Many recurring headaches are linked to the neck and the muscles around it, and physiotherapy can help when they are. Tension-type headaches, the most common kind, feel like a band of pressure across the forehead or the back of the head. Cervicogenic headaches start in the upper neck and usually sit on one side. Both often respond to a treatment plan that combines hands-on treatment, specific neck and shoulder exercises, and changes to how you sit, work and sleep.
This article explains how to tell the two apart, why the neck can cause head pain, what physiotherapy treatment involves, and the warning signs that mean you should see a doctor first.
Tension headache vs cervicogenic headache
Both can feel like they come from the neck and shoulders, but they behave differently.
Tension-type headache
- A dull, pressing or tightening ache, often described as a band or a heavy weight.
- Usually felt on both sides of the head, the forehead, or the back of the head.
- Mild to moderate, and does not usually get worse with walking or climbing stairs.
- Often comes with tight, tender muscles across the neck, shoulders and scalp.
- Commonly linked to stress, poor sleep, long hours at a screen and sustained postures.
Cervicogenic headache
- Starts in the neck and spreads up the back of the head, sometimes to the temple or behind the eye.
- Usually one-sided and tends to stay on the same side.
- Brought on or worsened by neck movement, an awkward neck position, or pressure on the upper neck.
- Often comes with reduced neck movement, especially turning the head.
- Common after whiplash and in people with long-standing neck pain.
Migraine is a different condition. It is typically throbbing, often one-sided, worse with activity, and comes with nausea or sensitivity to light and sound. People can have more than one headache type, which is part of why a proper assessment matters.
Why the neck can cause head pain
The nerves from the top three joints of the neck share a relay point in the brainstem with the nerve that supplies much of the head and face. When the upper neck joints or muscles are irritated, the brain can read that signal as pain in the head. This is called referred pain, and it is the reason a stiff upper neck can produce a headache behind the eye.
Muscles play a part too. The muscles at the base of the skull and across the top of the shoulders can become sensitive and develop tender points that refer pain into the head. Holding the head forward for hours, clenching the jaw, and shallow, stressed breathing all keep those muscles working when they should be resting.
Common triggers we see in north Edmonton
- Desk and screen work. Long stretches with the head drifting forward toward a laptop or phone.
- Driving. Commuting and shift driving with the shoulders held up and the neck fixed.
- Car accidents. Headaches starting at the base of the skull are a common whiplash symptom, sometimes appearing days later.
- Jaw clenching and grinding. The jaw muscles and the upper neck work closely together.
- Poor sleep and stress. Both lower the threshold for headaches and raise muscle tension.
- Physical jobs. Overhead work, carrying loads and repetitive lifting.
How physiotherapy treats tension and neck-related headaches
Treatment is built around what the assessment finds, so no two plans are identical. Most plans draw on the following.
Hands-on treatment
Joint mobilization to the upper neck and upper back, and soft tissue work to the muscles at the base of the skull and across the shoulders. The aim is to restore movement and calm sensitive tissue so the exercise work can take hold.
Specific exercise
Training the deep neck flexor muscles, which support the neck from the front, is one of the better-studied parts of headache care. It is gentle, precise work rather than heavy strengthening. Shoulder blade and upper back strengthening, and mobility for a stiff upper back, usually follow.
Posture and workstation changes
Practical adjustments to screen height, chair setup, phone use and driving position. The goal is not a perfect posture held all day, but more variety and fewer hours locked in one position. Our article on office posture tips covers the basics.
Other options where they fit
Depending on the findings, a plan may include dry needling or IMS for sensitive muscles, TMJ physiotherapy when the jaw is involved, registered massage therapy for muscle tension, or vestibular assessment when headaches come with dizziness.
Research supports exercise and manual therapy for cervicogenic headache and as part of care for tension-type headache, particularly when used together. Results vary from person to person, and a plan is reviewed and adjusted as you go.
Small changes to try this week
None of these replace an assessment, but they are low risk and often help while you wait for one:
- Raise your screen. The top of the monitor at about eye level stops the head drifting forward. On a laptop, a stand and a separate keyboard make the biggest difference.
- Break up long sitting. Stand, roll your shoulders and turn your head gently through its comfortable range every so often, rather than holding one position for hours.
- Check your phone habit. Bring the phone up toward eye level instead of dropping your head down to it.
- Notice your jaw. Teeth apart, lips together and tongue resting on the roof of the mouth is a relaxed jaw position. If you catch yourself clenching, let it go.
- Look at your pillow. A pillow that keeps your head level with your spine, neither propped up nor dropped down, suits most people.
- Keep a headache diary. Note when each headache starts, where it sits, what you were doing and what eased it. Patterns often show up within two weeks, and the diary makes your assessment more useful.
If a change makes your headaches clearly worse, stop it and mention it at your appointment.
Headache warning signs: see a doctor first
Physiotherapy is not the first step for every headache. Seek medical care promptly, and call 911 for sudden or severe symptoms, if a headache:
- Comes on suddenly and severely, often described as the worst headache of your life.
- Follows a head injury, or gets steadily worse after one.
- Comes with fever, a stiff neck, a rash, or confusion.
- Comes with weakness, numbness, slurred speech, vision changes, or loss of balance.
- Is new after age 50, or has changed pattern significantly.
- Wakes you from sleep, or is worst on waking and getting progressively worse.
Also talk to your doctor or pharmacist if you are taking pain medication for headaches on many days each month, because frequent use can itself keep headaches going.
A physiotherapy assessment includes screening for these signs. If anything suggests your headache needs medical investigation, we will tell you and point you to the right place.
What to expect at your assessment
At Trust Care Physiotherapy, the assessment starts with your headache history: where it starts, how often, how long it lasts, what brings it on and what eases it. A headache diary for a week or two beforehand is useful if you can keep one.
The physical assessment looks at neck movement, the upper neck joints, the deep neck muscles, shoulder and upper back mechanics, the jaw, and your posture at rest and at work. You leave with an explanation of what appears to be driving your headaches, a treatment plan, and a short home program to start right away.
If your headaches began after a car accident, physiotherapy may be covered under Section B accident benefits, and we bill your auto insurer directly. See whiplash treatment in Edmonton for how that works. For everything else, we direct bill more than 40 extended health insurers.
Frequently asked questions
Can physiotherapy help tension headaches?
Yes, when the neck, shoulders or posture are contributing. Physiotherapy for tension-type headache usually combines hands-on treatment, specific neck and upper back exercise, and changes to work and sleep habits. Results vary between people.
How do I know if my headache is coming from my neck?
Signs include a headache that starts in the neck and spreads upward, stays on one side, and is brought on by neck movement or sustained positions, often with a stiff neck. A physiotherapy assessment can test the upper neck to confirm whether it is involved.
What is the difference between a tension headache and a migraine?
A tension headache is usually a steady pressing ache on both sides that does not worsen with activity. A migraine is typically throbbing, often one-sided, worse with movement, and comes with nausea or sensitivity to light and sound.
How many physiotherapy sessions will I need for headaches?
It depends on how long the headaches have been present and what is driving them. Your physiotherapist will outline an expected plan after the assessment and review progress at each visit, with the home program doing much of the work between sessions.
Can massage help tension headaches?
Massage can ease muscle tension in the neck, shoulders and scalp and is often a helpful part of care. It tends to work well alongside exercise and habit changes that address why the muscles keep tightening.
Trust Care Physiotherapy, 14415 Miller Blvd NW, Edmonton, AB. Call (825) 525-2983 or book your initial assessment at trustcarephysio.ca.
Information provided is general and educational. It is not a substitute for an in-person assessment by a Registered Physiotherapist.
Educational physiotherapy content from the Trust Care Physiotherapy team in North Edmonton, with input from Registered Physiotherapists where clinically relevant.
