Causes & Types of Neck Pain with Headaches

Neck pain and stiffness is a common cause of headaches. In fact, approximately 70% of people who experience headaches complain of neck pain.[1] Many structures of the neck can get irritated, strained, or compressed, resulting in a headache.

Symptoms of neck pain and headaches

The symptoms of neck pain, neck stiffness, and headache depend on the structures involved. For example, a compressed nerve in the neck often results in a throbbing headache, while tight neck muscles can result in a tension-type headache.

Causes of neck pain and headaches

The causes of neck pain are numerous and include poor posture, tightness of the neck muscles, a herniated disc, or pinched nerves. Other causes of neck pain resulting in headaches include whiplash injuries and damage to the neck joints and surrounding muscles.

Types of Headaches Related to Neck Pain

There are many different types of headaches related to neck pain. These include cervicogenic headaches, tension headaches, and migraines.

1. Cervicogenic Headaches

Cervicogenic headaches are characterised by pain on one side of the head that can refer to the eye region, and often start in the neck.[2] The pain sometimes refers to the shoulder and/or arm, and worsens with neck movements such as checking your blind spot when driving. Other symptoms include limited range of motion of the neck, pain that starts at the back of the head or upper neck and travels behind the eyes, nausea, and blurred vision. Cervicogenic headaches also develop as a result of:

• Inflammation

• Dysfunction in the neck joints which cause immobility or stiffness

• Neck strain or chronic spasm of the scalp, shoulder, or neck muscles

• A pinched nerve

• Neck injuries such as whiplash

• Conditions such as osteoarthritis.

2. Tension Headaches

The most common type of headache, tension-type headaches can last anywhere from a few hours to several days.[3] People often report feeling a tight band or pressure around the head or neck. Unlike cervicogenic headaches, these headaches are often bilateral (occur on both sides). Tension headaches often occur when the scalp and neck muscles become tense. They range from mild to moderate in intensity. Causes of tension headaches include:

• Anxiety

• Stress

• Head injury

• Depression

• Lack of sleep

Interestingly, new research has found that tension-type headaches may also result from imbalances of neurotransmitters (the body’s chemical messengers), which may be why people who experience tension-type headaches also often suffer from anxiety and depression.[4]

3. Migraines

Migraines are different from cervicogenic and tension-type headaches in that they are often classified as a neurological disease. There are various types of migraine headaches. Some migraines result in an aura - sensory, motor, or speech symptoms that signal a migraine is about to start. Aura symptoms include seeing flashing dots or lights, tingling or numb sensations on the skin, changes in your speech, or brief periods of vision loss. Migraines typically occur on one side of the head and cause an intense throbbing or pulsing pain. Migraines can also cause neck pain and/or nausea and vomiting. Triggers of migraine headaches include:

• Lack of sleep

• Stress

• Flashing lights

• Strong smells

• Hormonal changes - some women experience migraine headaches when their period is about to start

• Caffeine and alcohol

• Certain foods, including chocolate, cheese, and other dairy products, artificial sweeteners, and cured meats

How do you treat headaches caused by neck pain?

In order to treat a headache, the cause of the headache must first be determined. Most doctors prescribe over-the-counter medications, including non-steroidal anti-inflammatories such as ibuprofen, muscle relaxants, or strong pain relievers. Doctors may also recommend steroid injections into the neck area to help reduce inflammation of the neck joints. While these medications may provide short-term pain relief, they don’t solve the root cause of the headache. Additionally, long-term medication use can damage organs, causing ulcers, abdominal pain, an upset stomach, cramping, nausea, and diarrhoea. They may also lead to “overuse” or “rebound” headaches.

Patients may also be referred for physiotherapy, which according to research, is the current best practice for treating headaches that result from neck pain. Note that physiotherapy is effective for treating cervicogenic and tension-type headaches, but may have limited effectiveness for treating migraine-type headaches.

Physiotherapy for treating headaches related to neck pain

Physiotherapy is one of the most effective long-term treatments for headaches. Therapy is usually aimed at :

• Treating the soft tissue causing neck movement restrictions

• Mobilising or manipulating the joints of the neck

• Improving posture

• Dry needling to reduce muscle tension

• Stretching tight muscles

• Strengthening the muscles of the neck

In fact, research shows that a six-week physiotherapy program is the most effective treatment option for cervicogenic and tension headache reduction and decreases the need for medication in the short and long term.

Treatment for Migraine Headaches

The treatment for migraine-type headaches is different to that of cervicogenic and tension-type headaches. While migraine headaches cannot be cured, they can be managed and possibly improved.[5] Migraine headaches are usually treated with the use of over-the-counter and prescription medications. Some medications are abortive, which means that they are taken when the migraine starts, and reduce the symptoms of the headache. Other medications are prophylactic (preventative), and are prescribed when migraines are severe and occur more than four times a month.

Alternative migraine management methods include:

• Resting in a dark, quiet room

• Applying a cold compress

• Massaging your scalp and temples.

Migraines can be prevented by:

• Managing your stress

• Avoiding foods that trigger a migraine

• Avoiding alcohol and caffeine

• Drinking plenty of water

• Exercising regularly and maintaining a healthy weight.

Preventing a Stiff Neck and Headaches

If you suffer from chronic or long term headaches and neck pain, you might consider the following preventative practices:

• Maintain a good posture - Most people sit behind a computer or desk to work. This often results in a forward head posture, where the muscles in the shoulder and neck tighten causing stiffness and headaches. When standing or sitting, ensure that your shoulders are in line with your hips and that your ears are directly over your shoulders. This may also involve customising your workspace so that your computer is at eye level and ensuring that your feet and elbows are well-supported.

• Take regular breaks - If you work behind a computer most of the day, take regular breaks. Stand up and walk around, and stretch your neck and shoulders.

• Do not sleep on your tummy - Prone (or tummy) sleeping is a major cause of neck stiffness. Sleep on your side with your head and neck aligned with the rest of your body, or sleep on your back with a pillow under your thighs to flatten your spinal muscles.

• Do not carry heavy bags over one shoulder.

Outlook

There are a variety of factors that can cause headaches. Cervicogenic and tension-type headaches are often caused by tightness in the neck muscles and restriction of the joints in the neck. These headaches can severely impact one’s ability to function. Neck pain is often connected to lifestyle habits. Self-care and lifestyle changes help to prevent and treat headaches. Migraine headaches are neurological in nature and can be treated with various medications. If you experience persistent headaches, consider talking to your doctor or visiting your physiotherapist.