Seek emergency care immediately for
A sudden severe headache that peaks within seconds, headache with fever and a stiff neck, headache after a head injury, or headache with confusion, weakness, slurred speech or visual loss. Also any headache that is genuinely different in character from what you normally get.
Three patterns worth distinguishing
- Cervicogenic headache: arising from the structures of the upper neck. Typically starts at the base of the skull and wraps forward over one side, usually without swapping sides between episodes, and is provoked by neck positions or sustained posture. Cervicogenic headache, which starts in the neck, is the type where the research is strongest.
- Tension-type headache: a band-like pressure on both sides, often through a long or stressful day, frequently with tight neck and shoulder musculature. Typically builds through a long day. Not dangerous, and genuinely miserable when it happens four days a week. Often has a mechanical component worth addressing.
- Migraine: usually one-sided, throbbing, moderate to severe, often with nausea and sensitivity to light or sound, sometimes preceded by aura. A neurological condition, not a mechanical one.
In practice these overlap. Plenty of people have migraine and a neck contribution, which is where the picture gets muddled and where a careful examination earns its keep.
Why the neck can produce headache
The upper three cervical segments share nerve pathways with structures that supply sensation to the head. Irritation arising at those segments can therefore be perceived as headache rather than as neck pain, which is why people frequently have no neck symptoms at all and are surprised when the examination reproduces their headache.
The most common driver of that irritation is sustained loading: holding the head forward of the shoulders for hours a day. See tech neck.
The working-week pattern
If your headaches are worse on Thursday than Monday and largely absent on holidays, the load is coming from something you do repeatedly during the week.
Usually that is sustained posture. Your head weighs about five kilograms, and holding it forward of your shoulders to look at a screen means the muscles and joints at the back of the neck work continuously against a lever, all day. Joints adapt to how they are loaded, and the upper cervical segments are where that adaptation frequently shows up as headache.
Worth ruling out: medication-overuse headache
Regular use of pain relief for headaches can, past a certain frequency, start perpetuating the headaches themselves. It is easy to miss because the pattern looks like worsening headaches rather than a side effect. If you are reaching for something most days, mention it: it changes the plan, and it needs your GP involved rather than more treatment from us.
Being straight about migraine
The evidence for manual therapy is considerably stronger for cervicogenic headache than for true migraine. Some people with migraine have a real cervical contribution and improve when it is addressed. Others do not, and no amount of neck treatment will change their migraines.
We would rather tell you that at the first visit than take you through a course of care hoping. If your presentation looks like migraine without a neck component, the honest recommendation is your GP or a neurologist, and we will say so.
How we assess it
A first visit takes about 30 minutes: a detailed headache history — location, character, triggers, frequency, what you have tried — and then examination of the upper cervical segments, the thoracic spine, the jaw where relevant, and your habitual posture. We record frequency and intensity at the outset so the review is against numbers.
What care might involve
Adjustment of restricted upper cervical and thoracic segments, soft tissue work to the sub-occipital and upper trapezius musculature, cold laser therapy where appropriate, and rehabilitation for the deep neck stabilisers and postural chain. Where jaw dysfunction is contributing, that gets addressed too. Practical workstation advice is part of it where desk posture is the driver.
And if the examination says your headaches are not coming from your neck, you will be told that, along with a recommendation about who to see instead.