A headache that starts in the neck is called a cervicogenic headache. It is usually felt on one side, and neck movement or certain neck positions can bring it on. Research suggests manual therapy and exercise may help this type of headache, although it may not help other types. A sudden, severe headache needs emergency care.
What is a cervicogenic headache?
A cervicogenic headache is a secondary headache, meaning that it comes from another source, in this case the neck. Published reviews describe it as a one-sided headache with signs of neck involvement. It accounts for only a small share of all headaches.
What are the signs that a headache may be coming from your neck?
These features can point towards the neck, but they don’t confirm the diagnosis:
- The pain stays on one side and doesn’t switch sides
- It starts at the back of your head or neck and spreads forward
- Neck movement, sustained positions or pressure on your neck can bring it on
- Your neck feels stiff or doesn’t move as far as usual
- You also feel pain in your shoulder or arm on the same side
Other headache types have different patterns. The Chiropractic Association of South Africa has an overview of headache types. Migraine and tension-type headache can also involve neck discomfort, so an accurate assessment is needed.
What does the research say about manual therapy and exercise?
A 2022 systematic review and meta-analysis of 20 studies and 1,439 patients found that manual and exercise therapy may reduce the intensity and frequency of cervicogenic headache and related disability.
There are limits to these findings. Most of the included trials had a high risk of bias. When the authors looked only at trials with a low risk of bias, the effects in favour of manual therapy were small, and both of those trials studied spinal manipulation.
The benefit also doesn’t necessarily carry over to other headaches. An earlier clinical review noted that manual therapy is unlikely to help most other forms of headache, which is why working out the type of headache comes first.
Which headaches need urgent medical care?
Most headaches aren’t dangerous, but some need immediate attention. Go to an emergency unit if your headache:
- Comes on suddenly and is severe, or is the worst you have ever had
- Comes with fever, a stiff neck, a rash, confusion or a seizure
- Comes with weakness, numbness, slurred speech, facial droop, double vision or loss of balance
- Follows a blow to the head or a significant accident
- Starts with sudden neck pain, especially after neck trauma or manipulation
Also see a doctor soon if your headaches are new and you are over 50, are becoming steadily worse or more frequent, or if you have cancer or a weakened immune system. Tell your doctor if you are pregnant or have recently given birth.
What can you do to manage headaches?
- Keep a headache diary: note the time, location of the pain, symptoms, sleep, stress, food, water and medication use.
- Vary your position: long periods at a screen may aggravate symptoms for some people. Read more in does posture really cause pain?
- Keep your neck moving: our article on neck pain includes self-care ideas.
- Watch your painkiller use: using pain medication often can itself contribute to headaches, so speak to a doctor or pharmacist if you need it regularly.
How does a chiropractor assess headaches?
A chiropractor will ask about your headache pattern and health history, examine your neck, check your nervous system and look for warning signs. If your headaches don’t appear to come from the neck, or there are signs of another problem, you should be referred to a doctor.
If the neck appears to be involved, the options may include exercises, soft tissue work and manual treatment. Please read about the benefits and risks of chiropractic adjustments, particularly neck manipulation, so you can make an informed decision.
Frequently asked questions
Can a stiff neck cause a headache?
It can be involved, but neck stiffness also occurs with other headache types. In some cases, such as a fever with a stiff neck, it needs urgent medical attention.
Is a chiropractor or a doctor better for headaches?
It depends on the cause. See a doctor first for new, severe or changing headaches, or if you have any warning signs. A chiropractor may be an option if your headache appears to be related to your neck.
You can read about chiropractic care or get in touch with any questions.
This article is general information and doesn’t replace an individual assessment by a registered healthcare practitioner.