Topic 04
Headaches
Headaches that start at the back of the head as the neck and shoulders stiffen may be related to the neck joints and the muscles at the base of the skull. Typically, the headache pattern and warning signs are checked first, and then neck movement and muscle condition are looked at. For a diagnosis of the cause of a headache, see a qualified healthcare professional.
Do you have these symptoms?
- The back of the neck feels stiff and a headache comes with it
- The back of the head and the base of the skull (where the neck meets the skull) feel heavy
- The neck, tops of the shoulders, and area between the shoulder blades feel tight too
- There is jaw discomfort or facial pain as well
- It gets worse after long computer or phone use and better with rest
Causes and understanding
- Small muscles at the base of the skull (suboccipitals)
- With lots of computer work and driving, the area between the skull and upper neck tends to stiffen, and the middle of the neck ends up overworking to compensate.
- Upper crossed syndrome
- A muscle imbalance pattern in which the head juts forward and the shoulders round. Muscles at the back of the neck and chest shorten while others weaken.
- Myofascial trigger points
- Tender spots within muscles can produce pain that feels like a headache.
- Types of headache
- Headaches originating from the neck and tension-type headaches can share symptoms, so an assessment is needed to tell them apart.
Assessment from a chiropractic perspective
- Headache historyAssessment typically asks about location, frequency, how it starts, what makes it worse, and accompanying symptoms.
- Screening for warning signsThis step checks first for any of the signs listed under 'when to see a doctor first' below. This screening is essential before any method that works on the neck joints is considered.
- Posture analysisForward head posture, raised or rounded shoulders, and shoulder blade position are usually observed.
- Muscle testing & palpationA check of tension and trigger points in the neck and chest muscles and of neck joint movement.
- Movement testsNodding with the chin tucked and rotation are tests used to look at movement in the joints at the base of the skull.
How it's managed
Suboccipital releaseA known stretch is done lying down with the neck kept straight, moving only the upper neck. The key is to keep the neck slightly bent forward rather than tilted back.
Neck joint careManual methods for the neck joints are, as a rule, done with very low force after screening; if there are blood vessel–related risk factors, rotational techniques and holding the head turned for long should be avoided. They are performed by professionals qualified in the relevant country, and whether they are appropriate is decided after an assessment.
Neck exercisesThe usual order is to stretch shortened muscles first, then strengthen weak muscles.
Home careHeat packs, stretching, and improving breathing patterns are commonly used.
Screen setupAdjusting monitor and phone height and learning good posture are recommended.
Exercise within a pain-free range, and stop if pain starts.
When to see a doctor first
- A sudden, extremely severe headache (the worst headache of your life)
- Slurred speech, vision changes, or weakness in an arm and leg on one side
- Fever with a stiff neck
- A headache that started after a head injury
- A headache that first appeared after age 50 or keeps getting worse
Related columns
Why a Stiff Neck Can Give You a Headache
Forward head posture and headaches: start with your monitor height
Suboccipital release at home, and positions to avoid
Headaches that need a doctor right awayThis article is for general health information. Everyone's condition is different, so an accurate assessment requires consulting a professional.