NeckŞişli, Istanbul
Cervicogenic tension-type headache
A significant proportion of headaches in practice originate in the neck. Nerve signals from the upper cervical segments are processed in the same region of the brain as signals from the surface of the head, so a neck problem is felt as a headache.
Also known as: Cervicogenic headache, tension-type headache, neck-related headache
What is it?
The nerves leaving the upper three cervical vertebrae converge with the trigeminal nerve in the same nucleus in the brainstem. That anatomical proximity causes pain signals from the neck to be perceived as belonging to the head. As a result, a problem in the neck joints or muscles is felt as headache in the forehead, temple or around the eye.
Distinct features separate this type from migraine. It is usually one-sided and does not switch sides; it begins at the base of the skull and spreads forward; it changes with neck movement and with holding certain positions. The nausea and sensitivity to light and sound common in migraine are either absent or very mild.
The most valuable diagnostic finding is reproduction of exactly the headache the patient describes when pressure is applied to the upper cervical segments or suboccipital muscles on examination. Where that reproduction is possible, treatment directed at the neck has a high chance of resolving the headache.
Symptoms
- Pain starting at the base of the skull and spreading to the temple, forehead or around the eye
- Usually one-sided pain that does not switch sides
- Triggered by turning the neck a certain way or long periods in front of a screen
- Restricted neck movement, particularly rotation
- Marked tightness and tenderness in the muscles at the base of the skull
- A band-like squeezing quality rather than throbbing
- Absent or very mild nausea and light and sound sensitivity
Causes and risk factors
- Restricted movement in the upper cervical segments
- Chronic tension and trigger points in the suboccipital muscles
- Prolonged forward-head posture
- Loss of endurance in the deep neck flexors
- A history of whiplash or previous neck trauma
- Stress, disturbed sleep and teeth clenching
The assessment
The assessment first distinguishes the type of headache: separating migraine, tension-type and cervicogenic headache completely changes the treatment. Where the pain starts and spreads, how long it lasts and what triggers it are taken in detail.
Mobility of the upper cervical segments is tested individually by hand and the suboccipital muscles are palpated. The finding sought is reproduction of the patient's own headache during that pressure. Deep neck flexor endurance is measured, providing the most reliable way to track the programme. A neurological examination rules out secondary causes of headache.
Course of treatment
Weeks 0–2
Freeing the upper neck
Gentle mobilisation of the upper cervical segments and suboccipital release are applied. As restriction in this region frees up, headache frequency usually begins falling from the first sessions.
Weeks 2–6
Deep muscle support
Endurance of the deep neck flexors is built. As these muscles carry the head, the suboccipital region no longer has to work continuously and trigger points stop reforming.
Weeks 6–10
Changing the triggers
Screen height, arm support, reading position and break rhythm are adjusted, and scapular strengthening is added. A headache diary is kept so triggers are identified objectively.
Maintenance
Keeping frequency low
A short daily neck routine is maintained. Sleep patterns and stress management also determine frequency, and the programme addresses these too.
How long does it take?
A clear reduction in headache frequency usually begins within three to five weeks, with a programme of 8–12 sessions. The goal is typically not complete resolution but a marked fall in frequency and intensity. Where the headache can be reproduced on examination, the likelihood of response is high.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- The worst headache of your life, starting suddenly — requires emergency assessment
- Fever and neck stiffness accompanying the headache
- Loss of vision, double vision or difficulty speaking with the headache
- Weakness in an arm or leg, or numbness in the face
- A new headache starting over the age of 50 and steadily worsening
- Headache markedly worsened by coughing, straining or changing position
Frequently asked questions
Is this migraine or cervicogenic in origin?
Cervicogenic headache is usually one-sided, does not switch sides, starts at the base of the skull and changes with neck movement. Migraine features throbbing, nausea and light sensitivity. The two can coexist; reproducing the headache on examination indicates a cervical component.
Is it advisable to stop taking painkillers?
Medication decisions belong to your physician. However, frequently used painkillers can themselves cause headache (medication-overuse headache). As physiotherapy progresses the need is expected to fall, which is a good indicator that treatment is working.
How many sessions are needed before results appear?
A reduction in frequency is usually noticed after three or four sessions. Clear and lasting change requires deep neck muscle endurance to develop, which takes six to eight weeks.
Can a pillow contribute to headache?
It can. A pillow that is too high or too low strains the upper cervical segments through the night and produces morning headache. Where headaches are worst in the morning, pillow setup is among the first factors examined.
Methods used
Related conditions
Articles on this topic
Articles covering the topic in detail: symptoms, treatment, exercise and daily life.
- Diagnosis and symptoms· 6 min readTension-type headache: symptoms and how it differs from migraine
- Treatment course· 6 min readWhat physiotherapy does in tension-type headache
- Exercise· 6 min readNeck exercises for headache: what each exercise targets
- Treatment decision· 6 min readWhen does headache require assessment?
- Daily living· 6 min readScreen use, sleep and daily routine in headache
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
No referral is required for assessment. Enquiries regarding Cervicogenic tension-type headache may be submitted via WhatsApp; available dates and times will be provided in response.