Headaches that start in the neck

A headache with a neck behind it

Not every headache starts in the head. The international classification of headache disorders defines cervicogenic headache as headache caused by a disorder of the cervical spine and its component bony, disc and soft tissue elements, usually but not invariably accompanied by neck pain.^[1] That is the category a chiropractic examination is looking for.

A neck-related headache requires assessment. A symptom diary can also help you describe the pattern, frequency and associated symptoms.

Why a neck can be felt in the head

Structures in the head and neck share pain pathways, so pain felt in one area can be referred from another nearby, as with the referred pain of a headache arising from a sore neck.^[2] The upper neck sits closest to those shared pathways, which is why a joint just below the skull can be felt behind the eye.

Describe where the pain begins, whether neck movement changes it, and any other symptoms. These details help guide assessment without establishing the cause on their own.

How it differs from migraine

Headache has many causes, and migraine, cluster headache and headaches driven by medication, infection or blood pressure are distinct from a headache arising from a sore neck.^[2] Those sit outside chiropractic scope and belong with your doctor. Medical assessment helps distinguish these causes.

Do not assume a headache is coming from the neck because the neck is sore. A new or changed headache pattern should be discussed with your doctor.

What the examination looks for

The upper neck is examined level by level: how you hold and move your head, a temperature comparison down either side of the spine, the joints felt at rest, and the same joints felt while they move, to find where movement is restricted and where the tissues are reactive.

The examination may include the rest of the neck and upper back. X-rays are considered only when clinically indicated, with any fee explained before imaging.

What care looks like

After the assessment, Dr Arthur explains whether chiropractic care is appropriate or medical review is needed. Any proposed care includes a discussion of options, risks and alternatives, without a promised outcome or number of visits.

The examination may include the upper back as well as the neck. The findings are discussed before any care is proposed.

What is worth changing between visits

If screen use, phone use or sleep position changes your symptoms, mention this during the assessment. Advice can then take account of the activities that matter to you.

Discuss any proposed changes to your routine with your clinician, including how to monitor symptoms and when to seek a review.

When a headache needs a doctor the same day

A sudden, severe headache unlike any you have had before, a headache with fever, neck stiffness or a rash, a headache after a head injury, or a new headache with weakness, slurred speech or vision changes all need urgent medical assessment. Call 000 or go to an emergency department. A headache that has changed its usual pattern is worth a conversation with your doctor before anything else.

There is more on headaches and on neck pain, and the appointment itself is set out in what to expect at your first visit.