Headaches from the neck

We start with the pattern: where it starts, which side, what brings it on, and whether desk hours, sleep, a fall or a crash play a part. Then we examine the neck:

• the joints at the top of the neck, and whether pressing or moving them brings on your usual headache
• how far your neck turns, bends and tips back
• the deep muscles at the front of the neck, and the muscles at the base of the skull and across the shoulders
• how you sit, stand and hold your head

Bringing on your usual headache by pressing or moving the neck is the clearest sign it comes from there. We also tell it from a migraine or a tension-type headache, because the patterns overlap.

Treatment matches what the assessment finds. It usually combines:

• Hands-on treatment of the upper neck: joint mobilization and, where it suits you, manipulation, with soft-tissue work on the muscles at the base of the skull. This is manual therapy, from physiotherapists with post-graduate manual therapy training.
• Exercise: the lasting part. We train the deep muscles at the front of the neck first, since they are often weak in these headaches. Then the shoulder blade and upper back muscles that carry the head all day.
• Dry needling: fine, solid needles placed into tight, tender spots in the muscles at the base of the skull and across the shoulders, to help them release. See dry needling.
• Massage therapy: soft-tissue and trigger-point work for the muscle tension across the neck and shoulders, alongside physiotherapy. See massage therapy.
• Desk and sleep set-up: where your screen sits, how often you change position, and how you sleep.

Most Whistler sports hold the upper neck in one position. On a bike the head sits up and back for an hour at a time, and rough descents jar it. Belaying and overhead work in the trades tip it back for long stretches, and a ski day is spent looking down the hill.

We build back in stages. First the deep neck muscles learn to hold your head steady in the position your sport asks for, then we add time, rough ground and effort. A session is fine if it leaves your headache no more than a little worse and it settles by the next day. No set date: you move on when the current stage no longer stirs it. A helmet that fits, and a bike set up so you can look down the trail without craning, take load off the neck.

Book an assessment if a one-sided headache keeps coming back, starts at the base of the skull, or comes with a stiff neck. Come in too if desk days, riding or a fall bring it on, or it is getting in the way of work, study and sport.

See a doctor or nurse practitioner first if the headache is new, severe, or comes with fever, vomiting, or changes in vision, speech, balance or strength. If the pattern we find does not fit the neck, we say so.

Go to the emergency department right away, or call 911, if any of these happen:

• a sudden, severe headache unlike any you have had before
• a headache with a fever and a stiff neck
• a headache after a blow to the head
• a headache with weakness, numbness, slurred speech, confusion or loss of vision
• a headache that keeps getting worse over hours or days