Tension headache, headache from the neck or migraine
Tension headache – in the international ICHD-3 classification, tension-type headache – is the most common primary headache. It usually affects both sides of the head, feels like pressure or tightening, is mild or moderate and does not get worse with ordinary activity. It often comes with tenderness in the muscles of the neck, temples and forehead. There is no single “blocked” structure behind it – factors such as stress, lack of sleep and greater sensitivity of the nervous system to pain all play a part.
Headache originating in the neck (cervicogenic headache) is a different problem: its source is the joints and tissues of the upper neck. Typically it is one-sided and does not switch sides, starts in the neck and spreads towards the forehead or eye, and is brought on by neck movement or by holding the head in one position for a long time. Migraine, in turn, can be throbbing and more severe, gets worse with exertion and often comes with nausea. Diagnosing and treating it is a job for a doctor, ideally a neurologist – here physiotherapy can at most support treatment when migraine comes with neck problems.
What the assessment looks like
We start with the history: where it hurts, how often, how long an episode lasts, what brings it on and what brings relief. A headache diary kept for a few weeks helps a great deal. We also ask about warning signs and how often you take painkillers. Taken on many days a month, they can themselves keep the pain going – in that case the first step is a conversation with a doctor.
Then we assess the mobility of the neck, especially the upper cervical joints, the endurance of the deep neck muscles, tenderness in the muscles of the neck, temples and jaw, and the position of the shoulder blades. We check whether pressing on specific spots or a particular movement reproduces your familiar headache. If the picture points to migraine or pain that needs medical investigation, we do not start treatment – we refer you to a doctor instead.
What really helps
For headache coming from the neck, the best-documented approach is combining manual therapy with exercise – it reduces how often and how severely the pain occurs, also over longer follow-up. For tension headache, physiotherapy is a complement: it can help, but it is rarely enough on its own. Regular sleep, movement, breaks from computer work and the way you cope with stress are just as important.
Mobilisation and soft tissue work reduce the symptoms at the start. What makes the effect last is exercises for the deep neck flexors and the shoulder blade muscles, plus regular activity such as brisk walking or swimming. We also often work on the mobility of the thoracic spine, because stiffness there puts extra load on the neck. The aim is fewer and milder headaches – usually within a few weeks of regular work, not after a single visit.
When to come in and when to see a doctor first
It is worth coming in when headaches keep coming back, are linked to desk work or come with a stiff, painful neck – we write more about the neck itself on the page about neck pain. If the headaches appeared recently, have changed in character or you do not yet have a diagnosis, see a doctor about them first. A sudden, very severe pain is a reason to call 112 straight away. You can arrange an appointment via the Contact page.