. This exploratory cross-sectional study investigated healthcare professionals’ attitudes and referral practices toward PT in headache management through an international online survey. Methods: A 27-item survey was emailed via REDCap to healthcare professionals actively working in the headache field. It explored the types of headaches for which PT is recommended, the referral criteria, assessments/treatments, healthcare professionals’ opinions on challenges in implementation, and ways to improve effectiveness. Results: Two-hundred four professionals from 41 countries responded to the survey, most of whom were neurologists (n = 154, 75.4%); 33 (16.1%) were physiotherapists. The most frequently recommended diagnoses for PT by professionals were cervicogenic headache (n = 169/187, 84.9%), chronic tension-type headache (n = 160/187, 80.4%), and chronic migraine (n = 130/187, 69.8%). The most frequently recommended approaches of neurologists and physiotherapists were exercises (87% and 78.7%, respectively) and manual therapies (66.2% and 96.9%, respectively). Specific referral criteria for PT (most commonly neck pain, neck stiffness, elderly/pregnants/children who can not take medication, etc.) were reportedly followed by 31.7% of professionals, while 20.6% of local professionals followed established guidelines or procedures. Respondents from high-income countries (HIC) placed more emphasis on the use of specific criteria for patient selection for PT compared to lower-to-upper-middle-income countries (LUMIC) (41% vs 22.2%, P = 0.004). Conclusions: The findings offer experts a preliminary perspective on whether PT may be a complementary part of headache management. Exercises and manual therapy were the most recommended approaches. Greater PT use in LUMIC than HIC suggests variability linked to healthcare context, resource availability, or non-Western medicine traditions and culture. These findings underline the need for consensus-based guidelines to optimize the integration of PT in headache care worldwide. © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).