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There are two types of common headaches that are successfully treated by physiotherapy. These are:

•    Cervicogenic headaches
•    Tension headaches

If migraine, allergic reactions or other causes are suspected, your physiotherapist will recommend that you see a medical practitioner.
It is also however important to note that different headaches may co-exist i.e. you can have a migraine and cervicogenic headache together, a tension headache may co-exist with a cervicogenic headache.

(1) Tension headaches

Anxiety or stress can cause changes in posture that cause neck muscles and those around the shoulder area to tense up. This causes a restriction in blood flow and irritation of the nerves resulting in a headache.

Signs and symptoms

•    Recent increase in stress
•    A feeling of tension in the neck and shoulders
•    Tenderness in the muscles around the neck and shoulders
•    Increases in stress increase headaches


Treatment of tension headaches will involve releasing tension in the associated muscle groups. Your physiotherapist may use soft tissue techniques, heat, electrotherapeutic modalities and stretches. They will also re-educate you about correct posture and provide exercises to address this. It is important however that the underlying stress or anxiety be addressed e.g. stress therapy, relaxation classes to prevent reoccurrence of headaches.

(2) Cervicogenic headaches

Refers to a type of headache that is caused by neck pain i.e. the headache is a symptom of the neck pain. This occurs because the nerves that supply the upper cervical (neck) spine are connected to the nerves that supply your face by way of the area they go to in the brain. Therefore any disorder of the neck joints, or muscles can cause referred pain to your head i.e. a headache.

Signs and symptoms

•    Headache is proceeded by neck pain
•    Variable pattern of onset or duration
•    The headache is usually located behind the eyes, at the base of the skull or in the temporal area (above the ears)
•    Headaches are related to the side of the neck involved i.e. if the neck pain is on one side, the headache will be on that side and if neck pain bilateral then the headache will be bilateral
•    Headache is not usually relieved by analgesics
•    Headache is usually worsened or occurs after prolonged neck postures or movements of the neck
•    There can be some dizziness or light headedness
•    Neurological symptoms e.g. blurred vision, photophobia are not features of this kind of headache –usually more associated with migraines

Diagnosis and treatment

Your physiotherapist will do a thorough assessment to determine which structures in the neck are the source of your neck pain and headaches. In most cases there is involvement of one or more of the cervical joints along with some muscular involvement. Treatment may include the use of mobilizations, soft tissue techniques, electrotherapeutic modalities, ice, heat, stretching and strengthening exercises. Your physiotherapist will also look at any predisposing/co-existing factors (e.g. poor posture, poor sleeping position, stress, poor work habits) and treat these as appropriate.