Headaches That Come From the Neck

Most people are surprised to hear that a neck can cause a headache. It sounds like the sort of thing someone says when they have run out of better ideas.

It is not. There is a specific piece of wiring that explains it, and once you have seen it, the whole thing makes sense. Section 3 covers it, and it is the part most people find genuinely useful.

The medical name for this is cervicogenic headache. It simply means a headache produced by the neck. You may hear that term used about you, so it is worth knowing.

This guide is not saying your headaches are in your head, which is an awkward sentence to write about a headache. Your pain is completely real.

The short version

• Pain is an alarm. It protects you. It does not measure damage.
• The nerves from your upper neck and the nerves from your head arrive at the same junction in your spinal cord. Signals get mixed up. That is why a neck problem is felt as head pain.
• Neck related headaches have a pattern: usually one side, usually the same side each time, starting at the back and spreading forward.
• Neck pain does not prove your headache comes from your neck. Most people with migraine get neck pain too. See section 4.
• Painkillers taken too often cause headaches. This is common, it is missed constantly, and it is fixable. See section 7.
• Hands-on treatment and neck exercises have reasonable evidence behind them for this type of headache. See section 13.
• There are a few headaches that need urgent help. Section 14 tells you exactly what to watch for.

1. Pain is an alarm, not a damage meter

Your body has danger sensors. They fire when tissue is stretched, squashed or irritated. They send warning signals to your spinal cord, and then to your brain. None of that is pain yet. It is just information.

Then your brain weighs that information against everything else it knows. What were you doing? What happened last time? What do you think this means? How stressed are you? Did you sleep?

Then it decides: how much danger am I in, and how much pain does this person need to feel to keep them safe?

Pain is the answer. Your brain produces it.

That is why damage and pain match up so badly:

• A paper cut really hurts. There is almost no damage.
• Soldiers get badly hurt and feel very little until they are safe.
• People who have lost an arm can still feel pain in it.

So how much pain you feel does not tell you how much damage there is. It tells you how protective your body is being right now.

2. The pain gate

In 1965, two researchers called Ronald Melzack and Patrick Wall came up with an idea that changed pain medicine. It is still one of the most useful pictures we have.

Picture a gate in your spinal cord. Warning signals have to pass through it to reach your brain.

When the gate is open, lots get through and you feel more pain. When it is closed, fewer get through and you feel less. Nothing in your neck has changed. Only the gate has.

What closes the gate

• Touch, rubbing, heat and hands-on treatment. Touch signals travel on bigger, faster nerves than danger signals, and they crowd them out.
• Moving and exercise. They release your body's own painkillers.
• Feeling safe and calm.
• A decent night's sleep, at regular times.
• Understanding what is going on. Reading this counts.

What opens the gate

• Stress and worry. Headaches are unusually responsive to this, and the classic pattern is a headache that arrives once the stressful thing is over rather than during it.
• Broken or irregular sleep, including lie-ins at the weekend.
• Low mood, and feeling that nobody has listened.
• Skipped meals and not drinking enough.
• Clenching your jaw or grinding your teeth.
• Worrying that the headache means something sinister.

3. Why a neck problem gives you a headache

This is the section worth reading twice, because it explains the whole thing.

The nerves that supply the top three levels of your neck run into your spinal cord and arrive at a junction near the base of your skull.

The nerve that supplies your face, your forehead, your temple and the area behind your eye arrives at exactly the same junction.

Two sets of nerves, from two different places, feeding into one relay station.

So the signals get mixed up. Your brain receives a warning from that junction, and it cannot always tell whether it came from your neck or from your head. It has to make a guess. Quite often it guesses head.

That is why an irritated joint at the top of your neck is felt as pain over the back of the head, behind the eye, or in the temple. You are not imagining the location. Your brain genuinely put it there. It is a wiring feature, not a mistake on your part.

This also explains three things people find odd:

• Why the headache and the neck ache come together, and why sorting one often helps the other.
• Why pressing on a spot in your neck can reproduce your headache. The junction is being fed from the neck side.
• Why treating the neck can change a headache. You are working on one of the inputs into that junction.

4. Which headache is it?

This matters, because the plan is different for each, and it is genuinely easy to get wrong. Most people who have headaches have more than one type.

Neck related headache usually looks like this:

• Usually one side, and usually the same side every time.
• Starts at the back of the head or the base of the skull, and spreads forwards over the eye or temple.
• Brought on or made worse by neck movement, or by holding an awkward position.
• Your neck feels stiff, and does not turn as far as it used to.
• Pressing certain spots in your upper neck reproduces or worsens it.
• Sometimes an ache into the same shoulder or arm.
• It builds gradually rather than arriving suddenly.

Migraine usually looks like this:

• Often one side, but it can swap sides between attacks.
• Throbbing or pounding, moderate to severe.
• Made worse by ordinary activity, so people want to lie down in the dark.
• Feeling sick, sometimes being sick.
• Real dislike of light and noise.
• Sometimes visual disturbance beforehand: zigzags, flashing, blind spots.
• Attacks that last anywhere from a few hours to three days.

Tension type headache usually looks like this:

• Both sides.
• Pressing or tightening, like a band around the head.
• Mild to moderate rather than severe.
• Not made worse by ordinary activity.
• No sickness.

Here is the trap, and it is a big one. Most people with migraine get neck pain and neck stiffness with their attacks. Very often the neck symptoms come first, before the head pain.

So neck pain with a headache does not prove the headache is coming from your neck. It is one of the commonest reasons migraine gets treated as a neck problem for years. Section 8 is how we tell them apart properly.

5. When the alarm gets too sensitive

If your headaches have been going on for months or years, this matters.

When a pain system has been busy for a long time, it does not wear out. It gets better at its job. The sensors fire more easily. The relay station turns signals up. The brain decides there is danger more quickly.

Think of a car alarm. When it was fitted, it went off if someone tried to force the door. Years later it goes off when a cat walks past.

The alarm is not broken. It is not lying. It is just set far too sensitive for the actual level of threat.

With long lasting headaches, that junction described in section 3 becomes easier and easier to set off. Smaller things trigger it. That is a learned change, and your body can unlearn it.

6. What scans show

Most headaches do not need a scan, and a scan will usually not tell us why you have them.

Researchers scanned the necks of 1,211 people who had no neck symptoms at all. Nearly 9 in 10 had disc bulging. Degeneration, narrowed discs and bone spurs are just as common in people with no pain at all, and get commoner with age.

So a report saying wear and tear in your neck does not explain your headaches. It describes your age.

There is no scan that diagnoses a neck related headache. The diagnosis is made from your story and from examining you, which is why the questions I ask matter more than any picture.

Scans are for ruling out the specific things in section 14 when something in your story suggests them. If your headache pattern is stable and typical, a scan usually adds worry rather than answers.

7. The painkiller trap

If you take painkillers for headaches more than a couple of days a week, read this twice.

Painkillers taken too often start to cause headaches. The medical name is medication overuse headache. It is extremely common, it is missed all the time, and people can spend years in it without anyone spotting it. It works like a trap. You get headaches, so you take painkillers. The painkillers wear off and you get a rebound headache. So you take more. Before long you have a headache most days and you are taking something most days, and you cannot tell which is causing which.

The national guidance sets the thresholds like this. Taking these for three months or more can cause it:

• Triptans, opioids such as codeine, or combination painkillers (anything with codeine mixed in): 10 or more days a month.
• Paracetamol, aspirin or anti-inflammatories such as ibuprofen: 15 or more days a month.

Codeine catches the most people, because it is in a lot of over the counter combination tablets and nobody thinks of it as a strong painkiller.

The way out is to stop the overused painkillers for at least a month. National guidance says to stop them outright rather than tail them off. It gets worse before it gets better, usually for a week or two, and knowing that in advance is most of what gets people through it.

Please do this with your GP rather than on your own, particularly with anything containing codeine. You may need something to help you through the first fortnight, and it is worth having support lined up.

When people come out the other side, a good number find their headaches were largely this all along. It is one of the few genuinely fixable causes of daily headache, and it costs nothing to address.

8. Keeping a headache diary

This sounds like homework. It is the most useful thing you can bring to an appointment.

Two to four weeks is plenty. For each headache, note:

• The date and time it started, and how long it lasted.
• Where it was. Which side. Front, back, behind the eye. Did it stay in one place or move?
• How bad it was, out of ten.
• What came with it. Feeling sick, dislike of light, visual changes, neck stiffness.
• What you took, and how much. This is the one people leave out, and it is the one that matters most. See section 7.
• What was going on. Sleep, stress, meals, your period if relevant, a long drive, a heavy day at a screen. Two or three weeks of this will usually tell us more than any scan. It sorts out which headaches you actually have, whether painkillers are part of the problem, and what sets yours off.

9. What turns your headaches up and down

• Sleep. Both too little and too much. Irregular sleep is worse than short sleep, which is why weekend lie-ins give so many people a Saturday headache.
• Stress, and particularly the let-down afterwards.
• Skipped meals and dehydration.
• Caffeine. Both too much, and the withdrawal from cutting it suddenly.
• Alcohol.
• Staying in one position too long. Long drives, long meetings, long stretches at a screen.
• Jaw clenching and teeth grinding, which often go with stress and disturbed sleep.
• Mood. Low mood and pain feed each other, both ways.
• Your monthly cycle, if that applies to you.
• Painkillers. See section 7.

Most of that list is something you can influence. That is more than can be said for the shape of a disc in your neck.

10. Moving is safe, and strength is treatment

Your neck is not a delicate stack of crockery. It is a strong structure that carries and balances your head all day, and it is surrounded by a lot of muscle.

Guarding and avoiding make things worse. Muscles get weaker, the range you use shrinks, and your nervous system gets more protective of whatever you avoid.

Some soreness while you build back up is expected. It does not mean damage. A good rule: discomfort that rises while you move and settles back to normal within about a day is fine. Still up the next day means you did a bit too much, not that you did harm.

Building strength and control in the neck and shoulders is one of the better supported things you can do for this type of headache. It is also the part people skip, because loading a neck that is giving you headaches feels wrong.

Start lighter than you think. Build slowly. What matters most is that you keep doing it. The exact exercises matter far less than the habit.

11. Posture, screens and desks

You have probably been told your headaches are caused by your posture. The honest evidence is more modest than that.

Studies have not shown a strong link between how people hold their heads and whether they get headaches or neck pain. Where links exist, they are small, and they cannot tell us which came first. A sore neck adopts a protective position, so the position may be the result rather than the cause.

What does reliably cause trouble is staying in one position too long. Any position held long enough becomes uncomfortable.

In practice:

• Change position often. Every twenty to thirty minutes. This matters far more than the height of your monitor.
• Raise your laptop if it is easy to do. Do not lie awake worrying about it.
• Aim for variety, not correctness. A perfectly set up desk you never leave is still a desk you sit still at.
• Watch the phone-under-the-ear habit if you take a lot of calls. That one is worth fixing.
• If you clench your jaw, mention it. It is a common and treatable contributor.

12. Pacing and flare-ups

A good day comes. You seize it and get everything done. Then you pay for it. Over months the trend quietly goes down.

Pacing is the way out:

• Work out what you could manage on almost any day, including a bad one.
• Do that amount consistently, good days and bad.
• Once it feels easy, add about a tenth more each week.
• Break long spells at a screen or a wheel into chunks. Take breaks before you need them, not after.

Flare-ups are normal and do not mean you are back to square one. They are usually a pile-up: a hard week, two bad nights, a long drive, a missed meal.

Keep moving gently, drop back to your baseline for a few days, protect your sleep, and use what settles it, within the limits in section 7. Get in touch if the pattern changes, if it is not settling as it normally does, or if anything in section 14 applies.

13. What treatment does, and what it does not

Hands-on treatment works through the mechanisms described above. It closes the gate. It calms the sensitivity at that junction. It relaxes muscles that have tightened to protect you. It gives you a spell where your neck moves more freely.

On the evidence, a review pooled 20 trials covering nearly 1,500 people with neck related headache. It found moderate to large short term improvements in how often headaches came and how bad they were, compared with a dummy treatment. The longer term effects were smaller but still there.

I want to be straight about the caveats. Most of those trials had weaknesses in how they were run, and the reviewers said so plainly. The evidence is reasonable rather than overwhelming. The best results came from combining hands-on treatment with exercise, not hands-on treatment alone.

What treatment does not do is put anything back in place. Nothing in your neck is out. The clicks and pops you sometimes hear are gas moving inside a joint, the same as cracking a knuckle. Not the sound of anything being repositioned.

Think of a session as a window: a stretch of time where your neck moves more freely and you can use that to build strength and tolerance.

And if your headaches are not coming from your neck, I will tell you, and I will point you somewhere more useful. Treating a migraine as a neck problem wastes your money and your time. Part of what you are paying me for is an honest answer to that question.

One note on progress. A better question than your pain score is: how many headache days did I have this month compared with last month? How long did they last? Did I need fewer painkillers? Those are the numbers that matter, and your diary from section 8 will show them.

14. When to get urgent help

Almost all headaches, including severe ones, are not dangerous. A small number are, and headache is one area where knowing the warning signs genuinely matters.

Call 999 or go to A&E

• A sudden, severe headache that reaches its worst within a minute or two. Often described as the worst headache of your life, or like being hit on the back of the head. This one is an emergency even if it then settles.
• Any sign of stroke. Face drooping on one side, weakness in one arm, slurred or muddled speech. Think FAST.
• Headache with a fever, a stiff neck, dislike of bright light, or a rash that does not fade when you press a glass on it.
• Headache after a blow to the head, especially with drowsiness, confusion, repeated vomiting, or a headache that keeps getting worse.
• Headache with a seizure, confusion, or a change in personality or behaviour.
• Sudden severe headache or neck pain unlike anything before, with double vision, slurred speech, unsteadiness, a drooping eyelid with a small pupil, or numbness down one side of the face.
• A red, painful eye with blurred vision or halos around lights, with headache and feeling sick.

Contact your GP or NHS 111 today

• A new headache if you are over 50, particularly with tenderness of the scalp or temples, aching in the jaw when chewing, or any change in your vision. If your vision is affected, go to A&E or an eye casualty department.
• A headache that is worse when you lie down, worse first thing in the morning, or worse when you cough, sneeze, strain or bend forward.
• Headache with new weakness, numbness, clumsiness, or a change in your vision.
• A headache that is getting steadily worse over days or weeks, rather than coming and going.
• A new or changed headache if you have had cancer, or if your immune system is weakened.
• A new headache during pregnancy or in the weeks after giving birth.
• Headache with vomiting that has no other explanation.

Worth mentioning at a normal appointment

• Any clear change in your usual pattern. New location, new type, more often, lasting longer.
• Headaches on most days of the month.
• How many days a month you take painkillers. See section 7.

Everything else, including a bad headache day, can wait for a normal appointment.

15. If you want to read or watch more

Start here

• The Migraine Trust. Excellent and reliable, and useful even if your headaches turn out not to be migraine. Has a good headache diary you can download. migrainetrust.org
• NHS advice on headaches. nhs.uk/conditions/headaches
• Tame the Beast. A five minute animation by Professor Lorimer Moseley on how pain works. tamethebeast.org
• Flippin' Pain. A UK campaign about long lasting pain. flippinpain.co.uk

Practical help

• The Pain Toolkit, by Pete Moore. Very good on pacing and the boom and bust cycle. paintoolkit.org
• Recovery Strategies, by Greg Lehman. A free illustrated workbook, one idea per page. greglehman.ca/recovery-strategies-pain-guidebook
• The Migraine Trust on medication overuse headache, if section 7 sounded familiar. migrainetrust.org

Books

• Explain Pain, by David Butler and Lorimer Moseley.
• The Explain Pain Handbook: Protectometer, by the same authors.

The research behind this guide

• Melzack R, Wall PD. Pain mechanisms: a new theory. Science, 1965. The original pain gate paper.
• International Classification of Headache Disorders, 3rd edition (ICHD-3), section 11.2.1. The diagnostic criteria behind section 4.
• Bogduk N, Govind J. Cervicogenic headache: assessment of the evidence on clinical diagnosis, invasive tests and treatment. The Lancet Neurology, 2009. The mechanism in section 3.
• Fernandez M et al. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis. Chiropractic and Manual Therapies, 2022. The evidence quoted in section 13.
• Nakashima H et al. Abnormal findings on MRI of the cervical spine in 1211 asymptomatic subjects. Spine, 2015. The scan figures in section 6.
• NICE clinical guideline CG150: Headaches in over 12s, diagnosis and management. The medication thresholds in section 7 come from this. Bring any of this to your next appointment, along with your diary. Especially the parts that did not sit right, or that felt uncomfortably familiar.

This guide is general information. It does not replace the advice I give you in clinic.