Our Approach

Manual therapy – specialist hands on physiotherapy assessment and treatment techniques provide the basis of our approach. Together with tailored exercise for strength, mobility and motor control, ergonomic considerations and psychological and social factors we provide a multidimensional, integrated approach that treats the individual as a whole person.

The Problem

Headache disorders are among the most common neurological conditions worldwide, affecting as many as 40% of the world’s population. They are amongst the top three most common neurological conditions for those aged between 5 and 80 years of age. They are a major cause of time lost from work, disrupted relationships and reduced quality of life. Women are affected up to three times more than men, and migraine alone is experienced by roughly one in seven people globally. Against that backdrop, our service focuses on safe, non-drug care that helps you reduce attacks and regain confidence in day-to-day life.

Primary and
secondary headache

Primary headaches include migraine, tension-type headache and cluster headache are headaches for which there is no known cause. Traditionally, it has been theorised that they originate due to issues within the brain. They are diagnosed by their clinical features, not by scans. Secondary headaches occur when there is a clear underlying cause—for example after trauma or due to medication overuse. Crucially, whether your condition has been characterised as primary or secondary, a careful assessment can still identify mechanical issues in your upper neck that are causing or contributing to your symptoms.

Why we examine the upper neck

Sensory signals from your upper neck (C0–C3) travel up your spinal cord and are collected in the brainstem at a critically important area called the Trigeminocervical Nucleus (TCN). Sensory signals from the Trigeminal nerve, a cranial nerve that provides sensation to areas of your head, scalp, face and jaw converge at the TCN with those signals from your upper neck. All those messages may cause the TCN to become over sensitised. The higher centres of the brain, to which messages from the TCN travel may misread neck input as being from the Trigeminal nerve and the result is head pain. That’s why some people feel headache or migraine when the main driver is mechanical dysfunction in the upper neck, even in the absence of obvious neck pain or other symptoms.

The Watson Headache® Approach

Our first-line physiotherapy method is the Watson Headache® Approach, a structured, gentle system of assessment and treatment focused on C0–C3. It is the only manual technique developed specifically for headache and migraine and the only approach with research supporting its ability to treat the underlying problem in primary headache: an over sensitised TCN in the brainstem. We assess for signs of mechanical dysfunction in your upper neck. During the assessment we use precise, sustained techniques to stress specific segments while monitoring symptoms. Our treatment techniques introduce input to the upper neck that both restores normal mechanics in the upper neck, while desensitizing the over stimulated brainstem. In this way it addresses the mechanism of headache and migraine, not just masking symptoms.

Evidence Supporting the WHA

An integrated,

multi-modal plan

As well as the Watson Headache® Approach we have several other manual therapy tools. Dependent on your individual presentation and response to treatment you may benefit from: •Manual therapy treatment inspired by the work of Maitland, Mulligan, Elvey, Hall, Jull, Gunn and Edwards •Dry needle acupuncture •Soft tissue techniques •Targeted strengthening, stability, mobility and motor control exercise to the head, neck, jaw, upper back and shoulder girdle •Sensorimotor rehabilitation to improve head-eye-neck control and to calm and improve symptoms of dizziness, disequilibrium and other sensory symptoms that accompany headache and migraine •Ergonomic assessment and recommendations for workstation setup and repetitive tasks

Biopsychosocial awareness

Headache and migraine are shaped by more than joints and muscles. Sleep, stress, mood, activity patterns, diet and medication use can all influence your threshold for symptoms. We work with you to identify relevant factors and make changes that fit everyday life. Where necessary we will refer you to other specialists in their field for management of diet and nutrition, mood and stress, medication interactions, and fitness and exercise.

Safety and collaboration

Your clinician screens for red flags and treats within scope. When needed, we coordinate with your Neurologist, ENT or orthopaedic consultant and your GP so non-drug care and medical care support each other. Our goal is clear progress you can feel and measure: fewer headache days, less reliance on medication and better function at home and work.

Based in Holywood, Northern Ireland

People travel to us from across Northern Ireland and beyond for assessment and targeted care centred on the Watson Headache® Approach, integrated with exercise, education and practical self-management.