Headaches From the Neck
Some headaches don’t start in the head at all — they come from the neck. These cervicogenic headaches are often mistaken for migraine or tension headaches, but once the neck is correctly identified as the source, they respond really well to the right physiotherapy.
Headaches that come from the neck
A cervicogenic headache is a headache that is actually driven by the neck. The joints, discs and muscles of the top of the neck (the upper three vertebrae) can refer pain up into the head — felt at the back of the head, over the temple or behind the eye — even though the source is the neck. It is commonly mistaken for migraine or tension headache, which is why it is so often missed.
How to recognise it
Usually one-sided and tends to stay on the same side. It is brought on or worsened by neck postures and movements — desk work, phone use, driving, sleeping awkwardly — and often comes with a stiff, restricted neck or tenderness at the base of the skull.
What it is not
It is different from migraine (which is often throbbing, with nausea and light sensitivity) and from tension headache. Getting the diagnosis right matters, because a neck-driven headache responds to treating the neck.
Where the pain actually comes from
The small suboccipital muscles at the base of the skull connect the head to the top two vertebrae (C1 and C2) and are richly supplied with nerves. When these joints and muscles become stiff, tight or irritated, they refer pain upward into the head — over the back of the skull, the temple or behind the eye. Treating these specific structures is what settles the headache.
Treat the neck, and it settles
The good news is that cervicogenic headache responds well to physiotherapy. In a landmark randomised trial, both manual therapy (mobilising the stiff upper-neck joints) and specific neck exercise (retraining the deep neck-stabilising muscles) significantly reduced headache frequency and intensity — and the benefits were maintained a year later (Jull et al., 2002).
Hands-on treatment
We assess and mobilise the specific upper-neck joints that are referring pain, easing the stiffness and sensitivity that trigger the headache.
Retrain and rebuild
Alongside that, we retrain the deep neck flexor muscles and address the postures and loads — desk set-up, screen habits — that keep feeding it, so the result lasts.
Sources & further reading
Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002;27(17):1835–1843. pubmed.ncbi.nlm.nih.gov
Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3): cervicogenic headache (11.2.1). ichd-3.org
Physiotherapy assessment for cervicogenic headache
Your first appointment is a proper assessment, in two parts:
Subjective assessment
A detailed discussion about how it started, what makes it better or worse, how it is affecting your work, training and daily life, and your goals — including any event you are building towards.
Objective assessment
A hands-on examination — strength, movement, loading and specific tests — to pin down the diagnosis and what is driving it. Where it will change your plan, we can arrange diagnostic ultrasound scanning in-house.
Book a headache & neck assessment
If your headaches seem to come from your neck, a proper assessment can confirm it and start the treatment that actually works — rather than another round of painkillers.