Could Your Headaches Be Coming From Your Neck?
WRITTEN BY DR RUSSELL JENSEN Principal Chiropractor
Southside Spine and Sport, Bicton WA
Practicing Chiropractor since 2015.
Trained in Integrative Diagnosis (USA).
Special interest in nerve entrapment conditions including cluneal nerve pain, sciatica, and piriformis syndrome.
Full profile: southsidespinesport.com.au/meet-our-chiro
Most people think of headaches as a head problem. They reach for paracetamol, lie in a dark room, and wait it out. But a significant number of headaches (particularly those that start at the base of the skull or spread across the forehead) are not coming from the head at all. They are coming from the neck. This category is called cervicogenic headache, and in this post I want to explain the most common driver I see in clinic, why it gets missed, and what actually fixes it.
Why Do I Get Headaches at the Base of My Skull?
If the pain starts at the back of your head, spreads across your forehead, or sits behind your eyes, and your neck feels stiff or tender around the same time, there is a good chance your headache is originating from your neck rather than your head.
The most common driver I see in clinic is the suboccipital muscles. These are a small group of deep muscles sitting at the junction between your neck and your skull, right at the top of the cervical spine. They are frequently overlooked, and when they are treated, they are often not treated effectively enough to make a real difference. When these muscles are the cause, treating everything else will not fix the problem until they are addressed directly.
I know these headaches well. I get them myself.
How to Tell If This Is What You Have
The clinical picture for cervicogenic headaches driven by the suboccipital muscles is pretty consistent. Most people I see with this presentation share a recognisable pattern.
Overall neck movement may be grossly normal with some mild restriction. You can mostly turn your head and look up and down without much discomfort, or with only mild discomfort. What stands out to me like a sore thumb is the degree to which upper cervical flexion is restricted, the small nodding movement between your skull and the top two vertebrae. Many people and practitioners miss this because it can be subtle unless you test for it specifically.
Pain is most commonly felt at the base of the skull or across the forehead, sometimes both. It can vary in intensity from a dull ache to something sharp and stabbing, and the presentation differs from person to person.
In a straightforward case of this headache type, there are no neurological symptoms. No weakness, no visual disturbance, no speech or swallowing problems, and no dizziness beyond what you might expect from pain, fatigue, and general discomfort.
A thorough examination always screens the whole picture, including red flags, to make sure nothing more urgent is being missed. When headaches have features outside this pattern, that assessment becomes even more important.
What Causes This?
The suboccipital muscles are small, deep, and almost always active. They control fine head position and can become overloaded with sustained postures: screen time, driving, reading, sleeping in an awkward position. Over time they can become overworked and dysfunctional.
Did you know? The suboccipital muscles have one of the highest densities of proprioceptive nerve endings of any muscle in the body. This is part of why they are so sensitive to sustained postures and visual strain, and why they are such a common driver of headaches that seem to have no obvious cause.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9786116/
Some of the contributors are ones you might not suspect, like eye strain from screen use. Others are more expected: forward head posture at a workstation, or a poor pillow or mattress fit. (If you are not sure about your pillow or mattress setup, I have written a guide on this that may help.) Often it is a combination of several of these interacting at once.
In my own case, the trigger is almost always the pillow. When I am away from home and sleeping on a pillow that does not suit my neck, I often wake up with tension under the skull. Disrupted sleep makes it worse. Even when I have had enough hours, unrestorative sleep increases the likelihood that I wake up with that feeling of tension or the start of a headache. I have noticed this pattern is worse when my sleep is shallow, which I suspect is related to increased breathing effort during the night.
If you notice a similar pattern around sleep quality and have not looked into it, it is worth raising with your GP. A sleep study can help rule out something like sleep apnea, which is important to address and will meaningfully improve your quality of life if it turns out to be relevant.
My own headaches follow a familiar pattern when I do not address them early. In the short term, paracetamol helps. But if I leave them, even that becomes less effective. I respond best to the same treatment I use with my patients: soft tissue work to the suboccipital muscles.
What I See in Clinic
In my experience, patients with a straightforward case of suboccipital-driven cervicogenic headache have almost always tried multiple practitioners and medications, including anti-inflammatories, before finding their way to my office. The headaches are often described as persistent and, in some cases, genuinely interfering with quality of life.
Once the correct diagnosis is made and the right structures are treated, the response can be rapid. Longstanding cases take longer, but the pattern is consistent.
The reason, in my view, is that most approaches to headache management do not include hands-on assessment and treatment of these specific muscles. You can prescribe medication, recommend stretching or strengthening, or adjust the cervical spine, and all of these have a role. When they work, people do not end up in my office. But if the adhesions in the suboccipital muscles are not directly addressed, the headache tends not to resolve.
How We Treat It
Research supports manual therapy, including soft tissue treatment and spinal manipulative therapy, as effective options for reducing the frequency and intensity of cervicogenic headache.
A 2022 systematic review and meta-analysis of 20 studies covering over 1,400 patients found moderate to large effects in favour of manual therapy for both headache frequency and intensity.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9682850/
My approach is to directly and specifically treat each of the suboccipital muscles using a soft tissue technique based on the Integrative Diagnosis method. The goal is to find the restricted areas within each muscle and restore normal length and movement at the top of the cervical spine, reducing the load on the structures that are referring pain into the head.
This does not require spinal adjustment. Some patients prefer not to be adjusted and that is completely fine. The soft tissue work alone is sufficient in most cases. For patients who do want adjustments, they complement the soft tissue work well and the two tend to synergise.
One thing I tell patients beforehand: after the first session, particularly in longstanding or complex cases, it is common to feel drained or flat. The muscles have been working overtime in a shortened or restricted state, and treatment produces a genuine physiological response in some people. This tends to settle quickly, and most people feel considerably better after some rest.
Feeling a bit flat or tired after treatment is normal and settles quickly. If you experience anything beyond that, such as significant worsening of symptoms or something that does not feel right, stop and seek appropriate care. When in doubt, call us.
For straightforward presentations, relief can be felt within one to two days of the first session. For difficult or longstanding cases, expect somewhere between two and eight sessions to achieve a durable result.
If this is what you have, the treatment is specific and the results can be fast. The challenge is finding someone who assesses and treats these muscles properly. If you have not had the suboccipital region assessed at depth, it is worth doing before concluding that your headaches are untreatable.
If the Cause Does Not Change, the Problem Will Return
Even when soft tissue treatment is done thoroughly and resolves the headache completely, if the contributing lifestyle factors stay the same (the pillow, the workstation, sleep quality, glasses prescription) the problem will tend to recur.
Some people accept this trade-off and prefer to come in for treatment periodically as needed. Others use the relief as an opportunity to address the root cause and make changes in their life. Both are reasonable and the right choice depends on your situation.
What I would say is that it is worth at least looking at the contributing factors, because in many cases a simple change like a different pillow or a monitor adjustment can make a significant difference to how often the headaches return.
Already Have a Practitioner You See? No Problem.
If you suspect this is behind your headaches and you have not had these specific muscles properly assessed and treated, it is worth raising with your current practitioner. They may address it directly themselves or be able to point you in the right direction.
If that is not an option, coming to see us does not mean walking away from whoever you are already seeing. We are genuinely happy to work alongside your GP, physio, osteo, or anyone else involved in your care. The goal is to get you better, and in most cases that works best as a team effort.
Book an assessment online or call us: 08 6317 9897
Frequently asked questions
Can cervicogenic headache feel like a migraine?
Yes. The pain from a cervicogenic headache can be felt in similar locations to migraine and the two can overlap in presentation. Cervicogenic headache typically does not include classical migraine features like light sensitivity, nausea, or aura, but not always.
This is why a thorough assessment including a detailed history and examination of the neck is important for anyone who has been diagnosed with migraine and is not responding well to migraine-specific treatment.
Do I need a spinal adjustment to treat cervicogenic headache?
No. The soft tissue treatment of the suboccipital muscles does not require adjustment. If you prefer not to be adjusted, that is not a barrier to treatment at all. For patients who do want adjustments as part of their care, they complement the soft tissue work well.
How many sessions will I need?
For straightforward presentations, most people notice a change within the first one to two sessions. Overall care may last up to six weeks. For longstanding or complex cases, treatment duration may be longer. We will always give you an open and honest assessment of where you sit and what to expect.
Will my headaches come back after treatment?
They can, particularly if the contributing lifestyle factors (pillow, posture, workstation, sleep quality) do not change. Many people find that addressing one or two of these significantly reduces how often the headaches return, or stops them altogether. For those who prefer to manage with periodic treatment rather than lifestyle changes, or where change is not possible, we are happy to support that approach too.
Ready to Book?
If you have had persistent headaches that have not responded to standard treatment, and you have not had your suboccipital muscles properly assessed, it is worth finding out whether this is what you are dealing with.
Call us on 08 6317 9897 or book online. Bring your health fund card to your first appointment and we will process your rebate on the spot through HICAPS. No paperwork, no waiting.
Or call us on 08 6317 9897 if you would prefer to talk first.
Written by Dr Russell Jensen, Principal Chiropractor (AHPRA: CHI0001927257), Southside Spine and Sport. Published June 2026.
This article is for general information only and does not constitute medical advice. Always consult a qualified health professional for diagnosis and treatment.
