Neck Pain and Headaches: How Physiotherapy Can Help

A significant proportion of chronic headaches have a musculoskeletal origin. They start in the neck, not the head. Cervicogenic headaches (headaches originating from the cervical spine) are frequently misdiagnosed as tension headaches or migraines, and treated with medication that addresses the pain but not the underlying cause. Physiotherapy, when applied to the right type of headache, can produce lasting relief that medication alone cannot.

What is a cervicogenic headache?

A cervicogenic headache originates from joints, muscles, or nerves in the upper cervical spine (typically C1–C3). The pain is referred into the head via the trigeminocervical nucleus, a pathway that processes both cervical and head pain. The result is a headache felt at the base of the skull, behind the eyes, or across the forehead that is actually driven by dysfunction in the neck.

How to tell if your headache is cervicogenic

• Headache onset or worsening with sustained neck postures (desk work, driving, reading)
• Reduced neck range of motion, particularly rotation
• Tenderness at the base of the skull or upper neck on palpation
• Headache relieved by hands-on neck treatment
• Headache typically one-sided and not associated with nausea, light or sound sensitivity (unlike migraine)

What physiotherapy treatment involves

Treatment for cervicogenic headache focuses on the upper cervical joints (particularly C1/C2), which are the most common source. Manual therapy to these joints, specifically high-velocity manipulation or lower-grade mobilisation depending on the presentation, is the most consistently effective intervention in the research. This is combined with deep neck flexor strengthening (the muscles most commonly inhibited in people with chronic neck pain and headache) and postural correction.

Neck pain from desk work

Sydney's Eastern Suburbs has a high concentration of knowledge workers, people spending 8+ hours a day at a desk or looking at screens. This is the most common driver of neck pain and cervicogenic headache in the area. Prolonged desk work, looking down at a phone, or sitting with the head forward all create sustained load on the structures at the back of the neck. Seth can assess your setup during a home visit and provide specific advice on ergonomics, movement breaks, and exercise prescription tailored to your working pattern.

Woke up with a stiff neck?

Waking up with a locked, painful neck is common, and most people blame their pillow. More often the overnight episode is the end of something that was building during the day: by evening the joint capsules and muscles are already sensitised from sustained postures, and a few hours of sleep in a slightly awkward position tips it into an acute flare.

• In the first hour, don't stay completely still. Gently turn the head side to side and nod up and down to the first point of resistance.
• Apply a heat pack to the neck and upper trapezius for 15 to 20 minutes alongside the movement.
• Avoid driving if rotation is significantly restricted, and take small movement breaks every 30 to 45 minutes.
• Skip the soft cervical collar: it promotes deconditioning and slows recovery.
• If the pain is severe, anti-inflammatories or muscle relaxants prescribed by a GP can help in the short term.

If it keeps happening, something upstream needs addressing, usually a combination of thoracic stiffness, weak deep neck flexors, and workstation setup. A physio assessment can identify the specific contributing factors and put a plan in place to stop it coming back.

When to seek further investigation

Most neck pain and associated headaches are benign and respond well to physiotherapy. However, seek prompt medical assessment if you have a sudden, severe 'thunderclap' headache (worst of your life), headache with fever and neck stiffness, progressive neurological symptoms such as weakness or coordination problems, or headache following a significant head or neck trauma.