Migraine and osteopathy: an integrative approach (without miracle claims)
When a headache is much more than “just a headache”
Article written by Blandine Chambonnier, osteopath at Aliantis.
Blandine works with adults, pregnant women and children using an individualised approach based primarily on gentle manual techniques adapted to each patient. In this article, she shares how she approaches migraine in clinical practice, always as a complement to medical care when necessary.
If you have made it this far, you probably know the feeling well: throbbing pain, sensitivity to light or sound, nausea, and the need to stop everything and find somewhere dark and quiet.
Migraine is not simply a more intense headache. It is a common neurological disorder that can be highly disabling and can affect work, family life, sport and quality of life. Despite this, migraine remains underdiagnosed and undertreated in many people.
My aim with this article is to give you a clear, honest and evidence-based overview of what migraine really is, its main triggers, how it is managed today, and the role that gentle osteopathic care may have within an integrative approach.
💡 Did you know?
It is estimated that more than one billion people worldwide live with migraine. It is one of the most common neurological disorders and one of the leading causes of disability in young adults. It also affects women approximately three times more often than men.
When should you seek prompt medical attention?
Most headaches are not serious, but some symptoms require prompt medical assessment, either in an emergency department or through an urgent medical consultation.
Seek medical attention if you experience:
- A sudden, explosive headache (“the worst headache of your life”).
- A headache accompanied by neurological symptoms such as weakness, difficulty speaking, loss of vision, confusion or seizures.
- An unusual aura, for example one lasting more than an hour or accompanied by weakness, or a first episode of aura without headache.
- A headache accompanied by fever, neck stiffness, rapid worsening or feeling severely unwell.
- A new headache following a head injury, particularly within the following three months.
- A headache that progressively worsens over several weeks or clearly changes from your usual pattern.
- A headache triggered by coughing, physical exertion or sexual activity, or one that clearly worsens in certain positions.
What happens during a migraine attack?
We now know that migraine is a complex neurological disorder involving several mechanisms within the nervous system.
These include activation of the trigeminovascular system — a network involved in transmitting pain signals from the head and face — and the release of molecules such as CGRP (calcitonin gene-related peptide), which plays an important role in the development of a migraine attack.
These mechanisms help explain why, during a migraine, the body can become particularly sensitive to light, sound, smells and even movement.
They also help explain why current migraine management does not rely on a single intervention, but on a combination of several approaches: treating attacks when they occur, preventive treatment when migraines are frequent, and education to better understand the condition and learn how to manage it.
What can trigger a migraine?
Many people identify situations or factors that seem to make a migraine attack more likely. Some of the most common include:
- insufficient or irregular sleep;
- skipping meals or inadequate hydration;
- prolonged stress;
- hormonal changes;
- excessive screen time or visual fatigue;
- associated neck discomfort or jaw tension.
However, it is important to understand that a trigger is not necessarily the cause of migraine.
Sometimes, what we interpret as a trigger is actually part of the premonitory phase of the migraine attack.
For example, someone may experience fatigue, changes in appetite, neck tension or difficulty concentrating several hours before the pain begins. These symptoms have not necessarily caused the migraine: they may instead be a sign that the migraine process has already started.
For this reason, rather than trying to completely avoid every possible trigger, it is usually more helpful to understand your own migraine pattern and develop management strategies adapted to your individual situation.
🏃 In practice
Many people come to the clinic convinced that there is one specific trigger behind their migraines. However, several factors often interact at the same time. Lack of sleep, stress building up over several days, or spending long hours in front of a computer may all coincide around the time of an attack.
Understanding these patterns can help you manage migraine with less uncertainty, without turning the search for triggers into an additional source of worry.
What can osteopathy offer?
Osteopathy does not cure migraine. It is more accurate to consider it a complementary approach, with clear and realistic goals.
In people with migraine, manual treatment may aim to:
- reduce associated musculoskeletal discomfort in the neck, base of the skull or jaw;
- improve mobility and comfort in everyday life;
- promote relaxation and rest;
- support the introduction of healthy habits and preventive strategies;
- form part of a multidisciplinary approach, coordinated with medical care when necessary.
Everyone is different. Some people mainly experience an improvement in their associated neck or jaw discomfort, while others particularly value the feeling of relaxation or improved tolerance to movement.
For this reason, the goals of each consultation are always adapted to the individual situation and needs of each patient.
What about cervical manipulation?
In my practice, I do not perform high-velocity cervical manipulations (HVLA or thrust techniques).
The available evidence does not demonstrate that spinal manipulation is an effective treatment for migraine. A systematic review published in 2024 found very low-certainty evidence and a higher frequency of adverse events in the studies that evaluated these techniques.
For this reason, I prefer a gentle manual approach, adapted to each individual and integrated into a broader care plan.
What does my approach focus on during a consultation?
Base of the skull and suboccipital region
Many people with migraine also experience associated neck discomfort.
The aim of treatment is to reduce tension, hypersensitivity and stiffness in this area, helping the neck to better tolerate everyday activities.
This does not mean that migraine “comes from the neck”. Migraine is a neurological disorder. However, cervical symptoms can coexist with migraine and contribute to discomfort in some people, so it makes sense to assess and treat them when they are present.
Temporomandibular joint (TMJ) and masticatory muscles
Bruxism, jaw tension, pain when chewing or clicking in the jaw may be present in some people with migraine.
When this occurs, treatment may include gentle work on the mobility and tissues of the jaw region, together with education about habits, the resting position of the jaw and simple strategies to reduce strain.
When necessary, this approach can be complemented by coordination with a dentist or other healthcare professionals.
Breathing, diaphragm and relaxation
During periods of stress or persistent pain, increased muscle tension and changes in breathing patterns are common.
In these cases, part of the treatment may focus on promoting more comfortable breathing and improving mobility of the rib cage, using gentle manual techniques and simple breathing exercises.
The aim is not to directly “regulate” or “reset” the nervous system, but to create conditions that support relaxation, comfort and recovery.
Cranial techniques, when appropriate
When I use cranial techniques, I do so with a very gentle approach focused on the patient’s comfort.
These techniques are not intended to “realign bones” or alter the movement of the cranial bones, but rather to provide low-intensity manual treatment that some people find pleasant and relaxing.
These techniques form part of a much broader approach that includes education, lifestyle habits, movement and, when appropriate, medical follow-up.
💡 Common myth
“If I have migraine, I must have a blocked vertebra in my neck.”
We now know that migraine is not caused by a displaced vertebra or a bone being “out of place”. Although some people experience neck or jaw discomfort, these findings alone do not explain why a migraine occurs.
Manual treatment may help improve comfort in these areas when associated symptoms are present, but it is not intended to correct a supposed “mechanical cause” of migraine.
What can help you manage migraine more effectively?
Keep a migraine diary
Keeping track of the frequency and duration of attacks, associated symptoms, possible triggers and any medication used can be very helpful.
Rather than searching for a single cause, a diary can help identify patterns and assess whether management strategies are working over time.
Maintain regular habits
Treat attacks early
When a migraine attack begins, it is often helpful to start the treatment recommended by your doctor early in the attack rather than waiting until the pain becomes very intense.
Each patient has an individual treatment plan, so it is important to follow the recommendations of the healthcare professional overseeing your medical care.
Avoid medication overuse
Using certain medications to treat migraine attacks too frequently can contribute to the development of medication-overuse headache.
If you find that you need medication increasingly often, it is worth discussing this with your doctor to assess the situation and, if necessary, consider other treatment options.
When attacks are frequent
When migraines are frequent, severe or significantly interfere with daily life, preventive treatments are available that can help reduce their frequency and impact.
Your doctor can assess whether this type of treatment is appropriate in your individual case.
🏃 In practice
Many people come to the clinic feeling that they have already tried “everything”. However, migraine management rarely depends on a single intervention.
Better understanding your attacks, maintaining some regularity in sleep and meals, recognising early symptoms, addressing neck or jaw discomfort when present, and having appropriate medical treatment can all form part of the same strategy.
Who may particularly benefit from a gentle osteopathic approach?
This type of complementary care may be particularly relevant when, in addition to a diagnosis or suspected diagnosis of migraine, there is:
- recurrent neck tension or discomfort at the base of the skull;
- bruxism or symptoms related to the temporomandibular joint;
- long hours spent in front of screens or prolonged postures;
- persistent stress or difficulty relaxing;
- a need to integrate manual treatment into a broader approach that includes education, movement and medical follow-up.
The aim is not to replace other treatments, but to provide care adapted to each person’s individual needs.
What happens during a first consultation?
The aim of the first visit is to understand your migraines and how they affect your daily life.
1. Detailed medical history
We will start by discussing the frequency and duration of your attacks, associated symptoms, whether or not you experience aura, possible triggers, the medication you use and how you respond to it, as well as the impact migraine has on your daily life.
This first stage also helps identify any signs that may require medical assessment before starting or continuing treatment.
2. Assessment
When appropriate, we will assess the mobility and sensitivity of the neck, the base of the skull, the jaw and other musculoskeletal factors that may be related to your symptoms.
The assessment is always adapted to each individual and to how you are feeling on the day of your appointment.
3. Realistic and measurable goals
Based on your medical history and assessment, we will define realistic and measurable goals together.
For example: reducing associated neck or jaw discomfort, improving mobility, increasing tolerance to certain activities, or learning strategies to help manage symptoms between attacks.
4. Treatment
Treatment is adapted to the findings of the assessment and to each person’s individual sensitivity.
In my practice, I mainly use gentle manual techniques on areas I consider relevant, such as the cervical and suboccipital regions, the jaw, associated muscles or the rib cage.
Throughout the session, the intensity and techniques used are adjusted to your comfort and your response to treatment.
5. After the session
Treatment does not necessarily end when the hands-on part of the session is over.
Depending on your individual situation, we may suggest a few simple recommendations for the following days: mobility exercises, strategies to reduce neck or jaw strain, adapted physical activity, breathing exercises, or changes in habits that are relevant to your situation.
It may also be helpful to continue keeping a migraine diary to monitor how your attacks evolve and distinguish changes in the migraine itself from changes in associated neck or jaw symptoms.
6. Follow-up and reassessment
During subsequent consultations, we will reassess the goals established at the beginning.
The aim is not to continue treatment indefinitely, but to determine whether the approach is producing meaningful improvements. If it is not, we will reconsider the treatment plan and, when necessary, recommend assessment by another healthcare professional.
The goal is for manual treatment to be one tool within a broader plan and for you to gradually develop more strategies to manage your symptoms independently.
Final thoughts
Migraine is not something you simply have to “put up with”. Although it is not always possible to eliminate attacks completely, there are now many tools available to better understand the condition and reduce its impact on quality of life.
At Aliantis, we see osteopathy as one part of an integrative, cautious and individualised approach. When neck discomfort, jaw tension or other associated musculoskeletal symptoms are present, gentle manual treatment can aim to improve comfort and complement medical care when necessary.
If migraine is part of your everyday life and you would like to explore whether this approach may be appropriate for you, we would be happy to listen and support you.
Migraine may be part of your story, but it does not have to define your everyday life.
FAQ about migraine
Can osteopathy cure migraine?
How many osteopathy sessions are needed?
Is it better to come during a migraine attack or between attacks?
Is migraine always related to the neck?
What is the difference between migraine and tension-type headache?
They are two different types of primary headache.
Migraine typically causes episodes of moderate to severe pain and may be accompanied by nausea, sensitivity to light and sound, and worsening with physical activity. Some people also experience aura.
Tension-type headache usually causes a more pressing or tightening pain, generally of mild to moderate intensity, and typically does not present with the same associated features.
Symptoms can overlap, and the same person may experience more than one type of headache. If there is any uncertainty about the diagnosis, a medical assessment is recommended.
Can I exercise if I have migraine?
When should I be concerned if my migraines change?
When should I see a neurologist?
This blog article does not aim to generate new knowledge; it is based on the reading of scientific publications, blog articles and other texts.
Sources:
Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nature Reviews Neurology. 2021;17:501–514. doi:10.1038/s41582-021-00509-5.
Steiner TJ, Jensen R, Katsarava Z, et al. Aids to management of headache disorders in primary care (2nd edition). The Journal of Headache and Pain. 2019;20:57. doi:10.1186/s10194-018-0899-2.
Posadzki P, Klimek AT, Ernst E. Spinal manipulations for migraine: an updated systematic review and meta-analysis of randomized clinical trials. Systematic Reviews. 2024;13:296. doi:10.1186/s13643-024-02719-6.
Sico JJ, Antonovich NM, Ballard-Hernandez J, et al. 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline for the Management of Headache. Annals of Internal Medicine. 2024.
Qaseem A, Tice JA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic Treatments of Acute Episodic Migraine Headache in Outpatient Settings: A Clinical Guideline From the American College of Physicians. Annals of Internal Medicine. 2025. doi:10.7326/ANNALS-24-03095.
Puledda F, Sacco S, Diener HC, et al. International Headache Society Global Practice Recommendations for Preventive Pharmacological Treatment of Migraine. Cephalalgia. 2024;44(9). doi:10.1177/03331024241269735.
