Condition Guide · Brighton & Hove
Many headaches that are labelled tension headache or even migraine originate in the neck. Treating the right source changes outcomes completely.
Understanding Headache Types
Headache is one of the most common symptoms in clinical practice, and one of the most frequently mismanaged. The same symptom, head pain, can arise from dozens of different sources with very different drivers and very different treatments. Getting the type right is the essential first step.
Cervicogenic headache, headache originating from the cervical spine, is significantly underdiagnosed. Studies suggest it accounts for 15-20% of all chronic headaches, yet many patients with cervicogenic headache are labelled as tension headache or migraine and treated with medication that targets the wrong mechanism.
Cervicogenic headache is reproduced by pressure on the upper cervical spine and by specific neck movements. If pressing on the suboccipital muscles or rotating the neck reproduces your headache, the cervical spine is almost certainly involved. This simple clinical test changes the management approach entirely and is the starting point for accurate diagnosis.
A sudden severe headache described as the worst of your life (thunderclap headache), headache with fever and neck stiffness, headache following head trauma, headache with visual disturbance and neurological symptoms, or progressive headache worsening over weeks all require urgent medical review before any manual therapy is considered.
Differential Diagnosis
These three headache types share some features but differ in important ways that determine the treatment approach.
Originating from the neck
Myofascial, bilateral
Neurological, episodic
Treatment Approach
Cervicogenic headache has one of the best response rates to manual therapy of any headache type. The key is accurate identification and targeted cervical treatment.
Segmental examination of the upper cervical spine, reproduction testing, postural analysis and screening for headache red flags before any treatment.
Targeted soft tissue work to the suboccipital muscles, upper trapezius and semispinalis, which are almost always involved in cervicogenic and tension headache.
Highly effective for suboccipital and upper trapezius trigger points. Often produces immediate and significant headache reduction within a session.
Specific upper cervical joint mobilisation targeting the C1-C3 segments most commonly involved in cervicogenic headache.
Jaw dysfunction frequently contributes to or co-exists with cervicogenic headache. A combined approach addressing both produces better outcomes.
Addressing the forward head posture and upper crossed syndrome pattern that loads the upper cervical spine and perpetuates headache recurrence.
If your headaches have a neck component, manual therapy can produce dramatic and lasting improvement. The first step is an accurate assessment to identify the source.