Headache is a complex type of pain. Headache may have several causes and may be difficult to diagnose and treat. Many headaches are unexplained. However, there is building evidence that a significant proportion of headaches have some contribution from the structures of the neck. There is also evidence that physiotherapy can help with this type of headache.

Headache from the neck

For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, the forehead, or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck joints or muscles can cause referred pain to your head.

What might it feel like?

Any of the following points could suggest that your neck may be causing the headache:

• Headache associated with neck pain.
• Headache brought on or worsened by neck movement or staying in the same position for a long time e.g. at a computer.
• Headache which always feels worse on the same side of your head.
• Headache eased by pressure to the base of the skull.
• Headache which persists after your doctor has checked for other causes.

What will a physiotherapist do?

An experienced physiotherapist will be able to determine if your neck is causing or contributing to the headaches. Physiotherapists may use:

• Mobilization of the joints and muscles in your neck.
• Manipulation.
• Functional and rehabilitative exercises.
• Postural assessment, correction and advice.
• Ultrasound and electrotherapy.

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation and exercise.