Chiropractic care for headaches that start in the neck
A headache that starts at the base of the skull and builds through a working day is worth having your neck looked at, though the headache alone cannot tell you where it started.
Sound familiar?
- “it starts at the base of my skull”
- “it comes on by the afternoon”
- “a band around my head”
What it actually is
The clinical name for a headache coming from the neck is cervicogenic headache. The International Classification of Headache Disorders describes it as a headache caused by a disorder of the cervical spine and its bony, disc or soft tissue elements, usually but not invariably accompanied by neck pain. That classification is a definition of the condition, not a recommendation about treatment; it makes none. The neck does not have to be the loudest thing you notice for it to be the source.
Nerves from the top three levels of the neck arrive at the same relay point in the brainstem as the nerve supplying your forehead and the area behind your eyes, so the brain can read an irritated joint up there as pain in the head. That is referred pain, and it is why a headache can be genuine and severe with nothing wrong inside your head at all.
The muscles matter too. An adult head weighs roughly five kilograms, and the further in front of the shoulders it drifts, the more of that weight the muscles at the base of the skull and across the upper back hold instead of the bones. Hold that shape through a working day and those muscles get tender, and tender muscles refer pain away from where they sit: a tight strip up the back of the skull, or an ache in behind one eye. When the ache is a band around both sides of the head, that is the tension-type pattern described below, and the two often overlap. Muscles fatigue when they are held, which is why the ache tends to build through the afternoon.
None of that proves your headaches start in your neck; it explains why they can. Tension-type headache is the common one, a band across both sides tied to long days and fatigue. Migraine is often throbbing and one-sided, with nausea or trouble with light and sound, and neck pain is a very common feature of it too, so a sore neck alongside a headache is not proof.
Migraine diagnosis and migraine medication sit with your GP; our work on the neck runs alongside that care. Migraine itself is not something we work on.
What people notice
- pain that begins low at the back of the skull and travels forward, often ending up behind an eye
- one side rather than both, and typically the same side every time
- pressure, or a steady ache, rather than anything that pulses
- a neck that is stiff and sore with it, and turns further one way than the other
- headaches that follow a position held too long: a meeting that ran over, a long drive, a bad night on the pillow
- usually no nausea, and light and sound generally tolerable
Where it sits in the body
- the top three joints of the neck, directly under the base of the skull
- the brainstem relay the upper neck nerves share with the nerve supplying the face and scalp
- the muscles at the base of the skull and across the upper back
- the bony, disc and soft tissue elements of the cervical spine
What the assessment looks for
Working out whether the neck is involved at all is the first job, and it is an examination rather than a label.
- How the top of the neck moves, and where in the range it stops.
- Whether pressure on those joints reproduces the headache you usually get.
- The muscles that hold your head up, and how quickly they tire.
- How the head is carried through a working day: screen height, the phone, how long you sit.
- The causes that belong with your GP or a hospital, screened for first.
What comes out of it is a finding rather than a verdict, and you get it the same day, in plain words. If the examination does not point at your neck, we say so on the day.
Choosing between professions? Should I see a chiropractor, a physio or an osteopath? compares the three for headaches from the neck.
What care involves
Where the neck is part of the picture, the hands-on work is gentle joint and muscle techniques through the upper neck and shoulders, applied to what the examination pointed at, not to the whole spine on principle. A neck adjustment is one option among several and never an automatic one.
Two things carry it between visits: loading for the deep neck muscles that give out first under a long day, and a blunt conversation about the parts of the day that keep the cycle going. Lifting the top of the monitor to about eye height, bringing the phone up to you, and getting up roughly every half hour are unglamorous, and they are the habits the coaching keeps coming back to.
Early on the aim is to settle what is there now and to pin down what is driving it, and the next visit is partly a test of whether anything moved. If nothing did, that is information too. If things ease, hands-on time comes down, the movement and habit work takes over, and visits spread out. The order is deliberate, because the work is built for lasting improvement rather than short-term relief.
What we will not do is put a number on it. Two people with the same finding can travel very different distances, and what separates them is usually how entrenched the pattern already is and how much of the working day can actually change.
That refusal is not evasion, and it is worth having at length: how many visits will I need? explains what is being weighed instead.
Everyone moves through this differently, so the plan is paced to your body, reviewed with you as you progress, not read off a fixed schedule of visits.
What the guidelines say
- International Headache Society, The International Classification of Headache Disorders, 3rd edition, 11.2.1 Cervicogenic headache, 2018. https://ichd-3.org/11-headache-or-facial-pain-attributed-to-disorder-of-the-cranium-neck-eyes-ears-nose-sinuses-teeth-mouth-or-other-facial-or-cervical-structure/11-2-headache-attributed-to-disorder-of-the-neck/11-2-1-cervicogenic-headache/
When to get it looked at
Headaches are where screening matters most, and it happens before anybody puts a hand on your neck.
Call an ambulance if there is any confusion, sudden weakness or numbness in the face, arm or leg on one side, facial drooping, slurred speech, sudden trouble speaking, seeing or understanding, loss of vision, a seizure, or a sudden loss of balance or coordination. Call an ambulance or go to a hospital emergency department straight away if a headache comes on suddenly and severely (the worst you have ever had), if a headache arrives with fever, a stiff neck or a rash, or if a headache follows a knock to the head.
Go to a hospital emergency department straight away for back or neck pain after a serious fall or a high-impact accident, such as a car accident; back or neck pain with a fever or feeling generally unwell; or new back or neck pain if your immune system is weakened, for instance by long-term steroids or chemotherapy, if you inject drugs, or if you have recently had a spinal injection, spinal surgery or a dental procedure. Go to a hospital emergency department straight away if you have weakness in one arm that is severe or getting worse, or numbness in an arm that is spreading or getting worse quickly. Go to a hospital emergency department the same day if you have new clumsiness in both hands, or new unsteadiness on your feet.
See your GP first if you have a brand-new type of headache, if your usual headache has changed its pattern, if your first bad headaches have started after the age of 50, if they are worse lying down or when you cough or strain, if you are taking pain relief for headaches more than a couple of days most weeks, or if you think you may have migraine and have never been assessed.
See your GP promptly, before booking here, if you have pins and needles, numbness or weakness in an arm or hand, a history of cancer, unexplained weight loss, pain at night that will not settle in any position, or known osteoporosis with new severe pain.
Short of that, the ordinary threshold for having the neck looked at is a plain one: headaches several times a month, headaches that turn up with a stiff neck, or headaches that build across the working week.
Common questions
Is this the same thing as a tension headache or a migraine?
They overlap, and plenty of people have more than one. A headache from the neck usually sits on one side, starts at the base of the skull and is set off by holding a position; tension-type headache is usually a band across both sides; migraine is often throbbing, with nausea or trouble with light and sound. Those are patterns rather than tests, and telling them apart takes an examination.
Do I need a scan or an X-ray before I come in?
Usually not. A scan shows structure and says nothing about how you move, so for most neck and headache patterns the history and the examination tell us what we need to know. Imaging is arranged only when clinically indicated. The International Classification of Headache Disorders also notes that imaging findings in the upper cervical spine are common in people who have no headache, so they are suggestive rather than firm evidence of causation.
Do you have to click my neck? The idea makes me nervous.
No. Gentle joint mobilisation, soft-tissue work and exercise are the alternatives, and which of them is used follows the examination rather than a default. Whatever is being suggested is described to you before it happens, and you can decline any part of it without it being awkward.
That last one has a longer answer than an accordion gives it, and the longer answer is the honest one. Is chiropractic safe, and what does the evidence actually say? sets out the risks of neck work, and what the guidelines do and do not support.
Read next
Nearby: Chiropractic care for neck pain and Chiropractic care for posture.
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