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)
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.
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!
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.
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
Headache - Migraine
Specific Migraine - Headache Types
- Neck Pain
- Bulging Disc
- Wry Neck
- Text Neck
- Pinched Nerve
- Cervical Radiculopathy
- Facet Joint Syndrome
- Neck Sprain
What is a Primary or Secondary Headache?The International Headache Society classifies headaches as Primary or Secondary. Primary headaches are not related to any other problem and include migraines, tension-type headaches and cluster headaches. Secondary headaches. Caused by an underlying problem, and can include a post-whiplash headache, neck headache, jaw headache and drug withdrawal headache. “Ice cream headache”, for example, is a secondary headache caused by extreme cold within your mouth. In other words, a secondary headache is a symptom of something else being wrong rather than the cause itself. Treatment for a secondary headache involves treating the source, e.g. loosen some stiff upper neck joints or stop eating ice cream!
Multi-Source HeadacheIt is also important to point out that many headache sufferers may suffer multi-source headaches. For example, a migraine sufferer may simultaneously experience a tension-type headache and neck headache. Treatment will vary depending upon your specific symptoms and headache source. Please consult with your healthcare practitioner for an accurate diagnosis and treatment pathway.
When Should You Be Concerned about a Headache?In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital and essential signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.
You MUST thoroughly investigate any Red Flags!Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:
- History your worst ever headache or a different headache to your usual.
- Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
- Age is higher than 50 years.
- Despite treatment, your headache persists.
- Acute onset.
- Central nervous system findings, e.g. motor weakness, memory loss, slurred speech.
- HIV or another immune system compromise
- fEver or other systemic symptoms, e.g. weight loss, rash.
Less Urgent & Severe Headache TypesFortunately, the vast majority of headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis. For specific advice, please consult your doctor or headache physiotherapist.
Suffering a Headache or Migraine?If you are suffering a headache or migraine, it is appropriate that your first step is to consult your doctor. Your doctor will examine you and then determine if a neurological opinion is required and whether a CT or MRI scan of your head is necessary. Occasionally, scans can identify significant but luckily uncommon headache sources such as an aneurysm or tumour. In the vast majority of cases, your scans will be reasonable.
If Your Scan is Normal?Firstly, you should feel relieved. Scans will rule out the more sinister causes of headache or migraine.
Discovering Your Headache Source?We recommend that you should then commence a process of elimination, starting with the most commonly diagnosed and easily fixed sources. Two familiar sources of headache that can undertake an assessment and elimination are neck headache and jaw headache. A thorough examination of your neck by a skilled headache physiotherapist is your next port of call. Researchers believe that at least one in four headaches are neck origin and less than that are jaw headache. You'll have over a 25% chance that your physiotherapist will confirm and then relieve your headache at your first consultation.
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, help patients to manage pain and prevent disease for people of all ages. Physiotherapists help to encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing activities of daily living while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, just to name a few.
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in the field of acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports physio requires an extra level of knowledge and physiotherapy skill to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Women's Health Physiotherapy is a particular interest group of therapies.
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your individual problem, please contact your PhysioWorks team.
Why Patients Choose PhysioWorks for their HealthcareYou'll be impressed with the experienced physiotherapists, massage therapists and reception staff who represent PhysioWorks. To ensure that we remain highly qualified, we are committed to continue education. If you've been searching for therapists with a serious interest in your rehabilitation or injury prevention program, our staff have either participated or are still participating in competitive sports at elite and representative levels. We also currently provide physiotherapy and massage services for numerous sports clubs. Our experience assists us to understand what you need to do to safely and quickly return to the sporting field, home duties or your employment. PhysioWorks is an undergraduate clinical placement facility for training the next generation of physiotherapists. Each year we handpick the cream of the crop, add them to our team and fast track their post-graduate education process to ensure that they become experienced physiotherapists well before their peers.
How You'll Benefit from the PhysioWorks Difference?At PhysioWorks physiotherapy and massage clinics, we strive to offer our clients quick, effective and long lasting results by providing high-quality treatment. Our aim is not only to get you better quicker, but also to create a friendly and caring environment conducive to successful healing. With many years of clinical experience, our friendly service and quality treatment is a benchmark not only in Brisbane but Australia-wide.
What are some of the BIG differences?
- Our therapists pride themselves on keeping up to date with the latest research and treatment skills to ensure that they are providing you with the most advantageous treatment methods. They are constantly updating their knowledge via seminars, conferences, workshops, scientific journals etc.
- Not only will you receive a detailed consultation, but we offer long-term solutions, not just quick fixes that in reality, only last for a short time.
- We attempt to treat the cause, not just the symptoms.
- PhysioWorks clinics are modern thinking. Not only in their appearance but in the equipment we use and in our therapists' knowledge.
- Our staff actually care about you! We are always willing to go that 'extra mile' to guarantee that we cater to our clients' special needs.
What are the Benefits of Good Posture?
- Keeps your bones and joints in the correct alignment.
- Helps to decrease the abnormal wearing of joint surfaces.
- Decreases the stress on the ligaments holding the joints of the spine together.
- Prevents the spine from becoming fixed in abnormal positions.
- Prevents muscle fatigue.
- Prevents any backache and muscular pain.
- Contributes to a competent and confident appearance.
To Achieve Good Posture You Will Require the Following:
- Good muscle flexibility
- Normal motion in the joints
- Strong postural muscles
- A balance of muscles on both sides of the spine
- Awareness of your posture, plus knowledge of proper postural position, which leads to conscious correction.
Article by John Miller
What is the Best Way to Sleep?
Your Best Sleeping Position?
Everybody has their favourite sleeping position. However, some are better for you than others. Try to sleep in a posture that helps you maintain the curve in your lower back. We recommend lying on your back with a pillow under your knees (if more comfortable) or on your side with your knees slightly bent.
It is preferable to not sleep on your side with your knees drawn up to your chest (the foetal position). However, having said that some back conditions will find this preferable. You should seek the advice of your physiotherapist if you are in doubt.
If you are suffering back pain, you could try lying over a lumbar roll or peanut cushion at night to make you more comfortable. A rolled sheet or towel tied around your waist may also be helpful. You may wish to avoid sleeping on your stomach, especially on a saggy mattress. This sag can cause back strain and can be uncomfortable for your neck.
What is Your Best Mattress?
Select a firm mattress or an ensemble that does not sag. If necessary, place a board under your bed's mattress. You can also set the mattress on the floor temporarily if needed. If you've always slept on a soft surface, it may be initially painful to change to a harder surface. Try to do what's most comfortable for you.
How to Rise from Bed
When standing up from the lying position, turn on your side, draw up both knees and swing your legs over the side of the bed. Sit up by pushing yourself up with your hands. Bend forward at your waist with your core muscles activated.
What is Your Best Pillow?
The human neck curves slightly forward (to sustain the weight of the head when upright), and it is crucial to maintain this curve when in a resting position. If the height of the pillow is too high or low when sleeping, your neck is bent abnormally out of alignment, causing muscle and joint strain. You can even wake with headaches.
Poor pillow support can also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep.
The best lying or sleeping position may vary, depending on your symptoms. No matter what posture you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.
To give your body the proper rest it needs, and to ensure the health of your spine, physiotherapists recommend only two sleeping positions: Side sleeping and supine sleeping.
Sleeping on your side, with the spine straight. Sleeping on your back, maintaining the primary curvature of the cervical spine. Both of these positions prevent poor alignment of the neck and upper back. Proper alignment can help to reduce the number of neck aches, backaches, pinched nerves, shoulder and arm referred pain, insomnia, and mental fatigue from a lack of effective sleep.
Why Do Physiotherapists Prescribe You Exercises?The prescription of exercise appropriate to you and your injury or fitness level is one of the many professional skills of a physiotherapist. Whether you have suffered an acute injury, chronic deconditioning or are recovering from surgery, the correct exercise prescription is essential. That's why your physiotherapist's knowledge and skills will personalise your exercise dose. Your physiotherapist not only is educated in injury diagnosis but also exercise physiology or the science of exercise. This training enables your physiotherapist to assess and diagnose your injury, plus also to prescribe injury, fitness or age-appropriate activities targeted to you now.
What Exercises Should You Do?Your exercises shouldn't be painful. Please take caution with some overzealous exercise prescribers who believe that the more painful the activity, the better. Thus simply isn't true—notably, the frail, immunosuppressed, deconditioned or post-operative person. You'll find that your physiotherapist will thoroughly examine you and prescribe a series of exercises suitable for you in quantities that will not injure you further. Please seek an exercise expert, such as your physiotherapist, when you are planning your rehabilitation.
What Happens When You Stop Exercises?Without some simple exercises, we know that specific muscles can become weak. When these supporting muscles are weak, your injured structures are inadequately supported and predispose you to linger symptoms or further injury. You can also over-activate adjacent muscles that may lead to further damage. It is also essential to understand that even if you are "in good shape", you may have crucial but weak localised or stability muscles. When you have an injury, you should perform specific exercises that specifically strengthen the muscles around your injury and the adjacent joints. Your physiotherapist will assess your muscle function and prescribe the right exercises specific for your needs. The exercises prescribed will usually be relatively simple, and do not require any special weights equipment, and can be performed safely at home.
Would You Stop Your Daily Prescription Drugs?Your physiotherapist will prescribe your individualised dose or exercises. They are using their professional expertise to optimise your exercise dose. Would you just stop taking your regular blood pressure medication because you were too busy or didn't think it was working? We would hope not! Exercise, when prescribed by an expert such as your physiotherapist, should be treated as your recommended dose. Just like when you don't take your blood pressure medication, you can't expect the drugs to work of you don't take it as prescribed by your health professional. So, next time you skip your "exercise dose" just remember that you are not putting your health first. If you have any questions, please contact your Physio Works physiotherapist for your best care.
Private Health Insurance Rebates
PhysioWorks Physiotherapy and Remedial Massage are more affordable than you think. Your Private Health Insurance (PHI) usually pays for the majority of your treatment fees, leaving you with only a small gap payment.
However, Private Health Funds do vary their rebates payable depending upon the level of cover that you have taken. Some funds have kept up with the costs of modern medicine whereas, sadly others haven't, with rebates similar to what they were a decade ago.
HICAPS - Instant Health Fund Claims
Most health funds are members of the HICAPS instant claims system. Swipe your health insurance card at our reception counter, and you can instantly claim your physiotherapy treatment via our online Hicaps System. Remedial Massage is claimable via Hicaps for some but not all funds. For more information, please visit Hicaps for the latest funds which can use their instant claiming system.
Private health insurance rebates are available for all of our physiotherapists. Instant claims are possible via our in-practice Hicaps system.
- All Private Health Insurance Funds including BUPA, Medibank Private, HCF
- For a full list of Hicaps instant claim funds see here: Hicaps Funds
- HCF More for Muscles Program
PhysioWorks practitioners are registered providers for government, Workcover and insurance companies including:
- Australia Post; Coles Myer; Woolworths
- Department of Veterans' Affairs
- CTP & Sports Insurers