# Headaches from the neck A headache from the neck (a cervicogenic headache) is head pain that comes from the joints and muscles of the upper neck. It usually sits on one side, from the base of the skull forward to behind the eye, and neck positions or desk hours set it off. We test whether the neck is the source, treat its joints and muscles, and build strength to keep it from returning. ## Symptoms - A headache on one side that stays on that side - Pain spreading from the top of the neck to behind the eye - A headache set off by holding your head in one position - Tender spots at the top of the neck that set off the headache - A stiff neck, or less turn to one side - A headache that builds after hours at a desk, on the bike or belaying - A dull, steady ache rather than a throb ## Assessment 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 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](https://backinactionphysiotherapy.com/services/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](https://backinactionphysiotherapy.com/services/dry-needling). - **Massage therapy:** soft-tissue and trigger-point work for the muscle tension across the neck and shoulders, alongside physiotherapy. See [massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy). - **Desk and sleep set-up:** where your screen sits, how often you change position, and how you sleep. ## Getting back to sport 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. ## When to come in 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 ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Manual Therapy](https://backinactionphysiotherapy.com/services/manual-therapy) - [IMS and Dry Needling](https://backinactionphysiotherapy.com/services/dry-needling) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Frequently asked questions ### Is it a migraine or is it coming from my neck? Hard to tell. A migraine tends to throb, often brings nausea or sensitivity to light and sound, and can change sides between attacks. A headache from the neck is more often a steady ache that stays on one side and changes when you move or press your neck. Some people have both, and a sore neck can trigger their migraines. The neck tests in the clinic usually settle it. ### Do you crack the neck to treat these headaches? Not always. Manipulation, the quick movement that can make a joint click, is one of the tools in manual therapy. We use it only where the assessment supports it and only if you are comfortable with it. Slower, gentler joint movements (mobilization) often do the same job, and you can choose those instead. Either way, the hands-on work eases the headache, and the exercise is what helps stop it returning. ### Can my pillow be causing the headaches? It can. If you wake with the headache, or it is worst first thing, your sleeping position is a likely part of it. A pillow that is too high or too flat holds the upper neck bent for hours, and sleeping on your front twists it. A pillow that keeps your head level with your spine, on your side or your back, is usually enough. We ask how you sleep as part of the assessment. ### Should I book massage therapy or physiotherapy first? Either. If tight muscles across your neck and shoulders are what you feel most, a massage therapist (RMT) can start on them straight away with trigger-point work. If the headache is one-sided and tied to neck movement, start with physiotherapy, which assesses the joints and sets the exercises. Many people use both, with massage carrying the soft-tissue side between physiotherapy visits. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*