Headaches

How common it is

Headache is one of the most familiar complaints there is, and tension type headache is described as the most common type, with two out of three people having at least one in their lifetime. ^[1]

Only a portion of headaches come from the neck. Sorting which is which is the first useful thing we do, and for many people it is the first time anyone has examined the neck at all.

What can be behind it

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. ^[2] That is the category our examination is looking for.

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. ^[1] Migraine, cluster headache and headaches driven by medication, infection or blood pressure sit outside our scope and belong with your doctor.

• Restriction in the upper cervical joints
• Sustained head-forward posture at a desk
• Jaw and upper shoulder muscle tension
• A past neck injury that never fully settled

How we assess it

We take a careful headache history: where it starts, what side, what brings it on, how long it lasts, what you have already tried and what your doctor has said. Patterns that do not look cervicogenic get named as such rather than treated hopefully.

The examination itself is of the neck. Movement in each direction, heat readings along the cervical spine, palpation of the upper levels at rest and in motion, and a neurological screen. A headache that is sudden and severe and unlike anything you have had, or one with fever, a stiff neck, a new neurological change or a recent head injury, needs medical assessment first and we will say so.

What care looks like

If the examination points to the upper neck, care is specific adjusting of the levels involved along with the soft tissue around them. If it does not, we tell you, and you have not committed to a course of anything.

We ask about your daily routines and keep a record of headache frequency and symptoms. That gives us something specific to discuss when reviewing the plan or considering a medical referral.

When to seek urgent care

We are not an emergency service. If you have loss of bladder or bowel control, numbness in the saddle area, weakness in both legs, or pain after a serious accident, call 000 or go to an emergency department.