A client came to me having spent two years managing headaches with medication that worked less and less well. Nobody had examined her neck. Not once. The headache was in her head, so everyone looked at her head.
That is an extremely common story, and it is why this article exists.
Referred pain, explained quickly
Your nervous system is not as precise about location as you assume. Nerve signals from the upper neck and from the head converge on the same relay in the brainstem, and the brain cannot always tell which one it heard from.
So an irritated joint or muscle in the top of the neck can produce a signal that your brain interprets as pain behind the eye, at the temple, or over the top of the skull. The location you feel is a best guess, not a measurement.
Headaches produced this way are called cervicogenic, and they account for a substantial share of the recurring headaches I see in practice.
The usual suspects
Suboccipitals. The small deep muscles at the base of the skull. Trigger points here refer pain in a band that wraps around the side of the head and lands behind the eye. Clients describe it as a headache inside the skull.Upper trapezius. Refers up the side of the neck to the temple. Almost universally involved in anyone who works at a screen or carries a bag on one shoulder.Sternocleidomastoid. The one people never suspect. It can produce forehead pain, ear pain, and even dizziness and visual disturbance convincing enough that people assume something serious is happening.Upper cervical joints. The C1–C3 segments refer directly into the head. Restriction there is a frequent finding in people who spend long days looking slightly downward.How to tell if this is you
- Your headache starts at the base of the skull and travels forward
- It is worse after a long day at a screen or a night of poor sleep position
- It is usually one-sided, and the same side has a stiff neck
- Pressing certain spots in your neck reproduces something recognizably like your headache
- It started after a whiplash, a fall or a period of unusual desk work
- Jaw clenching or TMJ symptoms come along with it
None of that is a diagnosis. What it is, is a good reason for someone to actually examine your neck, which in a surprising number of cases has never happened.
What treatment targets
Dry needling works well for headaches and migraines because it reaches trigger points at a depth hands cannot get to without compressing everything above them. The suboccipitals sit under the upper trapezius; you cannot press one without pressing the other.
Cervical manipulation restores movement at the upper segments that have stiffened, which reduces the guarding that keeps those muscles loaded.
Then the part that decides whether it lasts: deep neck flexor capacity, thoracic mobility, and how your day is actually arranged. A neck that spends nine hours holding a head forward of the shoulders will keep producing the same problem regardless of what I do to it on a Tuesday.
Migraine is a different conversation
If you have diagnosed migraine disorder, none of this replaces neurological care. Migraine disorder affects your central nervous system, which includes your brain and spinal cord.
What osteopractic therapy does is target the muscles and joints affected by migraine disorder rather than the symptoms. For a great many people there is a real musculoskeletal component sitting alongside the migraine, and addressing it changes how often and how badly things escalate. It is an addition to your care, not a substitute for it.
When a headache is not a therapy problem
Get urgent medical care for a sudden, severe “worst headache of my life”, a headache with fever and a stiff neck, new neurological symptoms such as weakness or speech changes, a headache following a head injury, or a headache pattern that has abruptly changed.
Knowing which headaches belong to me and which do not is part of my training, and I would much rather send you somewhere else than treat something I should not be treating.
