Headaches and neck pain

Headaches can affect up to 60% of Australians; they can be debilitating and affect productivity. What causes them and how can we treat them?

I’m going to classify headaches into 8 main categories

  1.         Headaches associated with illness (respiratory infections, allergies, etc.) 
  2.         Vascular headaches (migraine or cluster headache)
  3.         Cervical headache (joints, muscles and/or fascia)
  4.         Tension headaches (muscular tension, stress)
  5.         Intracranial headaches (tumours, aneurysm, haemorrhage etc.)
  6.         An exercise-related headache, also a benign exertional headache
  7.         Caffeine withdrawal (giving up coffee, very tough, very tough)
  8.         Other causes such as dehydration, drugs, psychological factors etc.


How can physiotherapy help?

Physiotherapists can help with headaches that are caused from musculoskeletal issues; symptoms can include muscle pain, tightness in the neck, shoulders and jaw, and restricted range of motion.

These sort of headaches usually occur around the back of the skull, side of the skull and the base of the neck. They may be caused by sustained or awkward postures such as sitting at a work desk, and may be triggered by daily activities such as looking over your shoulder when reversing your car.

The types of headaches that a Physiotherapist may see include:

Tension Headache

The onset is usually slow, with the duration potentially lasting days. A tension headache will generally come in the form of a dull ache and can arise in the back of head / behind the eye and temple regions. It may also present in the back, jaw, neck and shoulder regions. The likely triggers for such a headache are generated by trauma, posture, straining while lifting weights, stress, with pain also present in the back, neck and shoulder regions.  


Migraines are normally irregular in frequency and distressing for the client. The headache will normally present as a throbbing pain in the frontal and temporal lobes and is very fast in onset. Lasting hours, the migraine, which is vascular in origin, may be accompanied by blurred vision and nausea.

Facet Joint Irritation

Facet Joint Irritation can present as upper neck pain, or with referred pain to the shoulder and scapular regions. In the case of Upper Facet Joint Irritation, the referral of pain can move to the base of the skull and the forehead on the same side as the neck pain.

Acute Wry Neck

Acute Wry Neck can have a clinical presentation of facet joint irritation combined with several other symptoms. These symptoms can vary from a presentation of sharp pain or muscular spasm, through to reduced neck movement, more commonly towards the affected side. An episode may occur, where one turns their head quickly; has slept awkwardly or has had a sustained, awkward posture. With Acute Wry Neck, you can commonly have a headache.

Cervical Nerve Root Compression

Several symptoms accompany cervical nerve root compression, including a moderate to severe arm pain, to more serious symptoms such as the presence of pins and needles, paraesthesia, weakness or reduced reflexes. The client may also present with neck pain and headache.



After a thorough assessment, including questions relating to your symptoms and then a series of movements and tests before accurately diagnosing your condition.

Management may include:

  • Massage to the muscles of the neck, shoulder, back or jaw
  • Dry needling
  • Mobilisation of joints
  • Gentle stretches and assisted movement.
  • Strengthening exercises
  • Heat
  • Postural advice & education
  • GP referral


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