How Expert Physiotherapists Diagnose and Treat Neck Pain and Headaches

Table of Contents

1. Background
2. Understanding Neck Pain
3. Types of Neck Pain
4. Understanding Headaches
5. Types of Headaches
6. Diagnosing Neck Pain and Headaches
7. Treatment of Neck Pain and Headaches
8. Treatment for Mechanical Neck Pain
9. Treatment for Cervical  (Neck) Radiculopathy
10. Treatment for Whiplash-Related Neck Pain
11. Treatment for Cervical (Neck) Myelopathy
12. Treatment for Tension-Type Headaches
13. Treatment for Migraines
14. Treatment for TMJ Headaches
15. Conclusion

Background

Neck pain and headaches are two common conditions that can impact an individual’s quality of life. As there are many causes of neck pain and headaches, it’s important to visit an expert physiotherapist to help diagnose the underlying drivers of pain. This will also help determine the most appropriate treatment plan.

It’s essential to get an accurate diagnosis even if the headache is not coming from the neck, the evidence has shown that physiotherapy interventions can help with other headache types as well.

In this article, we will discuss how physiotherapists diagnose and treat neck pain and headaches and provide some background on the different types of neck pain and headaches.

Understanding Neck Pain and Headaches

Neck pain can be acute (short-term) or chronic (long-term). It’s important to understand that chronic pain can result in nervous system sensitivity that can cause more pain overtime and delay recovery. This is why it’s important to see a musculoskeletal physiotherapist as soon as possible to determine the cause of neck pain to prevent ongoing issues.

Types of Neck Pain

There are several types of neck pain, some of which include:

1. Mechanical Neck Pain: This common type of pain is driven from the joints or muscles in the neck (C0-C7). It is typically caused from fatigue or strain due to poor posture or not activating the correct muscles.
2. Cervical Radiculopathy: This type of neck pain occurs when the nerve that exits the vertebrae in the neck is irritated or compressed. This pain is typically more intense and can lead to arm pain, decreased strength in the arm and sometimes a loss of sensation.
3. Whiplash-Associated (WAD) Neck Pain: This neck pain is caused by a sudden trauma that involves a quick back and forth movement to the neck. This can damage the muscles, joints, and ligaments but can also lead to a sensitized nervous system that can prolong the pain and interfere with daily function.  WAD may also be associated with headaches.
4. Cervical (Neck) Myelopathy: This serious, but uncommon type of neck pain happens when there is compression on the spinal cord in the neck. In addition to pain, this can lead to balance issues, problems with co-ordination and paralysis if left untreated.

Understanding Headaches

Headaches are a common condition that affects people of all ages. Headaches can be caused by a variety of drivers, with some being more serious than others. This is why it’s important to always see a medical professional or physiotherapist to identify the specific cause of the headache to begin the appropriate treatment plan.

There are many types of neck pain and headaches, with the correct diagnosis determine the best course of treatment

Types of Headaches

There are many types of headaches, with some being primary (solely responsible for causing the headache) and others being secondary (as a result of another untreated injury or illness). Some of the types of headaches include:

1. Cervicogenic Headaches: These headaches are referred from the joints and muscles in the upper neck (C0-3). Typically, this will present with a stiffness in the neck and reproduction of the headache with neck positions and movements. The pain starts in the neck and then refers to the head.
2. Tension Headaches: These headaches are caused by muscle tension in the head and neck region and can be driven by stress or lack of sleep. This leads to a dull ache that affects both sides of the head and can last for several hours or days.
3. Migraine Headaches: These headaches are often severe, throbbing, and pulsating, with a sensitivity to light and sound. There may also present with aura (visual disturbance) and induce nausea and vomiting. There may be a genetic component.
4. Post-concussion headache: These headaches can arise following a head trauma, or mild brain injury.
5. Cluster Headaches: These are cyclical in nature, and are a series of short but very painful headaches characterized by severe pain on one side of the head often around the eye. These can occur every day for weeks or months at a time, hence the term ‘cluster’.
6. Occipital Neuralgia: This uncommon type of headache is caused by an irritated nerve at top of your neck. The pain is intense, sharp, and sudden. Unlike Migraines, it only lasts seconds to minutes.
7. Temporomandibular Joint (jaw) Headaches – Pain caused by TMD (temporomandibular disorders): This can be caused by dental issues, or chronic stress caused by grinding your teeth and clenching your jaw. Pain can be common when you first wake up.
8. Sinus Headaches: These headaches are caused from inflammation or blockages within the sinus that creates pressure and refers pain to the front of the head.
9. Sinister Headaches: These types of headaches are severe and require urgent medical attention; such as stroke, meningitis, brain tumour.

Headaches can arise from the neck, do a thorough assessment of the neck is crucial in determining the best treatment.

Diagnosing Neck Pain and Headaches

The first step in diagnosing neck pain and headaches is a thorough clinical history that involves detailed questions about symptoms, pain presentation, aggravating and easing factors, onset/mechanism of injury and any previous injuries/illnesses. This will give your practitioner clues about the origins and drivers of your headache.

An expert physiotherapist will then follow this with a physical examination. This typically involves measuring range of motion, assessing joint mobility, neurological tests, tenderness to touch (palpation), observing movement dysfunctions or muscle imbalances (motor control impairments) and tests to rule out sinister pathologies. Where sinister pathology may be suspected, a referral to a physician with imaging to confirm diagnosis may be warranted.

Once the history and physical examination are complete, a physiotherapist will be able to provide a clinical diagnosis, and determine the best course of treatment to reduce the pain and improve your function.

Treating Neck Pain and Headaches

Once the underlying cause and drivers of the neck pain and/or headache has been identified, the physiotherapist will develop an individualized treatment plan. The treatment may include a combination of the following techniques:

1. Manual Therapy: This technique involves hands-on treatment of the joints, muscles, and soft tissues in the neck, head, and thoracic region to reduce pain and improve function and mobility. There are many paradigms for successful treatment, such as mobilization, mobilization with movement, manipulation, or repeated movements to centralize pain. These are just some of the many tools an expert musculoskeletal physiotherapist can use to help reduce neck pain and headaches.
2. Exercise Therapy: Specific exercises will be prescribed to improve range of motion and to address motor control impairments. This may involve strengthening the ‘smaller’ muscles in the neck, scapular (shoulder blade) exercises to improve posture, or stretches that help mobilize the joints and loosen muscles around the neck, head, and thoracic region. There’s also evidence for general exercise helping with Neck Pain and Headaches – providing that it is properly supervised and dosed by a physiotherapist.
3. Ergonomic Correction: Poor posture throughout the day is the most common reason for neck pain and headaches. There’s a good chance you’re reading this now sitting and slouched. A physiotherapist can provide education and guidance on the best ergonomic postures and equipment to reduce neck strain and headaches. Sit-to-stand desks are often a great investment if you have a sedentary job.
4. Dry Needling or Acupuncture: Dry Needling or Acupuncture can help reduce neck pain and headaches by reducing muscle tension which can help promote greater movement and flexibility of the joints.  This is often used in conjunction with other physiotherapy techniques.
5. Lifestyle Modification: After the examination, a physiotherapist may provide education on lifestyle modifications to prevent or manage future episodes of neck pain and headaches. This may include advice on exercise regimes, stress management and stretches for prevention.

Treatment for headaches and neck pain may involve manual therapy, exercise or both.

Treatment for Mechanical Neck Pain

Mechanical neck pain is the most common type of neck pain and is typically caused by poor posture. The physiotherapist may provide a combination of manual therapy, targeted exercise therapy, posture correction, lifestyle advice and other adjunct therapies such as dry needling.

Manual therapy may involve techniques such as soft tissue massage, joint mobilization/manipulation, mobilization with movement, assisted repeated movements. These techniques can help centralize/alleviate pain and improve mobility in the neck region. While the pain is predominately felt in the neck, an expert physiotherapist will always assess and treat the shoulder and thoracic region which are connected through various body systems and treatment to these regions can have an effect and provide symptomatic relief of the neck pain.

Exercise therapy is related to the specific diagnosis and drivers. For example, if the neck pain is caused by poor scapular positioning, strengthening of the lower trapezius with correct posture may be warranted. There’s no ‘one size fits all’, which is why what exercise works for some may not work for others.

Posture correction involves education and guidance on the best ergonomic equipment, as well as how to maintain proper neck posture during daily activities. A physiotherapist may recommend a specific chair, desk, or computer equipment. Try slumping your lower back and see what happens to your neck – it pokes forward! This is why it’s important to address the complete picture. Additionally regular intervals of time away from computer may be warranted if the pain is acute.

Lifestyle modification includes looking at the ‘big picture’. We are designed for movement, and being sedentary often leads to a plethora of health problems (with neck pain being just one!). For example, you may have the best seat in the world, but if you are in it for several hours straight, it impacts your circulation and also your muscles will fatigue and strain will occur. Stress management, and exercises to maintain flexibility and strength are key. Eating well can also indirectly help reduce inflammation and provide you with more energy to take control of your pain and incorporate positive lifestyle changes.

Treatment for Cervical Radiculopathy

Cervical radiculopathy occurs when a nerve(s) that exits the neck becomes compressed or irritated, leading to pain, numbness, and weakness in the arms and hands. The physiotherapist’s role is to reduce the irritation by improving mobility. A detailed physiotherapy assessment will help direct you towards physician care or conservative management.

Manual therapy may involve techniques such as passive movements and targeted traction to help ‘open up’ the neck joints, taping around the shoulder blade to reduce ‘nerve tension’. These techniques can help alleviate pain and improve neurological signs in the upper extremities.

Exercise therapy may include specific exercises to maximise mobility where the nerve is compressed or irritated. Additionally, once pain has settled, strengthening of any weak muscles, or stretching of the ‘stiff’ areas may help prevent future episodes of nerve pain.

Lifestyle modification and improved ergonomics at work or home are another vital measure to help reduce strain of the nerves. Additionally, you may be referred by the physiotherapist to see a physician for medication and or imaging if the neurological signs worsen or don’t improve with treatment.

Treatment for Whiplash-Related Neck Pain

Whiplash-related neck pain can be challenging to treat, as it can be driven by over-sensitized nerves. This can make manual therapy and a generic exercise program sometimes prohibitive and worsen the condition. This is why it’s important to have a good health care team, including an expert musculoskeletal physiotherapist who can guide you on your path to recovery.

Treatment for Cervical Myelopathy

Cervical myelopathy is an incredibly serious condition that occurs when there is compression on the spinal cord, leading to numbness, weakness, balance, gait and coordination problems in the arms and legs. If this is diagnosed, depending on the severity, you may benefit from some physiotherapy or if signs and symptoms of severe spinal cord compromise you be referred to the hospital for possible decompression.

Treatment for Tension-Type Headaches

Tension-type headaches are the most common type of headache, and can be caused by stress, poor posture, or muscle tension in the neck and shoulders. Like with mechanical neck pain, the physiotherapist may recommend a combination of manual therapy, exercise therapy, education and lifestyle modification, and advice on how to reduce stress.

Manual therapy may involve techniques to reduce suboccipital and neck strain such as as soft tissue massage, joint mobilization/manipulation, mobilization with movement. These techniques can help alleviate pain and reduce strain in the neck and head.

Exercise therapy may include specific exercises to improve posture, strengthen the muscles in the neck and shoulder region, and promote relaxation. A physiotherapist may recommend exercises such as neck stretches, shoulder blade squeezes, or diaphragmatic breathing exercises.

Lifestyle modification may include incorporating exercise, meditation and breathing exercises to help reduce strain around the neck and head. For example, when you are stressed you ‘shallow breathe’ which results in the wrong muscles (scalenes) being overactive and can place additional stress on the head and neck.

Tension-type headaches can be caused by stress, poor posture or muscle tension

Treatment for Migraines

Migraines are a type of headache characterized by severe pain, sensitivity to light and sound, and nausea. New evidence suggests that physiotherapy can help ease the pain of migraine if there is a ‘neck component’ driving the pain. The exact cause of migraines is not known, but triggers may include stress, certain foods, or hormonal changes . An expert physiotherapist can determine if there is a cervical component to the migraine and trial targeted treatment to the neck. This may help to improve some of the symptoms of migraine headaches. Unfortunately, migraines that persist, may require a referral to physician or specialist for medication.

Treatment for TMJ Headaches

Headaches may be referred from the jaw. Treatment involves manual therapy aimed at reducing muscle tension from the TMJ joint, as well as a potential referral to a dentist for a mouth splint.

Conclusion

Neck pain and headaches are unfortunately common conditions that can significantly impact quality of life. A musculoskeletal physiotherapist can play an important role in the diagnosis, treatment and prevention of these conditions and provide a treatment plan to reduce pain, improve movement and function, and prevent recurrence.

The exact treatment approach will depend on the underlying cause of the neck pain or headache, as well as the individual’s clinical history. A Shared Decision Model will be used to ensure that your goals and perspectives are considered.

If you are experiencing neck pain or headaches, it is recommended to visit a physiotherapist or seek medical advice.

FAQS

Can stress cause headaches and neck pain?

Yes! From a physical point of view, stress can increase tension of the muscles around the neck, as it causes shallow breathing which over activates the upper trapezius and scalenes. Additionally, stress can cause grinding of the teeth which can create tension around your jaw and upper neck region.

From a physiological point of view, stress increases cortisol (stress-hormone) which can sensitize nerves and make small aches more painful.

So, reducing stress in your life is very important if you are experiencing headaches and neck pain.

Can neck pain cause headaches and nausea?

Yes! The neck contains many nerve endings that can refer pain to the head, especially at the top of your neck (from C0-C3). Because these nerves also control your balance and connect to your vestibular system (within your ear), you may also experience nausea when there is an injury or inflammation creating neck pain.