Headache Pain - Cervico-Genic, Tension, Migraines

Physiotherapy is an effective tool for dealing with Headaches.  Headaches are frequently misunderstood and therefore mismanaged. There have been some 300 different types of headaches described, from well known ‘migraine’ to the more ridiculous ‘chewing gum’ headache.  The Physiotherapists at Core Body Clinic 'know' how to differentiate, diagnose and rehabilitate headache syndromes. 

The good news is that headaches are rarely anything ‘serious’, however, persistant headaches must be seen by your Doctor or Physiotherapist. 14% of long term headache (chronic) sufferers will be suffering with a primary neck complaint (ie the neck is causing the headache). If it involves the neck we call this cervico-genic (serv-eye-co-jenic). However, up to 70% of all headache sufferers will have a component of neck involvement so it does make sense to see a physiotherapist.  Furthermore, like the 'core' muscles in lower back pain the neck muscles are often weaker in cases of headaches.  Physio's know how to identify weak muscles and if you have been treated without rehab of these muscles then your persistant headache may be a result of muscle weakness. 

Watch Adrian Wagstaff talk about headaches................

What Causes a headache?

Headaches manifest in a number of ways because of the way our nervous system is wired up. Nerves originating from the face, head, jaw and neck all converge, or junction, on the same bit of the brain stem (lower part of the brain). This is called the 'Trigeminal Nucleus'. Because the nerves are in close proximity the brain will often interpret pain as being derived from multiple sources – in essence our selection of information is confused. Therefore, we may experience pain in a number of different locations: the eyes, forehead, top of head and Jaw, causing confusion with diagnosis.  

Headaches should not be seen as complicated and with appropriate assessment by a healthcare practitioner, like a Physiotherapist, an accurate diagnosis can be made and efective treatment administered.

Below are three of the most common types of headache:

Cervico-Genic Headaches

The Neck (cervicogenic) is commonly responsible for, or is a contributing factor to headache development.  

The structures in the neck that are responsible include: tight or weak muscles, irritated joints, trapped or irritated nerves, sensitivity in the ligaments.

The causes might include: postural abnormalities, poor seating and sleeping habits, trauma, repeated and stressful movements, stress causing muscle tension.  A patient will often associate with a position or activity that makes the pain 'worse' or 'better'.  Sometimes, there appears to be no pattern to the symptoms.  Again, this is common and with approriate assessment by a Physiotherapist a diagnosis can be made and an understanding of how to treat and prevent a recurrance can be understood. 

Diagnosis:  Spinal movements are often reduced with greatest limitation towards the direction which brings on the headache.  Using palpation we are able to feel the joints enabling the identification of changes in joint thickness, sensitivity or stiffness.  These may be a result of injury, degeneration or local muscle spasm.  Pressing on the joints will often reproduce the headache helping us to identify the area where treatment is necessary.  The deep neck flexor muscles are almost always weak.


  • Boring and dull ache
  • worse during day
  • worse with activity of neck movements
  • usually points of tenderness in neck  
  • Pain can be vague and referred over the top of the head, jaw and into the shoulders  
  • Sudden movements may cause a sharp pain in the neck and lead to a headache
  • Waking at night with rotation in bed



Treatment is directed at symptom relief using manual hands-on techniques.  


Tension headaches

Tension headaches are thought to be due to tension of the deep muscles acting on the membrane in the upper spine. The Memebrane is a stabilising sheath that helps keep the head connected to the neck.  There is also a link between the membrane, ligaments and the Dura mater (Bit that surrounds the spinal cord).  As a result changes in posture or tension throughout the lower spine may contribute to the development of tension and therefore a headache.  It is essential to look at the 'whole' body and spine.  Stress is a major contributing factor because of the 'defensive' poses we adpot.  Muscles fatigue causes a change in postural habits and therefore can place stress on strucutres higher in the neck.


  • Band-like pain in head
  • heaviness around head
  • Nausea
  • May be episodic and associated with stress
  • can be continuous over a specific time period but less consistent than migraine.


  • Removal of stressors
  • Spinal manipulation
  • Spinal Mobilisation
  • Massage
  • Dry needling
  • Trigger point therapy 
  • relaxation
  • exercise
  • Acupuncture
  • Dry Needling


Migraine is a complex phenomenon and one that was historically attributed to a dysfunction of the vascular system of the brain. It was a sound theory but only half the storey. 

One of the more popular ‘theories’ is the influence of reduced ‘Neurotransmitters’. Our bodies/brains require the release of chemicals to bring about an action, function, changes in mood, and the extent to which we feel pain. Serotonin is one such chemical that helps to suppress mood, provide a relaxed state and with this reduce pain. In pre-migraine situations serotonin levels have been found to reduce considerably.  This may be associated with stress, illness, general hormone levels or a learned behaviour of the brain.

In such a state the brain is more sensitive pain and a headache manifests. 


  • Throbbing
  • crescendo type pain
  • can be excruciating
  • aura and even hallucinations
  • photo-sensitive
  • wake at night
  • more prevalent in women
  • possible association with diet or alcohol
  • May occur as a pattern: weekly, monthly, yearly.


Due to the complex nature of migraine it often requires a multi-discipline approach and each individual case will differ.  The removal of cervical (neck) tension points is a great way to reduce some of the symptoms associated with migraine.  

At Core Body clinic we have found 'manual therapies' to help:

  • Spinal manipulation
  • Acupuncture
  • Dry needling
  • Activity pacing and exercise 
  • Relaxation
  • Medication Advice (Liase with the GP)

If you are unsure if your headache can be helped by physiotherapy then please get in touch or call 07475436547