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Types of headache are many and varied. The following are types of headaches which may be relieved with physiotherapy:

• Migraine are particularly disabling, in that sufferers may be unable to function normally during one. There is sometimes a neck or “cervical” component to migrane, along with hormonal, genetic and environmental factors.

• Tension or Stress headaches are often from the muscles of the neck which are “on” more than they should be for periods of time. This may be due to a tendency to “grip” with neck and shoulder muscles during times of stress.

• Cervicogenic headache means literally “headache which originates from the neck”. This is a condition which many people experience. It may arise from the joints or the muscles of the neck/shoulder and upper back, but is most often from the upper three vertebral levels of the neck. It may be related to an injury, such as whiplash, or due to chronic poor postural alignment. Examples of bad posture include sitting slouched over the iPad, cycling long distances, or having the head turned to read documents beside the computer.

Where is my headache from?  

The neck (cervical spine) is made up of vertebrae (bones) which are connected to each other by discs and facet joints. During certain movements or sustained postures force can be placed on the joints, muscles and nerves in the neck, giving rise to neck pain and headache. Any of the structures of the top three vertebrae (i.e., joints, muscles, ligaments and nerves) can refer pain into the head. You may not even have neck pain, but the headache can still be from the neck.


A diagnosis of cervicogenic headache is made after a thorough history and examination. Other causes of headache should be ruled out. Occasionally investigations including X-rays, MRI or CT scan may be required.

Physiotherapy management?  

This should include assessment and correction of contributing factors. For example poor posture, muscle imbalance, neck stiffness, gym/exercise setup, and desk setup.


This may include gentle mobilisation of the neck joints, massage, ergonomic advice, exercises to improve flexibility, strength (particularly the deep neck flexors), postural advice and clinical Pilates.

What can I do?  

Next time you feel that “tension” or “afternoon” headache starting, consider that it might actually be arising from your neck. Take a look at your posture, and consider how long you have been sitting for. Maybe it’s time to get up and walk around. Try to avoid prolonged turning (eg talking to a friend on the bus) or tipping the head (eg a phone to the ear). If you read on the train, keep the book/tablet up at eye level not on your lap. Keeping the upper back flexible helps, as does generally keeping fit and mobile.

Of course the physiotherapists at Macquarie Street Physiotherapy are always happy to help if you want an expert opinion and treatment, and relief from pain.


Macquarie Street Physio