Neck Headache

Neck Headache

Article by I.Kelly, J.Ferguson

Neck Headache

(Cervicogenic Headache)

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

What is a Neck Headache?

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

A neck headache is the most likely cause of head pain at the top of your neck or base of your skull. The good news is that by fixing your neck problem alleviates your neck headache. Researchers feel that a neck headache accounts for between 4% to 22% of all headaches seen clinically. (Racicki et al. 2013; Watson 2014)

neck headache

What are the Symptoms of Neck Headache?

Neck headaches can often be misdiagnosed or confused with other sources of a problem, including a migraine since the head pain may refer to a similar area as a migraine.

It is 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:

  • Upper neck tenderness. Or, the base of your skull.
  • Neck stiffness or a mild loss of movement, although this is not mandatory. Joint movement loss can be quite subtle and needs confirming during your physiotherapist’s physical examination.

One of the main differences between a neck headache and migraine is that physiotherapy treatment of your neck can alter or relieve your headache pain 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 frequently appears to be worse on one side of your head. The headache side usually is constant and does not swap sides.
  • Your headache appears to ease up when you apply pressure temporarily, 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 typically be very tender to touch and painful at the extreme of movement. This scenario is a more severe neck headache.

If your headache or migraine is longstanding, and you haven’t had your neck joints examined, we recommend a thorough neck assessment.

Your physiotherapist will be able to confirm and treat your neck headache or exclude a neck disorder as the cause of your trouble.

How is a Neck Headache Diagnosed?

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

A physiotherapist who has a particular interest is neck headache is the best professional to diagnose and treat your neck headache.

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.

For more specific advice, please consult your neck headache physiotherapist.

Neck Headache Treatment

Quality neck physiotherapy can have a speedy and effective result for relieving your neck headache—the key to better treatment response in confirming your diagnosis. PhysioWorks physiotherapists are experts in the diagnosis and treatment of a neck headache. After your assessment, your physio will start you on treatment techniques that fix 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 weakness may include your postural shoulder blade and neck muscles.
  • Nerve dysfunction identified by your physiotherapist will depend 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.
  • Provide helpful advice on how to prevent neck dysfunction in the future, e.g. awkward neck positions and postures to avoid.

What Results Should You Expect?

Relief of your neck headache is quite often immediate! If a neck headache solely causes your trouble, 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, your physiotherapist aims to address the reasons why you are experiencing neck headaches. After all, helping you to avoid future neck headache is a crucial component of your rehabilitation. For more information, please consult your neck headache physiotherapist.

What’s Causes Your Neck Headache?

Your neck headache originates from a variety of musculoskeletal and neurovascular structures. These structures include the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. 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 source of your neck headache is a dysfunction of your upper neck joints. Your neck muscles or nerves become involved from 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 the 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 (e.g. wobbly and unsupported by weak muscles) or locked in an abnormal joint position, e.g. a “locked” facet joint or poor posture.

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

cervicogenic 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 further demand on your overworking muscles resulting in muscle fatigue-related symptoms.

Your neck muscles work best when they have healthy 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.

Cervical and Occipital Nerves

Nerves in your upper neck may become pinched by extra bony growths, e.g. 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 to 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.

What if Physiotherapy Doesn’t Help Your Headache?

Since there are over 300 sources of a headache, and neck headache is responsible for about 20% of headaches, your trouble 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 resolve, 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 process of elimination.

In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which require investigation. 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 help your diagnosis and treatment.

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

For more information, please ask your physiotherapist.

Can an Unsupportive Pillow Cause Neck Headaches?


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 problem, 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.

For pillow advice specific to your neck, please ask one of our physiotherapists which pillow is best for you.

Headaches & Migraine FAQ’s