Headaches have a way of ruining the best parts of life in Nice, from the bright light on the Promenade des Anglais to a late dinner in the old town. Many are tension-type headaches driven by neck and shoulder tension, stress, screens and poor sleep, and those are the ones where an osteopath can make a real difference. Migraine is different, and I will be straight with you about what manual therapy can and cannot do for it.
I am Aloïs Ruetsch, an English-speaking osteopath and manual therapist in central Nice, with 15 years of practice and more than 10,000 consultations. If you see a chiropractor or a manual therapist back home, a French osteopath is the closest equivalent.
This article explains which headaches respond to treatment, what the evidence says, and which headaches need a doctor first.
The essentials
- Tension-type headaches and neck-related (cervicogenic) headaches respond best to osteopathy; migraine responds less predictably.
- The evidence for manual therapy is moderate for tension-type headache and limited for migraine; some migraine patients find fewer or milder attacks, but nothing is promised.
- Osteopathy complements your doctor’s care; it never replaces migraine medication or a neurologist’s advice.
- In France, thrust manipulation of the neck requires a medical certificate; I treat headaches mainly with gentle techniques.
- A sudden ‘worst ever’ headache, a headache with fever and stiff neck, or one with weakness, confusion or vision loss is an emergency. In France, dial 15 or 112.
What causes headaches, and which types respond to manual therapy?
The most common headache by far is the tension-type headache, a dull, pressing pain on both sides of the head or like a band around it, usually with tight neck and shoulder muscles. Stress, long hours at a screen, poor sleep, dehydration under the Nice sun, a clenched jaw and a stiff upper neck all feed it. A close relative is the cervicogenic headache, which starts in the upper neck joints and spreads to the back of the head, the temple or behind one eye, and worsens with neck movement. These two types respond best to manual therapy.
Migraine is a neurological condition with throbbing, usually one-sided pain, often with nausea, sensitivity to light and sound, and sometimes a visual aura. The neck is often tense during and between attacks, which is where osteopathy can play a supporting role. Rarer headaches, such as cluster headache, and headaches caused by overusing painkillers, need medical management first.
What does an osteopath actually do for headaches?
I start by listening carefully to the pattern of your headaches, because the pattern tells me which type you have and whether anything needs a doctor before I touch you. I then examine your neck, upper back, shoulders, jaw and the muscles at the base of the skull, looking for the stiff joints and tender muscles that reproduce your head pain.
Treatment relies on gentle techniques such as soft-tissue work on the neck and shoulder muscles, slow mobilisation and articulation of the upper neck and upper back joints, muscle energy techniques to release the tight muscles at the base of the skull, light work on the jaw when clenching is part of the picture, and gentle cranial techniques that many patients find relaxing. Under French law (décret 2007-435) a thrust manipulation of the neck requires a medical certificate of no contraindication, and for headaches I rarely need it anyway. You leave with practical advice on screens, sleep, hydration and neck movement.
Does osteopathy work for headaches and migraines?
For tension-type and neck-related headaches, there is moderate evidence that manual therapy reduces how often they occur and how much they hurt, especially when combined with exercise and changes to posture and stress. For migraine the evidence is limited. Some of my migraine patients report fewer or milder attacks after a course of treatment, often because their neck is less of a trigger, but I cannot promise that, and the research does not allow anyone to.
Osteopathy does not replace migraine medication, preventive treatment or a neurologist’s assessment. The UK guideline on headaches (NICE CG150) sets out medical management, and in France your médecin généraliste or a neurologist leads that. Osteopaths do not make medical diagnoses here, so if your headache pattern is new or unusual I will send you to a doctor first.
How many sessions will I need?
For tension-type or neck-related headaches, I usually suggest two to four sessions over four to six weeks, then a review. Most people know after two sessions whether treatment is helping. For migraine, osteopathy is an add-on to medical care, so I prefer a short trial of three sessions that we assess together rather than open-ended treatment.
Long-standing daily headaches linked to stress, sleep and medication use change slowly, and the manual therapy part is only one piece. If you are not improving, I will say so and suggest the right next step.
What can I do myself in the meantime?
Drink water regularly, especially in the summer heat of the French Riviera, and do not skip meals. Keep a simple headache diary on your phone for a couple of weeks, noting sleep, screen time, alcohol, caffeine and the weather, because patterns often jump out. Take short breaks from screens every 30 to 45 minutes and raise your laptop to eye level.
Gentle neck movements and heat on the shoulders ease tension headaches. Wear sunglasses on the Promenade des Anglais if glare triggers you. Be careful with painkillers, because taking them on many days of the month can itself cause a daily headache; your pharmacist or médecin généraliste can advise. Regular sleep, a walk in the hills above Nice and a little less espresso help more than most people expect.
When should you see a doctor instead?
Call for emergency help if a headache comes on suddenly and is the worst you have ever had, if it follows a head injury, or if it comes with fever and a stiff neck, a rash, confusion, drowsiness, weakness or numbness on one side, slurred speech, double vision or loss of vision, or a seizure. In France, dial 15 (SAMU) or 112.
See a médecin généraliste soon if your headaches are new and you are over 50, if they are getting steadily worse over weeks, if they wake you or are worse when lying down, coughing or straining, if you are pregnant, if you have a history of cancer or a weakened immune system, or if you have a painful red eye. I ask about all of these at the first visit and will send you to a doctor rather than treat if anything does not fit a benign pattern.
Osteopath, chiropractor or physio: who should I see in Nice?
For a headache that clearly comes from neck and shoulder tension, an osteopath is a sensible first stop in Nice, with no referral needed. Osteopaths and chiropractors are very similar hands-on professions, and in France the osteopath is the everyday equivalent, with a five-year state-recognised degree; chiropractors are far fewer here.
For migraine, frequent headaches or any new pattern, see your médecin généraliste first; they can prescribe, order a scan if needed and refer you to a neurologist. A physiotherapist (kinésithérapeute) can help with posture and exercise on prescription. Pharmacies give advice on over-the-counter relief, SOS Médecins visits at home, and 15 or 112 are for emergencies. Osteopathy complements medical care; it does not replace it.
How do I see an English-speaking osteopath in Nice?
Message me on WhatsApp at +33 7 71 27 24 25 or book online via Doctolib. My clinic, Pôle Ostéo, is at 22 rue Gounod in the Musicians’ quarter of central Nice. A session lasts about 45 minutes and costs €90 at the clinic. I am open seven days a week, often with same-day availability.
If a headache has flattened you in your hotel, apartment, villa or yacht at berth, I visit in Nice and along the nearby coast for €120, with no surcharge for evenings, weekends or same-day calls. I take card or cash and provide a receipt for your insurance, in English on request. No referral is needed in France to see an osteopath or manual therapist.
In practice
Illustrative example, details changed. A software developer from Ireland, working remotely from Nice, came to me with near-daily headaches at the back of the head and behind the right eye, worst by late afternoon after hours on a laptop at a kitchen table. His doctor had already ruled out anything worrying. His upper neck joints were stiff, and the muscles at the base of the skull were tender and reproduced his headache when pressed. Three sessions of gentle mobilisation, soft-tissue work and muscle energy techniques, plus a raised screen and hourly breaks, reduced the headaches to an occasional mild one on long days.
Frequently asked questions
Is an osteopath the same as a chiropractor?
Can osteopathy get rid of my migraines?
Do you crack the neck to treat headaches?
Should I stop my painkillers before the session?
Can flying and jet lag cause headaches?
Book an English-speaking osteopath in Nice
Clinic at 22 rue Gounod (€90) or a visit to your hotel, villa, yacht or home in Nice (€120, no surcharge). Seven days a week, often same day. Write in English, Spanish or French.