Neck Headache

john-miller-physio zoe-russell-physiotherapist

Article by J. MillerZ. Russell

What is a Neck Headache?

neck headache

What Causes Headaches in the Back of the Head and Neck?

The most likely cause of a headache at the base of your skull or top of your neck is a neck headache.

Neck Headache, or as it is known medically - a Cervicogenic Headache, is a secondary headache disorder. In other words, your headache is caused by a neck joint problem. 

The good news is that by fixing your neck problem, your neck headache can be alleviated. Researchers feel that a neck headache accounts for between 4% to 22% of all headaches seen clinically. (Racicki et al 2013; Watson 2014) 


image source: diply


What's Causes Your Neck Headache?

Your neck headache can originate from a variety of musculoskeletal and neurovascular structures in your upper neck; including the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. A dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).

Upper Neck Joints

The most likely sources of your neck headache are dysfunction of either your upper neck joints, neck muscles or nerves, which trigger pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.

The most common cause of a neck headache is dysfunction of your upper three neck joints. The most common neck joints involved are your:

  • Atlanto-occipital joint (O-C1), 
  • Atlanto-axial joint (C1/2), and 
  • C2/3 cervical spine joints.

neck headache

In simple terms, your neck joints can cause a neck headache or pain if they are either too stiff or move too much (eg wobbly and unsupported by weak muscles) or are locked in an abnormal joint position eg. locked facet joint or poor posture. 

Once your neck joint becomes stressed and painful, the pain signals are referred to the trigeminocervical nucleus in your brainstem... and you start to feel a neck headache or, in some cases, face pain!

cervical headache

Your physiotherapist is highly-trained in the assessment and correction of neck joint dysfunctions that result in a neck headache. Their professional diagnosis and treatment are essential for neck headache sufferers.

Neck Muscles

Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. 

Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse, which places a further demand on your overworking muscles resulting in muscle fatigue-related symptoms.  

Your neck muscles work optimally when they have normal resting tension, length, strength, power and endurance.

Your physiotherapist is highly-trained in the assessment and correction of muscle imbalances that result in a neck headache. 

neck headache

Cervical and Occipital Nerves

Nerves in your upper neck may be directly pinched by extra bony growths eg arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in the neural motion known as neuromechanosensitivity or abnormal neurodynamics

Irritation of your upper neck structures refer pain messages along the nerves and cause your headache.

In simple terms, your neck is the "switch", nerves are the "power cords" and your headache is where the "light" comes on.

neck headache

What are the Symptoms of Neck Headache?

Neck headaches can often be misdiagnosed or confused with other sources of a headache, including a migraine since the head pain is typically felt in the same area as a migraine.  

It is really the interpretation from your headache physiotherapist of the whole combination of your symptoms plus the findings of your physical examination that will confirm a neck headache diagnosis

Commonly, neck headache sufferers will usually notice:

  • Tenderness at the top of their neck and base of the skull. 
  • Neck stiffness or a mild loss of movement, although this is sometimes is only subtle and needs to be confirmed during your physiotherapist's physical examination.

One of the main differences between a neck headache and migraine is that physiotherapy treatment of your neck is able to alter or relieve your headache immediately.

Common Characteristics of a Neck Headache?

The following symptoms are characteristics of a neck headache. You may experience any one or several of these symptoms:

  • Your headache may seem to radiate from the back to the front of your head.
  • Your headache is provoked or eased by a neck movement, a sustained posture, stomach sleeping or with your head turned to one side.
  • Your headache normally appears to be worse on one side of your head. The side is normally constant and does not swap sides.
  • Your headache appears to temporarily ease up when you apply pressure or you massage your neck or the base of your skull.

If you experience any of the above symptoms, you are more likely than not to be suffering a neck headache. Please inform your physiotherapist and they will assist you.

What if Your Neck Isn’t Sore?

Even if your neck isn’t sore or painful, you can still experience neck headaches. It is important to remember that your neck joints may NOT be sore at REST, but they may be tender to touch or painful on movement. 

Neck joints that are sore at rest will normally be very tender to touch and painful at the extreme of movement. Obviously, this scenario is a more severe neck headache.

If your headache or a migraine has been present for years and your neck has not been examined, then a thorough neck examination is recommended and is appropriate to either confirm and treat your neck headache or exclude a neck disorder as the cause of your headache.

How is a Neck Headache Diagnosed?

Accurate diagnosis is important to guide the correct treatment and management your neck headache. A headache and head pain can have many causes, not just neck headache or a migraine. Correctly identifying the cause will lead to better treatment.

A physiotherapist who specialises is Neck Headache is the best professional to diagnose and treat your neck headache.

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What about X-rays, CT-scans and MRI?

Unfortunately X-rays, CT-scans and MRI's are not diagnostic of a neck headache. You can suffer a neck headache with or without some abnormal findings on X-rays or scans. Likewise, scan abnormalities do not guarantee that you will experience a neck headache.

However, X-rays and scans may identify structures that could potentially be causing your neck pain or a neck headache. We recommend that you have at least cervical spine X-rays if you have been suffering headaches or head pain for an extended period.

How Can Physiotherapy Help You?

Quality neck physiotherapy can have a very quick and effective result for relieving your neck headache. The key to a better treatment response is confirming your diagnosis. PhysioWorks physiotherapists are experts in the diagnosis and treatment of a neck headache. After you have been assessed your physio will start you on treatment that fixes YOUR problems.

Your neck headache treatment may include all or some of the following techniques:

  • Stiff neck joints may need to be loosened or unlocked via joint mobilisation (gentle gliding techniques), joint traction or in specific cases a gentle and localised joint manipulation technique.
  • Hypermobile (or dynamically unstable) joints may require specific deep neck muscle strengthening exercises to stabilise, control and limit the joint movement available.
  • Tight or overactive muscles may require stretching, massage, acupuncture, dry needling, or other relaxation techniques.
  • Weak muscles may require specific strengthening exercises. This may include your postural shoulder blade and neck muscles.
  • Nerve dysfunction may be addressed by your physiotherapist depending upon your specific examination findings. Neurosensitivity is a common finding that needs to addressed with cautious professional care and attention.
  • Posture correction may be recommended via specific exercises, posture awareness techniques, taping or a posture brace.
  • Helpful advice on how to prevent neck dysfunction in the future eg awkward neck positions and postures to avoid.

What Results Should You Expect?

Relief of your neck headache is quite often immediate!

If your headache is solely caused by a neck headache, it is common to experience instant relief as you walk out of the clinic.

Depending on the severity and what are the specific underlying causes of your neck headaches, most sufferers will resolve their neck headache within days or a few weeks. In addition to relieving your neck headaches, it is the aim of your physiotherapist to address the reasons why you are experiencing neck headaches.

After all, helping you to avoid future neck headache is a very important component of your rehabilitation.

What if Physiotherapy Can't Help You?

Since there are over 300 sources of a headache, and neck headache is thought to be responsible for about 20% of headaches, your headache may stem from a problem that neck headache treatment is not able to help relieve.

You may also be suffering from a mixed or a multi-source headache. In these instances, your neck headache may be solved but another source of your head pain could linger.

Your physiotherapist will advise you if you have symptoms that could indicate a different cause for your headache. In these instances, they will also direct you towards further investigations or tests that may assist your diagnosis and subsequent treatment.

Mixed Headache-Migraine Types

You can simultaneously suffer one, two or more types of a headache or a migraine.

One type may cause another or overlap with another. For example, a painful neck can cause an increase in muscular tension, which will increase your blood pressure. In this scenario, you would be suffering a neck headache + a tension headache + a migraine!


In our experience, finding the primary source of your headache or a migraine is the key to successful management. 

What Else Could Be Causing Your Headaches or a Migraine?

Your physiotherapist and doctor will be able to assist your diagnosis and headache source. Sometimes specific tests can confirm your diagnosis. On other occasions, it can be by a process of elimination.

In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which should be thoroughly investigated. These can include brain tumours, aneurysm, meningitis and other systemic illnesses.

Your physiotherapist or doctor may recommend that you complete a headache or migraine questionnaire that will assist in your headache classification, diagnosis and treatment. Once you complete these questionnaires please present the results to your physiotherapist or doctor to assist your diagnosis and treatment.

Headaches or Migraine Questionnaire

At PhysioWorks, we have a special interest in the assessment, diagnosis and treatment of a neck headache, stress headache and jaw headache.

For more information, please ask your physiotherapist. 

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Headache - Migraine

Common Causes

General Information

Specific Migraine - Headache Types

Migraine - Headache Questionnaires

Neck Conditions

Jaw Conditions

Systemic Conditions

Headache Red Flags!

If suffer any of the following symptoms, please notify your physiotherapist or doctor as soon as possible.

All Red Flags MUST be thoroughly investigated!

We urge you to check with your doctor or physiotherapist to investigate further if your headaches have any of the following characteristics:

  • A sudden or a severe headache - a “thunderclap” type headache.
  • A new or "different" headache to your normal type.
  • Your “worst headache ever”!
  • Signs of neurological complications e.g. motor weakness, memory loss, confusion, behaviour changes, reduced alertness or meningismus (stiff neck + photophobia + a headache).
  • New headache onset over the age of 40 to 50 years.
  • Headaches at night or waking in the morning.
  • A headache associated with systemic symptoms e.g. weight loss, fever, nausea or vomiting.
  • The onset of a headache after a cough or sneeze, exercise, coitus or head turning.
  • New onset of a headache during or following pregnancy.
  • A previous history of cancer.

If you have any of the above Red Flags symptoms, we strongly recommend that you inform your physiotherapist and seek the advice of your doctor or an emergency department immediately.

Can an Unsupportive Pillow Cause Neck Headaches?

neck headache

Yes. Unfortunately, a non-supportive pillow or one not suited to your neck can predispose you to neck pain or a neck headache.

If you suffer neck pain or a headache, it is wise to ask for the professional advice of your physiotherapist regarding what pillow style and size they would recommend for you.

Pillows do vary and the best one for your neck shape and body size will help you prevent neck pain and neck headache.

More info: Best Pillows

Headaches and Migraine Questionnaires

Discover what is causing your Headache or Migraine...

Helpful Products for Headaches & Migraine


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Common Neck Headache Treatments

  • Early Injury Treatment
  • Avoid the HARM Factors
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Scapular Stabilisation Exercises
  • Closed Kinetic Chain Exercises
  • Biomechanical Analysis
  • Proprioception & Balance Exercises
  • Medications?
  • Ergonomics
  • Posture Correction
  • Soft Tissue Massage
  • Brace or Support
  • Deep Neck Stabilisation Exercises
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Neurodynamics
  • Physiotherapy Instrument Mobilisation (PIM)
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
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    Book Online

    Headaches & Migraine FAQ's

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Headache or Migraine... What to do?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Can You Relieve Your Neck Pain?
  • How to Achieve the Best Standing Posture
  • Migraine? Free Online Test
  • Neck Headache? Free Online Test
  • Tension-Type Headache? Free Online Test
  • What are the Benefits of a Standing Desk?
  • What are the Common Adolescent Spinal Injuries?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What are the Healthiest Sleeping Postures?
  • What are the Signs of an Unsupportive Pillow?
  • What Can You Do To Help Arthritis?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Good Standing Posture?
  • What is Musculoskeletal Physiotherapy?
  • What is Nerve Pain?
  • What is the Correct Way to Sit?
  • What to expect when you visit PhysioWorks?
  • What's the Benefit of Stretching Exercises?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Headache - Migraine

    Common Causes

    General Information

    Specific Migraine - Headache Types

    Migraine - Headache Questionnaires

    Neck Conditions

    Jaw Conditions

    Systemic Conditions

    Call PhysioWorks

    Book Online

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    Last updated 14-Feb-2019 10:45 AM

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