Is Your Headache Coming From Your Neck?

Is your headache coming from your neck?

There are a number of different types of headaches. The International Headache Society has 14 different classifications of headaches! Some of the common types of headaches many people have heard of are migraine, sinus, tension, and cluster headaches.1 Headaches are common and almost everyone will experience one or more types of headache in their life. Each type of headache has its own unique presentation and symptoms. This picture shows common pain patterns for 4 different types of headaches:

Image result for 4 different types of headaches

There are two main types of headache that a physical therapist can help manage. These are tension type headaches and cervicogenic headache. Tension type headaches are the most common of all headaches.2 Tension type headaches often are brought on by stress and can be described as pressure or tightness in the area of the temples. Tension headaches are different than migraine headaches because there are no other symptoms like sensitivity to light or sound, and no nausea or vomiting.2

Cervicogenic means the headache is caused by a problem or dysfunction of the muscles, joints, or nerves in the neck that can refer pain to the head. Cervicogenic headaches are often described as starting as neck pain that radiates to the back of the head and can cause a “ram’s horn” headache pattern:

Image result for rams horn headache

In the image above you can see the occipital nerves come from the spine and wrap up the back of the head. These nerves run through the suboccipital muscles and fascia at the base of the skull. If these muscles are tight or in spasm they can press on this nerve and it is believed this can be one of the causes of cervicogenic headache. Similarly the joints of the cervical spine and muscles of the upper neck can also refer pain to the head.3,4,5 With all of the different structures that can contribute to cervicogenic headache the presentation can vary with different pain sensations and patterns.

As doctors of physical therapy we are trained to identify the types of headaches we can help with and which types of headache require us to send you back to see your doctor. By talking in depth about your symptoms and performing a thorough exam we can identify if your headache is appropriate for treatment by a physical therapist.4,5

Manual therapy including mobilization and manipulation of the joints of the cervical and thoracic spine as well as to the muscles of the suboccipital, neck and upper back has been shown to help improve symptoms with tension type and cervicogenic headache.5 Exercise and education on posture and ergonomics are also helpful to treat these types of headache.5

If you are not sure what type of headache you are experiencing come and see us! We can talk about the symptoms you are experiencing and discuss the treatment options for your specific situation.

DISCLAIMER: Some types of headaches can be signs of more serious health issues. If you have had a trauma or have a sudden onset of severe headache symptoms call your doctor right away.


1 - International Headache Society Headache Classification -

2 - UpToDate - Headache Causes and Diagnosis

3 - Racicki S, Gerwin S, Diclaudio S, Reinmann S, Donaldson M. Conservative
physical therapy management for the treatment of cervicogenic headache: a
systematic review. J Man Manip Ther. 2013 May;21(2):113-24.

4 - Howard PD, Behrns W, Martino MD, DiMambro A, McIntyre K, Shurer C. Manual
examination in the diagnosis of cervicogenic headache: a systematic literature
review. J Man Manip Ther. 2015 Sep;23(4):210-8.

5 - Page P. Cervicogenic headaches: an evidence-led approach to clinical
management. Int J Sports Phys Ther. 2011 Sep;6(3):254-66.

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