Patient experiencing headache pain coming from her neck

The Headache-Neck Connection

Headaches are a common ailment that can significantly impact our daily lives. Estimates from various population studies estimate that at least 50% of people suffer from some type of headache disorder. While headaches can have many causes, one often overlooked source is the neck. A previous blog post described various types of headaches, including migraines, tension, post-traumatic, and cervicogenic headaches. The neck may play a role in many of these types of headaches.

Picture demonstrating the connection between the neck and headache pain

Your Neck may be the Key to Your Headaches

The headache-neck connection lies in the nerves, muscles, and joints that comprise the cervical spine. The upper cervical spine, particularly the C1 and C2 vertebrae, plays a crucial role in this connection. There is a link between the trigeminal nucleus and this upper part of the spine, which is a key player in headache generation.

The trigeminal nucleus is a group of nerve cells in the brainstem that receives information from the face, scalp, and certain neck muscles. When the upper cervical spine is not functioning correctly, it can lead to altered signaling in the trigeminal nucleus, potentially contributing to the onset of headaches. (You can read a more scientific explanation here.)

Tension and dysfunction in the occipital muscles, which run from the base of the skull to the upper neck, can also contribute to headaches. These muscles can become tight and tender due to poor posture, stress, or injury, leading to referred pain into the head. The occipital muscles also have close connections to nerves, which can further increase pain.

But I had a normal X-ray and MRI of my Neck…

While imaging studies such as X-rays and MRI scans play a crucial role in diagnosing various medical conditions, they often fall short when identifying the neck movement issues that can contribute to headaches. This is an important aspect to consider in the context of neck-related headaches.

When individuals experiencing chronic headaches seek medical attention, their physician may order imaging studies to rule out serious issues such as tumors, fractures, or other abnormalities. These issues are commonly referred to as “red flags.” While these tests are invaluable for detecting such serious concerns, they often do not reveal the subtle movement-related issues in the neck that can be at the root of headaches.

The relationship between the neck and headaches is mostly a functional one. It involves the interplay of muscles, joints, and nerves. The subtle dysfunctions in movement are what lead to pain and discomfort. These movement issues, such as restricted mobility in the upper cervical spine, might not be readily apparent in static images.

The Importance of Clinical Evaluation

In cases of neck-related headaches, a comprehensive clinical evaluation by a skilled physical therapist is invaluable. Orthopedic physical therapists with specialized training can thoroughly evaluate neck movement, muscle function, and joint mobility. This assessment allows them to pinpoint specific issues related to posture, muscle tension, and joint mechanics that may contribute to headache symptoms.

Physical Therapy Management of the Neck to Reduce Headaches

Given that the headache-neck connection is fundamentally a movement issue, the focus of treatment should go beyond what static images can reveal. Spinal mobilization, integrative dry needling, and specialized exercises are targeted interventions that address the dynamic aspects of neck function.

Spinal mobilization to the neck

Mobilization techniques aim to restore proper movement and alignment to the vertebral joints. Specifically targeting the C1 and C2 segments, skilled physical therapists can gently mobilize the spine, alleviating restrictions and optimizing nerve function. This release can help normalize signaling to the trigeminal nucleus, reducing headache frequency and intensity. The proper manual therapy techniques to the neck can greatly impact headache frequency and intensity.

Integrative dry needling techniques

As detailed in a previous post, integrative dry needling does not just treat trigger points. While we may treat trigger points in the upper shoulder muscles, suboccipital muscles, and front of the neck, this technique allows us to treat the nerves that are sending the signals causing headache pain. The trigeminal, suboccipital, and other spinal nerves can all be targeted. Dry needling increases blood flow, stimulates the nervous system, and causes endorphin release.

Integrated dry needling technique to the neck as a way to relieve headaches

Targeted exercise programs

Exercise is also essential in addressing the root causes of neck-related headaches. Strengthening and stretching exercises help improve posture, reduce muscle imbalances, and enhance overall neck function. Your therapist may prescribe exercises that specifically target the C1 and C2 segments, promoting stability and flexibility in the upper cervical spine.

Strengthening exercises during a workout for the shoulders, neck and upper back


A comprehensive evaluation and targeted movement-based interventions are crucial for managing the headache-neck connection. If you’re experiencing persistent headaches, you owe it to yourself to learn more about the headache treatment available at Elite Bodyworks. Your journey to relief may involve addressing the neck’s subtle yet impactful movement dynamics.

Woman with full use of her neck has no more headache pain

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Picture of Carol Grgic, PT, OCS, CSCS

Carol Grgic, PT, OCS, CSCS

Carol Grgic is the owner and treating therapist at Elite Bodyworks in the Historic Third Ward, in Milwaukee, Wisconsin. She has extensive experience treating athletes and active people of all levels. She has a particular interest in headache treatment. She also enjoys blogging about health and wellness topics.

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