By Tony ter Ellen, Physiotherapist

Headaches can be associated with serious illness when accompanied by fevers, sudden weight loss and general malaise. However many headaches are stand alone events and can be grouped into two categories – primary and secondary.

Primary headaches include Migraine, tension or exercises induced headaches and are thought to be the caused by vascular fluctuations or muscle tension.  Secondary headaches originate from the neck and are thought to be the cause of around 20 per cent of all headaches.

Neck Headaches vs Migraines

Neck (Cervical) headaches are thought to occur because nerves that supply the top 3 joints in the neck join the spinal cord very close to where the main nerve supply to the head is also situated. The brain gets the signals crossed, interpreting the neck pain as head pain.

While they (headaches) can be similar in some respects, there are some differences which make it possible to distinguish between the two. This is relatively important as cervical headaches  are more likely to respond to manual and exercise therapy.

Migraines tend to start earlier in life (around 18 years) and women are twice as likely to get them. They are often frequent and regular, can be triggered by foods and are associated with nausea and sensitivity to light. The pain comes on fast, is described as throbbing, and more towards the front of the head.

Cervical headaches tend to start in the 30’s with males slightly more likely to get them. They are less frequent with slower onset. They are often triggered by awkward neck movements or sustained positions. The pain usually is less intense and originates in the neck and tends to spread to the back of head and is often one-sided and locked to that side.

Treatment Plan

Because there is an overlap of symptoms the therapist will need to perform motion assessment of the neck to help decide if the neck is the likely source.

Cervical headaches will usually respond to freeing up fixed movement patterns but don’t respond to migraine medication whereas the opposite is true for migraines. Likewise the treatment will usually involve mobilizing the upper neck and doing exercises which target the deep stabilizers of the neck while relaxing the larger muscle which are being overused. Inevitably there will some postural contribution. A forward head position over extends the upper neck and this can be exacerbated by a rounded upper back or forward shoulders. So at some stage the treatment will usually involve addressing these aspects to support the changes further up the spine.


We see a fair number of these headaches in the CBD where are clients are often in front of the computer for large parts of the day.

Give us a call on 834 9901 to make an appointment if you think this might be you!

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