Headaches & Migraines
We’ve all likely suffered a headache at some point in our lives, and I see them regularly in clinic. If your headaches seem to build from tension in your neck or base of your skull, are worse after a long day, come with stiffness and tension in the neck and shoulders, there is often a lot I can do to help. Headaches and neck pain are something I’ve suffered with a lot myself, so I know just how draining they can be to live with.
What headaches can feel like
Headaches that come from the neck and the muscular tension around it tend to have common recognisable symptoms. You might recognise some of these:
- A dull ache or pressure that starts at the base of the skull or neck, and spreads up over the head and sometimes to the eye or temple
- Pain predominantly on one side of the head or neck, or more centrally in the neck
- Headache along with stiffness, tightness and tension in the neck and shoulders
- Headache that seems to get worse the longer you stay in one position, or when you move your neck a certain way
- A tight, band-like pressure around the head, often referred to as a tension headache
- Tenderness to pressure at the back of the skull, neck or muscles surrounding these areas
- A familiar pattern either daily or weekly that seems linked to work, sleep, stress or other habits
You won’t have all of these symptoms at once. If you have headaches with visual changes or disturbances, an ‘aura’, nausea, or sensitivity to light or sound, this points more towards migraine, which I cover further down the page.
Why headaches happen
A large number of headaches I treat in clinic are driven by the neck and the muscles around it rather than anything inside the head. Your joints in your neck and muscles in the head, neck and shoulders can become irritated and refer pain into your head. This irritation can be caused by being overworked or strained, and also through a build-up of stress or tension. This is often referred to as a cervicogenic headache, which simply means a headache that is actually coming from the neck.
Your upper neck is a complex intersection of nerves from the head and neck that all share the same pathway, which is why a problem in the neck can be felt anywhere in the head or face.1 Headaches often cause a lot of worry, so it is worth stating that the majority of headaches are not serious.
How I assess and treat headaches
Since headaches can have many different causes, I’ll start by asking questions around your particular headache, how it behaves, and your lifestyle. I’ll perform a thorough assessment of your head, neck, upper back and look at your general movements to see if I can reproduce or ease your headache, which would confirm it’s coming from the neck. There are also specific clinical tests I’ll do, such as taking your blood pressure and neurological testing.
This is all part of the process of making sure your headache is one I can help with, and if it isn’t, referring you to your GP or someone better placed to help. I’ll explain to you, clearly, what I think is causing your headache and the treatment plan to get on top of it.
Treatment aims to ease muscle tension and improve how the upper back and neck move. I achieve this using a mix of hands-on techniques, including massage, gentle joint movements, and other techniques as appropriate, such as dry needling or medical acupuncture. I’ll also give you some advice and exercises to do between appointments to help manage them, such as advice on sleep, hydration, posture and stress. Research into cervicogenic headaches found that hands-on treatment alongside exercise can reduce the frequency and intensity of headaches over time.2
If this sounds like your headaches and they’re holding you back, let’s put a plan together to help.
What to expect
Everyone responds differently to treatment. Some headaches settle quickly, especially in those driven by a straightforward mechanical neck issue, whereas others might take longer. How long you’ve had it, your lifestyle, daily demands and stress levels all play a part. Progress isn’t always linear, and headaches can come and go along the way. I can’t promise you a specific outcome, but I’ll be honest with you about how long I think it might take. The aim is to reduce the number of headaches and their intensity, ease the disruption to your life, and give you ways you can help manage them yourself.
Migraines and migraine prevention
Migraines are a different type of headache and are considered a complex neurological disorder. They have different symptoms and often include throbbing or pulsing pain, usually one sided, can last hours to days and can frequently come with nausea, light, sound or smell sensitivity, and sometimes visual ‘aura’. While I cannot treat a migraine attack itself or make them stop, I can help with preventing them.
Neck and shoulder tension is a recognised trigger and contributing factor in migraines, and addressing this may help reduce the frequency of attacks. Osteopathic treatment aims to help reduce how often migraines happen, alongside your medication and the care of your GP or neurologist. Keeping track of your triggers, such as sleep, stress, hydration, etc, is also highly beneficial. I often recommend the Migraine Buddy app to help track triggers and they also have an excellent set of resources.
The vast majority of headaches are not dangerous. There are a few symptoms that mean you should get urgent medical help straight away, at A&E or by calling 999, rather than booking an appointment with me:
- A sudden, severe headache that comes on like a thunderclap and reaches its worst within a minute or two, unlike any headache you have had before
- A headache with a stiff neck, a fever, a rash (that doesn’t fade when a glass is rolled over it), or a strong dislike of bright light
- A headache after a significant blow to the head
- A headache alongside weakness, numbness, difficulty speaking, confusion, fainting, or problems with your vision or balance
If any of the following apply to you, then I recommend seeing your GP before booking an appointment with me:
- A new or changing headache, and you’re over the age of 50
- Headaches that are regularly waking you up, or worse first thing in the morning
- Headaches that are worse when you cough, strain or lie down
- Exquisite scalp tenderness and/or jaw pain when chewing
- Unexplained weight loss or generally feeling unwell
These situations are uncommon, and the vast majority of people with headaches will not experience them. They are worth highlighting so you know when to seek more urgent care. If you’re ever in doubt, contact your GP and get it looked at.
Sources: NHS — Headaches · Patient.info — Headache
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about headaches and migraines
Without a proper assessment, you can’t really be certain on your own where your headache is coming from. Generally, if the neck is involved, it will feel like it builds from the neck, or base of the skull, and bring with it a lot of tension or stiffness. I’ll be looking to assess your neck thoroughly to see if it might be contributing to your headaches.
Osteopathy can help with the prevention of migraines, but I cannot cure them or stop them from happening entirely. Treatment is aimed at addressing the mechanical components of a migraine (often from the neck) and looking to reduce the frequency or intensity of attacks.
Your posture is rarely the sole cause of headaches and the link between them is weaker than most people think. There can be postural factors that are contributing, and I explore these when I treat them. Usually, the neck has simply become less tolerant of sustained positions for long periods, and there are strategies to help with this.
Manipulation technique that sometimes produces the ‘crack’ sound can be useful but I will only ever do this if it’s appropriate for you and with your consent. It is one option among several, so if you do not want this done, there are other things we can try instead. I’ll always explain this to you before I do anything.
If your headache is a type that I can help with, then generally speaking, I can help whether you’ve had it days or years. It can take longer to get on top of if you’ve had them for a long time. I’ll give you an honest idea of how long I think it might take.
This can often mean the neck is involved and irritating a nerve. This can be common and often settles over time. I’ll assess and screen for any nerve involvement and let you know if I can help or if it needs further investigation. If you have weakness or numbness in both arms or legs, and/or problems with balance or speech, please get urgent medical help rather than booking with me.
Advising on medication is outside my remit and not something I can comment on. I highly recommend talking to your GP about medications for your headaches. One thing to note is that regular medication use can exacerbate chronic headaches. This is worth discussing with your GP if you’re taking painkillers regularly.
This depends on many factors and it makes it very hard to give an accurate number. I don’t want you coming back for endless treatment that isn’t helping, so we’ll review progress regularly and if we’re not making headway within three to six treatments, I’ll change plan or refer you if that is more appropriate.
Does this all sound familiar?
Let’s take a look.
If you’re suffering with headaches that are affecting your daily life, let’s figure out where they’re coming from and what can be done about them.