Many people assume that all severe headaches must be migraines and end up relying on prescription or over-the-counter medication for relief.

However, a significant proportion of recurrent headaches come from the joints and muscles at the top of the neck. They are known as cervical or cervicogenic headaches and research has shown that musculoskeletal physiotherapy can provide substantial relief.

How does the neck cause headaches?

The upper three cervical nerves supply the joints and muscles at the top of the neck and the back of the head as far as the crown. These nerves also have connections with the nerves that supply the rest of the head. This area of overlap occurs in the upper part of the spinal cord and is known as the Trigemino-cervical nucleus. Pain caused by irritated joints and muscles in the neck can be felt in the back of the head, temples, forehead and even behind the eyes.

What can I expect if I see a Musculoskeletal Physiotherapist for my headaches?

A Musculoskeletal Physiotherapy consultation will start with a detailed interview to form a provisional diagnosis and rule out causes of headache that might require medical referral. They will perform a thorough physical examination to determine if your neck is causing or contributing to your headaches. Targeted treatment of manual therapy and an exercise program specific to you, can provide significant and long-lasting relief.

How effective is Physiotherapy for Cervicogenic headache?

There is strong scientific evidence that Musculoskeletal Physiotherapy is an effective treatment for cervicogenic headache. A high-quality Australian trial found that manual therapy and specific exercises were highly effective and superior to usual management from a General Practitioner, even at 12-month follow-up (Jull et al 2001).

What causes migraines?

Most people with migraine inherit a predisposition of the trigemino-cervical nucleus to become extremely sensitive when exposed to certain triggers (eg particular foods or smells, bright or flashing lights, stress, sleep disturbances or pre-menstrually). Some patients report that neck pain can also act as a trigger or combine with other factors. Chemical changes in the brain during an attack often cause inflammation of blood vessels around the brain leading to the characteristic severe, throbbing headache.

Can neck treatment cure migraines?

The scientific literature does not support the use of manual therapies provided by physiotherapists, chiropractors or osteopaths as a primary treatment of migraine. However, some migraine patients have significant upper cervical dysfunction (eg stiff joints and tight muscles) that can act as a trigger for the migraine or contribute to the headache and neck pain of a migraine attack. For these people, physiotherapy may be a valuable adjunct to proven migraine therapies. Accurate diagnosis is essential to ensure that the patient receives appropriate and effective care.

What is Tension-type headache?

Like migraine, tension-type headache is classified as a primary headache, ie not associated with any particular structural pathology. The pain of tension-type headaches is often described as aching, pressure or band-like and usually felt all over the head. There may be a genetic or inherited component to tension-type headache, predisposing to a degree of sensitivity in the trigemino-cervical nucleus, although not as pronounced as in migraine.

Can physiotherapy help tension-type headache?

A proportion of patients with tension-type headache also have painful joints and muscles in their necks (see review by Jull and Hall, 2018). However the relationship between the neck disorders and the patient’s headaches is not always clear. In some patients with tension-type headache, there is little or no dysfunction found on examination and physiotherapy treatment is unlikely to be of significant benefit. In other patients there is a clear relationship between the painful joints and muscles in the neck and the patient’s headaches. Physiotherapy treatment is likely to be beneficial for these people. As with migraine, a thorough examination is vital to determine the relationship between painful neck disorders and the headaches.

How do I know if the headaches are coming from my neck?

If your headache satisfies one or more of the following criteria it could be coming from your neck:

  • starts in the neck and spreads to the rest of the head
  • brought on by neck movements or prolonged postures (often sitting at the computer)
  • eased by heat or pressure applied to the neck
  • more severe on one side of the head
  • described as aching rather than throbbing