Headaches are among the most common health complaints worldwide. For many people, the immediate response is to reach for a painkiller, rest in a dark room, or simply wait for the pain to disappear. But what if the headache is not actually originating from the head?
In some cases, the source lies in the neck.
Known as a cervicogenic headache, this condition occurs when pain originating from structures in the cervical spine – the neck – is felt in the head or face. It is often overlooked because its symptoms can resemble other common types of headache, including migraine and tension-type headache. Understanding the connection between the neck and the head can therefore be an important step towards receiving appropriate treatment.
A cervicogenic headache is a secondary headache, meaning that the headache is caused by another underlying musculoskeletal problem rather than being a primary headache disorder.
The upper portion of the cervical spine has a close neurological relationship with structures of the head and face. Pain-sensitive structures in the upper neck can transmit signals through pathways that converge with sensory pathways from the head. As a result, irritation or dysfunction in the upper cervical region can be perceived as pain in the head.
Patients may experience pain that begins around the neck or back of the head and travels towards the forehead, temple, or behind the eye. The pain is often one-sided, although it does not necessarily remain strictly on one side.
Certain movements or sustained positions of the neck may aggravate symptoms. Some people notice increased pain after prolonged computer work, smartphone use, driving, reading, or sitting at a desk. Reduced neck movement and tenderness around the cervical and shoulder muscles may also accompany the headache.
There is rarely a single cause.
Cervicogenic headaches may be associated with dysfunction of the upper cervical joints, muscle tightness, poor movement patterns, prolonged static postures, previous neck injuries, or conditions such as cervical osteoarthritis. Whiplash injuries and other forms of trauma may also contribute.
Modern lifestyles can add another layer to the problem. Hours spent looking down at phones, working on laptops, or sitting without adequate movement can place considerable demands on the neck and shoulder region.
However, it is important to avoid the simplistic idea that “bad posture” alone causes every headache. Human posture naturally varies, and headaches are influenced by multiple factors. A proper clinical assessment is therefore more useful than focusing on posture in isolation.
Physiotherapy can play an important role in the assessment and management of cervicogenic headache. The first step is not treatment—it is identifying the source of the symptoms. A physiotherapist assesses the cervical spine, range of motion, muscle function, joint mobility, posture and movement patterns, while also screening for symptoms that may require medical evaluation.
Once a cervicogenic component has been identified, treatment can be tailored to the individual’s presentation. Manual therapy may be used to address restricted cervical or upper thoracic movement and reduce pain. Depending on the assessment, this may include joint mobilisation and soft-tissue techniques. Therapeutic exercise is another important component. Exercises may target the deep neck flexor muscles, cervical extensors, scapular stabilisers and other muscles involved in controlling the head and neck. The goal is not simply to make muscles stronger, but to improve coordination, endurance and the ability of the neck and shoulder complex to tolerate everyday activities. For individuals with restricted neck movement, physiotherapists may also prescribe specific mobility exercises. These are generally progressed gradually according to symptoms and clinical findings. Education is equally important. Patients may be advised on workstation setup, movement breaks, sleep positioning, activity modification and strategies to avoid prolonged static loading of the neck.
Some physiotherapy clinics use techniques such as dry needling, kinesiology taping, heat, electrotherapy or other adjunctive modalities. These approaches may provide symptom relief for selected patients, but they should generally be viewed as adjuncts rather than replacements for an active rehabilitation programme. A long-term approach should address the factors contributing to the patient’s symptoms through appropriate exercise, education and functional rehabilitation.
Not every headache is a cervicogenic headache, and persistent or severe headaches should not automatically be attributed to the neck. A sudden, extremely severe headache; headache following significant trauma; new neurological symptoms such as weakness, difficulty speaking, loss of consciousness or significant visual disturbance; fever with neck stiffness; or a rapidly changing headache pattern warrants prompt medical assessment. Similarly, recurrent headaches that interfere with work, sleep or daily life deserve proper evaluation rather than repeated self-medication.
The neck and the head do not function as completely separate systems. Their muscles, joints and nervous system are closely interconnected, and dysfunction in one region can influence symptoms in another.
For people whose headaches are genuinely cervicogenic in origin, physiotherapy can offer more than temporary pain relief. Through careful assessment, manual techniques where appropriate, targeted exercise, education and gradual return to normal activity, treatment can address both symptoms and contributing physical factors. The key is individualised care. There is no single exercise, posture or treatment technique that works for every headache patient.
A headache may be felt in the head—but sometimes, the answer begins with looking at the neck.
The writer is Founder and Consultant Physiotherapist at Dr Parsa’s Clinic. parsamusawir@gmail.com
