Headaches are one of the most common reasons people seek help, and for many of them the neck is part of the picture. Tension-type headaches and headaches that arise from the neck often build gradually, come with a stiff neck and tight shoulders, and are made worse by long hours at a desk, driving or sleeping awkwardly.
Understanding neck-related headaches
Headaches are classified into primary headaches, such as tension-type headache and migraine, and secondary headaches that arise from another cause. Two of the types that physiotherapists commonly help with are:
- Tension-type headache: a pressing or tightening ache on both sides of the head, usually mild to moderate, often linked to muscle tension, stress, posture and fatigue
- Cervicogenic headache: a headache that arises from structures in the upper neck, typically one-sided, starting at the base of the skull and often provoked by neck movement or sustained positions
Headaches can overlap, and migraines can also come with neck pain, so accurate assessment matters. Where you also have neck pain, see our neck pain page for more detail.
Symptoms we commonly see
- A dull, band-like ache or pressure across the forehead or the back of the head
- Pain that starts at the base of the skull and spreads towards the forehead or behind the eye
- Neck stiffness or reduced movement, and tight upper back and shoulders
- Headaches that build over a work day, after screen use or driving, or after sleeping awkwardly
- Pain that can be reproduced by moving the neck or holding a position
Our evidence-based approach
A review of physiotherapy treatments for headache found evidence that some manual therapy and exercise approaches can reduce headache frequency and intensity, particularly for tension-type and neck-related headaches, although the quality of studies varies. Our approach includes:
- Careful screening and assessment, including your headache history and warning signs, and testing neck movement, joint and muscle findings, posture and strength
- Referral where needed, so that headaches needing medical assessment or management, including migraine, are handled by your GP
- Hands-on treatment, including gentle joint mobilisation and soft tissue work, to ease pain and restore movement
- Dry needling where appropriate, to help manage muscle tension and trigger points
- Exercise for the neck and upper back, including deep neck muscle and shoulder blade strengthening, to build lasting support
- Posture, workstation and activity advice, plus guidance on sleep, stress and regular movement
What to expect: recovery timeline
- Many tension-type and neck-related headaches: respond over several weeks to a combination of hands-on treatment, exercise and changes to the things that trigger them
- Longer-standing or frequent headaches: may take a few months of consistent work, and often need input from your GP as well
- Ongoing management: a simple strength and posture routine helps keep headaches from coming back
When to seek help urgently
Seek urgent medical care for any of the following: a sudden, severe headache that’s the worst of your life; a headache with fever, a stiff neck or a rash; a headache after a head injury; new weakness, numbness, vision changes, confusion or trouble speaking; or a new headache pattern if you’re over 50, or a headache that wakes you or steadily worsens. These are uncommon but need prompt medical assessment.
References
- Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine: systematic review and meta-analysis. Cephalalgia. 2016;36(5):474-492.
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
- Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134-144.
- Rubio-Ochoa J, et al. Physical examination tests for screening and diagnosis of cervicogenic headache: a systematic review. Man Ther. 2016;21:35-40.