Headache and Migraine: How the Neck Contributes

Headache and migraine are distinct, and separating them changes what helps. Migraine is typically one-sided and throbbing, aggravated by light, sound and movement, and often accompanied by nausea. Tension-type headache presents as a band of pressure on both sides. A third type, cervicogenic headache, begins at the base of the skull and is reproduced by neck movement or sustained positions.

That third type is where the neck genuinely contributes, and the identifying feature is that pressure over specific points at the top of the neck reproduces the familiar headache. For headache and migraine, a short diary of timing, triggers and recent activity can add useful context to the examination.

This guide to headaches and migraines, and how the neck can refer pain into the head, is published by Chiropractic Specialty Center, Bukit Damansara (KL) main center: WhatsApp+60 17 269 1873 Call+603 2093 1000

Key Takeaways

• Migraine, tension-type headache and cervicogenic headache are different conditions, and the evidence for neck-focused care is strongest for cervicogenic headache.
• The upper three neck segments share a relay station in the brainstem with the nerve that carries sensation from the head, which is why a neck problem can be felt as head pain.
• Neck strengthening and endurance exercise has the best research support for neck-related headache; gentle manual therapy can help make that exercise possible.
• Frequent use of pain tablets can itself cause daily headache, a condition called medication-overuse headache.
• A sudden severe headache, headache with fever, neurological symptoms or a new pattern after age 50 needs medical assessment first.

Headache Types: Migraine, Tension-Type and Cervicogenic

The International Classification of Headache Disorders describes well over a hundred headache types, grouped into primary headaches, which are conditions in their own right, and secondary headaches, which are caused by another problem such as an injury, an infection or medication overuse.

Migraine

Migraine is a primary headache disorder of the brain. Attacks usually last hours to days, are often one-sided and throbbing, and come with nausea and sensitivity to light and sound. The word comes from the Greek hemicrania, meaning half of the head. Some people have aura, a temporary visual or sensory change such as flashing lights, zigzag lines or tingling, usually before the headache. Some have aura with little or no head pain.

Tension-Type Headache

Tension-type headache is the most common headache. It feels like a pressing or tightening band on both sides of the head, is usually mild to moderate, and does not usually come with nausea. Its causes are not fully understood; muscle tenderness, stress and sleep are all involved.

Cervicogenic Headache

Cervicogenic headache is a secondary headache that comes from the neck. It usually starts at the base of the skull on one side and can spread to the forehead or behind the eye. It is often provoked by neck movement or sustained postures, and the neck is usually stiff on examination.

Headache and Neck Assessment at Two KL Centers

If your headaches seem linked to your neck, posture or jaw, an assessment can show whether the neck is contributing and what a conservative plan would involve. You can reach either center through the Bukit Damansara contact page and the Bandar Sri Damansara contact page, or call directly:

• Bukit Damansara (KL, main center): Call +603 2093 1000 or WhatsApp +60 17 269 1873 to see the Bukit Damansara / KL center.
• Bandar Sri Damansara (KL): Call +603 6262 5777 or WhatsApp +60 12 455 6939 to see the Bandar Sri Damansara center.

How the Neck Can Refer Pain Into the Head

Sensory nerves from the upper three neck segments share a relay station in the brainstem with the trigeminal nerve, which carries sensation from the face and head. Because those signals converge in the same place, the brain can read a problem in the upper neck as pain over the back of the head, the forehead or behind the eye. That convergence, rather than a bone sitting out of place, is why a neck assessment belongs in a headache workup, and it also explains why the neck can contribute without being sore itself.

When the upper neck is sensitive, forceful neck pulling, sudden twisting or strong traction may aggravate it, so care should begin with assessment rather than force. You can watch our educational videos on aggressive neck care and headache-related concerns and on rhomboid, neck and upper back self-care.

Jaw, Upper Back and Posture

The temporomandibular joint (jaw joint) and chewing muscles can refer pain to the temples and side of the head, and jaw and TMJ problems often coexist with neck pain and headache. Tightness between the shoulder blades, rounded shoulders, and long periods of looking down at a phone or screen can add load through the neck and skull base. Degenerative neck change, often called cervical spondylosis, is common on scans, and whether it explains a headache depends on the examination rather than the image.

Hormones, Pregnancy and Migraine

Migraine is about three times more common in women than in men, and attacks are often linked to the menstrual cycle, particularly the drop in estrogen just before a period. Many women find migraine improves during the later months of pregnancy, while others notice changes in pattern. Posture, sleep, hydration and neck and upper back strain can all add to headaches in pregnancy. You can read more on our pregnancy headache and pregnancy pain pages.

A sudden, severe or unusual headache in pregnancy or after delivery, especially with vision changes, swelling of the face or hands, or high blood pressure, needs urgent medical assessment because it can be a sign of preeclampsia.

Medication-Overuse Headache

Medication-overuse headache is diagnosed when someone with a pre-existing headache disorder has headache on 15 or more days a month and has regularly overused acute headache medication for more than three months: 10 or more days a month for triptans, ergotamines, opioids or combination analgesics, or 15 or more days a month for paracetamol, aspirin or other NSAIDs (International Classification of Headache Disorders, third edition). It is estimated to affect roughly 1 to 3 percent of the general population, and a much higher share of people attending headache clinics. If your headache days and your tablet days have both been climbing, raise it with your doctor rather than stopping medicines abruptly on your own.

Common Triggers

Triggers vary from person to person, and a diary is the best way to identify your own. Commonly reported triggers include:

• Irregular sleep, too little or too much.
• Skipped meals and dehydration.
• Stress, and the let-down period after stress.
• Alcohol, particularly red wine, and changes in caffeine intake, including caffeine withdrawal.
• Some foods in some people, such as aged cheese or processed meats. The evidence for individual food triggers is mixed, so avoid cutting out foods without a clear pattern.
• Hormonal changes, bright or flickering light, strong smells and weather changes.

What Care May Involve

Care starts with an assessment of the neck, upper back, jaw and posture, and a screen for symptoms that need medical care first. When the neck appears to contribute, a plan at Chiropractic Specialty Center may combine gentle, non-rotational chiropractic and physiotherapy techniques, soft-tissue work, posture advice and, most importantly, progressive neck and shoulder girdle exercise. The chiropractor and physiotherapists plan this from one assessment.

Migraine is a medical condition with effective medical treatments. Manual therapy and exercise may help people whose migraine is accompanied by neck pain, but the evidence for them in migraine is weaker than for neck-related headache, and working alongside your doctor is often the sensible approach.

Headaches in Children

Children get headaches too, and in CSC's experience long periods of looking down at a phone, tablet or book, clenching or grinding the teeth, and stress such as exams are common triggers. A child's neck is still growing, so care for a child is a much gentler version of adult care: non-force methods for young children and, for teenagers, at most a low-force instrument such as the Activator. The guide to chiropractic care for children explains how headaches and jaw problems go together in children.