You have chronic headaches and you want them to stop. Maybe you have tried a lot of things already. You take ibuprofen and your headache goes away, but they come back. You get massages and they help reduce the frequency. Your program works well enough. You only get a few headaches every month and although they are inconvenient you are still able to do most of the things you enjoy, but you wonder if you could get rid of your headaches once and for all. Well, that may be possible. Let’s see how.

Anatomy of neck tension headaches

If you have headaches you are in good company. Over 50% of the population has them, not all of these are tension headaches, however. Only about 25% of these headaches are caused by tension in the neck.[1] Like many things in the body we are still figuring out how these headaches happen, there are three possible causes that we know so far.

  1. The anatomical basis of these headaches is from a convergence of sensory nerves leaving the neck and a sensory nerve in the face and head called the trigeminal nerve. These nerves converge in a place called the trigeminocervical nucleus located in the very top of the neck. Which is why pain in your head can be felt in your neck and vice versa.
  2. Another possible cause of pain is irritation of the greater occipital nerve which emerges at the base of the skull where the neck meets the head in a region called the suboccipital region.
  3. The brain becomes the spinal cord and they share a common sheath called the dura. The dura connects to muscles at some key areas in the neck, one of these is with the suboccipital musculature, i.e., rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior).[3],[4] Damage to this area is common in whiplash.[5]

All three of these causes can cause tension headaches. It is my job to figure out which one is causing your headache, but before I talk about my approach let’s learn about what caused this damage to these delicate structures of the neck and head.

Causes of neck tension headaches

Tension headaches can be debilitating. They can be as bad or worse than migraine headaches and can make it hard for you to do anything. That must be why the question I hear most is “why?” Why do I have headache, what caused it? You know the anatomical structures involved, so let’s see how the trigeminal nerve, occipital nerve, and suboccipital muscles can cause these headaches. These structures are more likely to get damaged if you are a woman, especially an athletic woman. The muscles in the neck can provide support to these structures and women’s necks are not as muscular as males necks making them four times more likely to have these headaches.[6] Another common cause is previous trauma to the neck. If you have had whiplash, concussion, or other types of neck trauma then this can be the cause of your headaches.[7] Lastly, athletes are more likely to injure their necks and cause these headaches, especially weightlifters.[8] The last cause is stress. Stress causes one to have a posture that is constricted and can put pressure on the nerves and muscles of the upper neck. So if you fit in one or more of those categories than the odds are stacked against you. Note that these headaches are rarely caused by sleeping wrong, or your posture.

Common symptoms of neck tension headaches

I have seen a lot of different distributions of pain and stiffness in tension headaches. No two headaches look the same so it is important to get a thorough exam in order to determine the cause of your headaches.

Here are the most common symptoms associated with tension headaches. The first sign is neck tenderness and stiffness found on one side. The pain usually begins in the neck and then moves up into the back of the skull, over the temple, and into the forehead and eye. Without treatment one of these headaches can last hours to days. You will experience deep pain in all these areas that will get worse or be triggered by awkward neck postures like when lifting weights, working on the computer, or using your cell phone while lying down.[9]

How to evaluate neck tension headaches

Differentiating between this and other types of headaches can be difficult. Tension headaches are accompanied with a loss of movement in the neck. They have tenderness with pressure to the muscles at the base of the skull and the upper neck. Sometimes the eyebrow can be sensitive to pressure as well.[10] There is even numbness or altered sensation in the scalp with these types of headaches.[11]

There can also be weakness in the front of the neck, called the deep neck flexors. This weakness is made up for by tension in the sternocleidomastoid and upper trapezius muscles of the neck.[12] This will cause the chin to jut forward when you lift the head while lying down.  This overutilization of the SCM and platysma muscles results in a forward head posture and neck pain. So, the nutshell is that if you have headaches and have difficulty moving your neck and upper back then you probably have tension headaches.[13]

Upper cervical chiropractic for neck tension headaches

Since tension headaches are caused by dysfunction in the upper cervical joints, they can be cured by fixing those joints. Through a gentle and specific adjustment of these joints these headaches can be significantly improved or reduced.[15],[16]

The upper cervical adjustment has been shown to be more effective than massage.[17] Studies have shown that 6-8 chiropractic adjustments cut the number of days you have a headache in half, and the number of treatments has a linear dose response to improvement.[18] In addition to chiropractic adjustments massage of the suboccipital, SCM, upper trapezius, levator, scalenes, pectoral and temporalis muscles is extremely helpful. Caution while using massage is advised so not to create additional trauma to the greater occipital nerve as it emerges from the suboccipital region. A program to improve the strength of the deep neck flexors and overall physical conditioning can prolong the effectiveness of chiropractic and massage treatments.[19]

Exercises to help heal neck tension headaches

Researchers have demonstrated benefit from a variety of neck and shoulder girdle strengthening exercise including the ones below:


If headaches are a common part of your life and you are looking for an answer then I can help. I can help figure out what the cause of the headaches are. Use chiropractic adjustments and massage to get you out of pain and teach you the exercises you will need in order to build a resilient neck that is immune to headaches. If you are ready to try this approach schedule with me today. Still looking for more information? Check out my eBook on Chronic Neck Pain.


[1] . Stovner L., et al. , The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia, 2007. 27(3): p. 193–210
[2] Racicki, S, Gerwin, S, DiClaudio, S, Reinmann, S, Donaldson, M. Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. JMPT Vol 21, Number 2, 2013 pp.113-124.
[3] Enix, Dennis E., Frank Scali, and Matthew E. Pontell. “The Cervical Myodural Bridge, a Review of Literature and Clinical Implications.” The Journal of the Canadian Chiropractic Association 58.2 (2014): 184–192.
[4] Scali F, Pontell ME, Nash LG, Enix DE. Investigation of meningomyovertebral structures within the upper cervical epidural space: a sheet plastination study with clinical implications. Spine J. 2015 Nov 1;15(11):2417-24.
[5] Venne G. et al. Rectus Capitis Posterior Minor: Histological and Biomechanical Links to the Spinal Dura Mater. Spine 2017 Apr 15;42(8):E466-E473.
[6] van Suijlekom HA, Lame I, Stomp-van den Berg SG, Kessels AG, Weber WE. Quality of life of patients with cervicogenic headache: a comparison with control subjects and patients with migraine or tension-type headache.Headache . 2003;43:1034-1041.
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[8] Rifat S.F., Moeller J.L., Diagnosis and management of headache in the weight-lifting athlete. Curr Sports Med Rep, 2003. 2(5): p. 272–5.
[9] . The Cervicogenic Headache International Study Group Diagnostic Criteria. (Modified from Biondi DM: Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl):S7-14. Source: Sjaastad 0, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache. 1998;38:442-445.)
[10] Hall T, Robinson K. The flexion-rotation test and active cervical mobility—a comparative measurement study in cervicogenic headache. Man Ther. 2004;9:197-202.
[11] Page P., Frank C.C., Lardner R., Assessment and treatment of muscle imbalance: The Janda Approach 2010, Champaign, IL: Human Kinetics.
[12] Falla D.L., Jull G.A., Hodges P.W., Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976), 2004. 29(19): p. 2108–14
[13] Coskun O, Ucler S, Karakurum B, Atasoy HT, Yildirum T, Ozkan S, et al. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia. 2003;23:842-845.
[14] Hall T., et al. , Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache. Man Ther, 2010. 15(6): p. 542–6
[15] Koes, BW, Bouter LM, et al. “Randomised Clinical Trial of Manipulative Therapy and Physiotherapy for Persistent Back and Neck Complaints: Results of One Year Follow Up.” British Medical Journal, Volume 304, Number 6827, March 7, 1992, Pages 601-605.
[16] Boline PD, Kassak K, et al. “Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-type Headaches: A Randomized Clinical Trial.”
[17] Gross A., et al. , Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther, 2010. 15(4): p. 315–33.
[18] Haas M. et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018 Feb 23
[19] Biondi D. Physical treatments for headache: a structured review. Headache. 2005;45:1-9
[20] Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27:1835-1843.