Self Help Series: Headaches

Self Help Series: Headaches

Self Help Series: Headaches

 By Dr Anna Staehli Wiser

Headaches are a very common problem.  According to the World Health Organization, headache disorders were found to be the third highest cause worldwide of working years lost due to disability1.  When headache pain becomes debilitating, people usually say they have a migraine.  According to the International headache Society (IHS), the most common type of migraine is without aura and is classified as typically “unilateral in location, pulsating in quality, moderate to severe in intensity, aggravated by physical activity, and associated with nausea and light and sound sensitivity (photophobia and phonophobia)”2.

Tension headaches are a very common type of headache as well, and are classified by the IHS as bilateral in location, with mild to moderate intensity, with a pressing/tightening (non pulsating) quality3

Another common type of headache is one that arises from problems with the joints in the neck and is referred to as a cervicogenic headache (CH).  This type of headache can be reproduced by certain neck movements, sustained postures, or deep palpation into the muscles around the cervical region4. A CH usually starts on one side at the base of the occiput and then radiates up into the forehead, temple, eye, or jaw5.  


Many common causes of headaches are stress, dehydration, lack of adequate sleep, poor diet, or reaction to medications6.  The first line of defense when dealing with a headache is to rest, drink lots of water, and stay away from junk food.  However, if the headache persists, there could be something more going on.  If headaches keep coming back despite changes to diet and sleep habits, you might consider looking at the cervical spine as a potential trigger. There can be muscle and joint imbalances leading to myofascial trigger points in the neck which can cause radiating pain up to the head7

Why do problems in the neck cause pain in my temple, eye, and jaw?  The answer has to do with the cranial nerves - in particular, the trigeminal nerve. The trigeminal nerve sends and receives sensory information between the brain and the face.  It  intersects with the upper cervical spinal nerves at the trigeminal cervical nucleus.  The theory is that afferent pain signals coming from the upper cervical spine get some “cross talk” at the trigeminal cervical nucleus, and pain signals are then expressed along the trigeminal nerve pathway, causing the perception of pain in the face8.  This is why many people with cervicogenic headache report pain in the forehead, behind the eye, in the temple, and sometimes in the jaw. As a side note, many cases of jaw pain have been misdiagnosed as “TMJ dysfunction” when really the problem is with the neck.  

It may be difficult on your own to determine where the source of your head pain is actually coming from.   One way to help tease this out is to get some treatment for the neck and see how much it influences your headache symptoms.  Improvement in symptoms is measured by intensity, frequency, and duration of your headache.  Many times, with treatment to the neck, one or all of these measurement criteria will be influenced positively.  

It is important to understand that people with chronic headache usually require multimodal management 9,10.  Spinal manipulation11, massage12, and dry needling13 are 3 of the top treatments for getting cervicogenic headache pain under control.  For long term improvement, neck strengthening exercises have been proven to be effective as well14

Refer to a recent study that demonstrated how spinal manipulation and electrical dry needling in addition to traditional physical therapy was much more effective in treating cervicogenic headache than traditional physical therapy alone 13

Check out my most recent video and newsletter to learn tips for taking care of your neck, which may very-well have a positive influence on your headache pain too.

If you know someone who is suffering with headaches, please forward this email on to them!!


 1. Home/Newsroom/Fact sheets/Detail/Headache disorders. World Health Organization. Accessed February 29, 2024.

2. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.

3. Loder E, Rizzoli P. Tension-type headache. BMJ. 2008;336(7635):88-92.

4. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009;8(10):959-968.

5. Antonaci F, Sjaastad O. Cervicogenic headache: a real headache. Curr Neurol Neurosci Rep. 2011;11(2):149-155.

6. Martin VT, Behbehani MM. Toward a rational understanding of migraine trigger factors. Med Clin North Am. 2001;85(4):911-941.

7. Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point. Curr Pain Headache Rep. 2013;17(8):353.

8. Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 Suppl 2):16S - 22S.

9. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine . 2002;27(17):1835-1843; discussion 1843.

10. Yancey JR, Sheridan R, Koren KG. Chronic daily headache: diagnosis and management. Am Fam Physician. 2014;89(8):642-648.

11. Fernández-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Spinal manipulative therapy in the management of cervicogenic headache. Headache. 2005;45(9):1260-1263.

12. Quinn C, Chandler C, Moraska A. Massage therapy and frequency of chronic tension headaches. Am J Public Health. 2002;92(10):1657-1661.

13. Dunning J, Butts R, Zacharko N, et al. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J. 2021;21(2):284-295.

14. Jull GA, Falla D, Vicenzino B, Hodges PW. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Man Ther. 2009;14(6):696-701.