Do Your Headaches Start at the Back of Your Neck? Here Is Why
Do Your Headaches Start at the Back of Your Neck? Here Is Why
If your headache starts as tightness at the base of your skull, creeps up and wraps around your temple or eye, and gets worse the longer you sit at your desk, it is probably not a random migraine. It is likely a cervicogenic headache — a headache driven by your neck. Our physio team at PHYZFIT Bexley North and Marrickville sees this every day.
Short Answer
A cervicogenic headache is a headache that originates from the upper neck (the top three vertebrae, C1 to C3) and refers pain into the head via a shared pain pathway with the trigeminal nerve. It typically feels one sided, starts at the base of the skull, and worsens with neck movement, poor posture or long desk hours. Physiotherapy is a first line evidence based treatment, and most patients notice clear improvement within 4 to 8 sessions.
Below we walk you through how neck driven headaches differ from tension headaches and migraines, what causes them, and exactly what our physio team does about them.
What is a cervicogenic headache?
A cervicogenic headache is a headache that comes from the neck rather than the head itself. It is caused by irritation of the joints, muscles or nerves of the upper three cervical vertebrae (C1, C2 and C3). Because these upper cervical nerves converge with the trigeminal nerve in the brainstem (the trigeminocervical nucleus), pain from the neck refers into the head as a true headache.
Cervicogenic headaches account for around 15 to 20 percent of all recurrent headaches. They are commonly missed and mistreated because they sit on the border between neck problems and headache problems.
How is it different from a tension headache or migraine?
Cervicogenic Headache
Origin: Upper cervical spine. Location: Usually one sided, starts at the base of the skull, spreads to the temple or behind the eye. Triggers: Neck movement, sustained posture, pressure on upper neck joints. Neck signs: Reduced neck range, tender upper neck.
Tension Type Headache
Origin: Muscle and stress related. Location: Both sides, band like around the head. Triggers: Stress, fatigue, dehydration, jaw clenching. Neck signs: May feel tight but usually good movement.
Migraine
Origin: Neurological. Location: Often one sided but can shift, throbbing. Triggers: Foods, hormones, sleep, light. Extras: Nausea, light or sound sensitivity, sometimes visual aura before onset.
Many people experience a mix. A common pattern is cervicogenic headache overlapping with migraine, where a stiff neck triggers or amplifies migraine episodes. That is why a proper physio and medical assessment matter.
What causes neck pain and headaches?
The upper neck takes constant load from head position, screen time, sleep posture and old injuries. Common drivers we see at PHYZFIT include:
- Forward head posture and desk work. The head weighs about 5 kg. Every 2.5 cm it drifts forward doubles the load on the upper neck.
- Long screen and phone time. "Tech neck" holds the deep neck flexors long and weak while the upper trap and suboccipital muscles stay short and tight.
- Poor sleep setup. Wrong pillow height, stomach sleeping and old mattresses stiffen the upper neck overnight.
- Old whiplash or sporting knocks. Even minor whiplash from years ago can leave lingering upper cervical stiffness.
- Stress and clenching. Tension travels up the upper trap and into the suboccipital muscles at the base of the skull.
- Weak deep neck flexors. Without deep stabiliser strength, the surface muscles overwork and stay tight.
- Prolonged driving for tradies, sales reps and commuters into the Sydney CBD from the St George region.
How do I know if my headache is coming from my neck?
See how many of these apply to you:
- Headache starts at the base of the skull or top of the neck and spreads forward
- Usually one sided and does not swap sides in the same episode
- Worse the longer you sit, drive or scroll on your phone
- Provoked by turning or tilting your neck, or by pressing on the upper neck joints
- Neck feels stiff and tender, especially at the base of the skull
- Wakes you up sore in the morning after a heavy day at the desk or bad sleep position
- Often eased short term by heat, massage or firm pressure at the base of the skull
Three or more of these strongly suggests a cervicogenic component. Our physios use specific upper cervical movement and joint tests during your assessment to confirm it.
How does PHYZFIT treat neck pain and cervicogenic headaches?
Cervicogenic headache is one of the most treatable headache types with physio. Our team (Julian De Rosa, Ari Moushis and Sam Nunan) uses an evidence based approach that targets the upper cervical joints, the deep neck flexors and your daily posture load.
A first appointment includes a full history, a movement and joint assessment of the upper cervical spine, deep neck flexor and postural testing, and a clear explanation of what is driving your headaches.
What treatment typically looks like
- Upper cervical joint mobilisation to unlock C0 to C3 stiffness
- Soft tissue release of the suboccipital, upper trapezius and levator scapulae
- Dry needling for stubborn trigger points where clinically indicated
- Deep neck flexor retraining using pressure biofeedback and progressive loading
- Thoracic mobility work because a stiff upper back always loads the neck
- Workstation and phone habit coaching so gains actually stick
- A written home program of stretches, chin nods and postural resets
- Referral back to your GP if a migraine or medication overuse component is suspected
Sore neck. Headache every day.
A proper assessment is the fastest way to work out what is actually driving it.
What can I do at home right now for neck pain and headaches?
- Chin nods. Gentle nod like saying yes to activate the deep neck flexors. 10 slow reps, 3 times a day.
- Upper trap stretch. Ear towards shoulder, hold 30 seconds each side, twice a day.
- Levator scapulae stretch. Look down towards your armpit, hand gently guides. Hold 30 seconds each side.
- Thoracic extensions over the back of a chair or on a foam roller, 8 to 10 reps, once a day.
- Screen at eye level. Raise your laptop on a stand and use an external keyboard.
- Sleep setup. One pillow that fills the gap between your ear and the mattress in side lying. Avoid stomach sleeping.
- Move every 30 minutes. Even a 30 second stand and shoulder roll resets the neck load.
- Heat pack to the upper trap and base of skull for 10 to 15 minutes before bed.
⚠ Seek urgent medical care if your headache
- Is sudden and severe, like a thunderclap
- Comes with fever, stiff neck and light sensitivity
- Comes with new weakness, numbness, speech changes, vision loss or dizziness
- Follows a significant head or neck injury
- Is progressively worsening over days to weeks and different to your usual headache
How long until physio helps my neck pain and headaches?
Most patients notice a clear reduction in headache frequency and intensity within 4 to 8 sessions across 6 to 10 weeks. Longer standing chronic cases with strong postural drivers usually respond within 8 to 12 sessions over 3 to 4 months, with the goal of moving from daily headaches to occasional ones.
Our team supports patients across Bexley, Kingsgrove, Beverly Hills, Bardwell Park, Earlwood, Rockdale, Kogarah and Hurstville from the Bexley North clinic, and Marrickville, Newtown, Enmore, Dulwich Hill and Petersham from our Marrickville clinic inside World Gym.
Frequently asked questions about neck pain and headaches
Yes. This is well established. Pain fibres from the upper three cervical nerves share a pathway with the trigeminal nerve at the trigeminocervical nucleus in the brainstem, which is why neck irritation is felt as head pain.
Usually not. Cervicogenic headache is diagnosed clinically through history and physical examination. Scans are reserved for red flag features, new neurological symptoms or when conservative care has not worked as expected.
Migraine itself is neurological, but many migraine sufferers also have a neck driven component that amplifies attacks. Treating the neck often reduces the frequency and severity of episodes and improves the effectiveness of medical management from your GP or neurologist.
Occasional self mobilisation is not dangerous, but repeatedly cranking your own neck often provides short term relief while the underlying issue stays unchanged. A trained physio can mobilise the specific stiff joints without stressing the healthy ones.
Long term results depend on maintaining your posture, strength and workstation habits. Patients who stick with the home program and address the workstation setup tend to have very few flare ups. Occasional maintenance sessions can help through busy work periods.
Yes. Medicare covers 5 sessions per year under a Chronic Disease Management plan. Private health Extras rebates through HICAPS on the day. Workers Compensation, CTP and NDIS (plan managed and self managed only) are all accepted.
Ready for Us to Help You With Your Pain?
If your headaches keep starting at the back of your neck, book a physiotherapy assessment at PHYZFIT Bexley North or Marrickville with Ari Moushis, Sam Nunan or Julian De Rosa. Same day appointments are usually available.
📍 20 Shaw Street, Bexley North 2207
📍 4 Carrington Road, Marrickville 2204 (inside World Gym)
✉ admin@phyzfit.com.au
PHYZFIT Health and Rehab | Bexley North and Marrickville, Sydney | Helping you rebuild trust in your body and live a life without limits.