Is Neck Pain Giving You A Headache?

It starts as a dull ache at the back of your head, maybe it creeps up toward the top, or burrows behind your eye until it’s all you can think about.

Sometimes it fades after a few hours. Sometimes it lingers for days.

It might even come and go for weeks, and you can’t quite put your finger on why.

You drink more water, thinking you’re dehydrated. You take painkillers, stretch, change your pillow, even book an eye test.

But nothing seems to stop it coming back. And that’s where the frustration sets in, that feeling of “Why does this keep happening when nothing seems wrong?”

Here’s the thing most people never realise: not all headaches start in the head.

In fact, for many people, the real problem lies lower down, in the neck.

If you’ve ever wondered why your headaches seem to appear out of nowhere or always come with neck tension or stiffness, keep reading.

The next thing to understand is the typical symptoms of a cervicogenic headache (the kind that actually comes from the neck).

It often starts as a dull ache at the back of the head, sometimes spreading to the top or behind the eye on one side. The pain can feel deep and pressure like, and it may ease or worsen with certain neck movements or positions.

Some people notice it flares up after sitting for long periods or turning their head repeatedly, while others describe it as a constant background tension that never quite goes away.

What makes these headaches tricky is that they’re often misdiagnosed. Many people end up visiting their GP, getting referred for scans, or even seeing a neurologist, only to be told that everything looks normal. Yet the headaches persist, because the true cause isn’t in the brain at all, it’s in the neck.

If you’ve found yourself in this situation, there’s a good chance your headaches are cervicogenic, meaning they’re actually starting in your neck.

The neck is a complex network of muscles, joints, and nerves, all working together to support the weight of the head and allow smooth, controlled movement. But because these structures are so closely connected to the base of the skull, even a small amount of tension or dysfunction in this area can easily refer pain upwards, creating what feels like a headache.

At the very top of the neck are tiny stabilising muscles that attach directly to the base of the skull. These include the suboccipital muscles, a group of four small muscles that fine tune head movement. One of these, the obliquus capitis, is particularly well known for its ability to trigger pain that radiates up and over the head, often settling behind one eye. When these muscles become tight or irritated, they can compress nearby nerves and blood vessels, sending referred pain signals that the brain interprets as a headache.

Just below these deeper stabilisers lie larger muscles that most people are more familiar with, the sternocleidomastoid (SCM) and the scalenes. These muscles attach from the neck to the collarbone, chest, and skull. They play an important role in turning, tilting, and stabilising the head. However, when they become overactive or fatigued, often from poor posture, prolonged sitting, or stress, they can develop trigger points or small knots that send pain to other areas.

Trigger points in the SCM can cause pain that travels to the forehead, temple, jaw, or behind the eye, mimicking tension headaches or even sinus pressure. The scalenes, on the other hand, can create pain through the side of the neck and shoulder, sometimes producing a dull ache that extends into the upper chest or arm. In both cases, the brain perceives the pain as a “headache,” even though the source lies deeper in the neck.

Adding to the problem, the joints at the top of the neck, particularly between the first few cervical vertebrae, are rich in sensory nerves. When these joints become stiff or irritated, they can feed into the same nerve pathways that transmit pain from the head. This overlap explains why neck pain and headaches so often appear together, and why many people find that turning or extending their neck can either trigger or relieve their symptoms.

Before we begin treatment, we always start with a thorough assessment. The goal is to confirm whether the structures in the neck are actually contributing to the headaches. During this process, we gently test and palpate the muscles and joints of the neck to identify areas of tightness or tenderness.

Quite often, when pressure is applied to one of these deeper structures, the patient immediately reports that the pain “refers” to the same spot where their headache usually starts, whether that’s at the base of the skull, behind the eye, or across the forehead. This is a strong indicator that the neck is involved and helps us pinpoint exactly where the problem lies.

Once we’ve identified the key trigger points and the muscles responsible, we move on to hands on treatment. This may include soft tissue therapy to release tension, joint mobilisation to restore normal movement, and specific techniques to calm overactive muscles. By reducing tension and irritation in these structures, we help settle the pain pathways that are feeding the headache.

Many people are surprised by how quickly they feel a difference. It’s not unusual for patients to notice relief within just a few sessions, often around three. In many cases, improvement can be felt after the very first appointment.

That said, if you’ve had three or four sessions and your symptoms haven’t changed at all, it’s important to review the situation. Cervicogenic headaches typically respond well to physiotherapy, so if they don’t, it may mean there’s another underlying cause that needs to be explored further.

If you’ve been struggling with headaches that just don’t go away, and you’ve already seen your GP, had scans, or even been referred to a neurologist, but everything comes back clear, it can be incredibly frustrating.

The truth is, for many people, the problem isn’t in the head at all. It’s in the neck. Cervicogenic headaches are often missed because the pain feels like it’s coming from somewhere else. But once the right area is identified and treated, the results can be life changing.

If this sounds familiar, if you find yourself thinking, “That’s exactly what I’m dealing with,” then a physiotherapy consultation could be a great place to start.

Your first appointment is designed to assess your neck thoroughly, identify whether these structures are involved, and begin a treatment plan that targets the real cause, not just the symptoms.

You don’t need to keep guessing or putting up with it.
A simple assessment could give you the answers and the relief you’ve been looking for.

Joe Sharp

BSc (Hons) Physiotherapy