Headaches That Start in Your Neck: When a Chiropractor Can Help Your Migraines (and When to See a Neurologist)

If you get headaches often, you've probably been told it's "just migraines" or "just stress." Sometimes that's true. But a lot of the headaches I see actually start in the neck, and those are very treatable.

Here's how to tell the difference, what chiropractic care can and can't do, and when you should be seeing a neurologist instead of me.

Not every headache is the same headache

The three types I see most:

• Cervicogenic headache (starts in the neck). Pain usually starts at the base of the skull on one side and spreads toward the temple, forehead or behind the eye. It often gets worse with certain neck positions, long hours at a desk, or after an injury like whiplash. Your neck is often stiff on the same side.
• Tension-type headache. A band-like pressure around the head, often with tight neck and shoulder muscles. Common with stress, poor sleep and desk work.
• Migraine. Usually throbbing, often one-sided, and commonly comes with nausea, sensitivity to light or sound, or an aura (visual changes before the headache). Migraine is a neurological condition, and triggers vary: sleep, hormones, food, stress and more.

Plenty of people have more than one type. A neck problem can also act as a trigger for someone who already gets migraines.

Where chiropractic care fits

Let me be straight about this:

• Headaches that start in the neck often respond well to care aimed at the neck: restoring motion to stiff joints, calming overworked muscles, and building strength and endurance in the neck and upper back.
• Tension-type headaches often improve with the same approach, plus work on sleep, stress and desk setup.
• Migraine is different. Chiropractic care is not a cure for migraine. For some patients, especially when neck tension is a clear trigger, treating the neck can reduce how often or how badly migraines hit. For others, it won't change much. The research on chiropractic care for migraine is mixed, so I won't promise you a result I can't back up.

That's why the first step is figuring out which headache you actually have.

How we figure it out: test, don't guess

Your first visit includes:

• A detailed headache history: where it starts, how it feels, how often, what sets it off, and what you've already tried
• An orthopedic and neurological exam: neck motion, muscle testing, reflexes, sensation, and specific tests to see whether your neck reproduces your headache
• Motion Study X-Rays when the exam points to the neck, so we can see how it moves and not just how it looks standing still

If your neck is a driver, we'll show you why. If it isn't, I'll tell you, and point you to the right provider.

What treatment looks like

When the neck is involved, a typical plan includes:

• Chiropractic adjustments to restore motion to stiff segments of the upper neck
• Soft-tissue work on the muscles at the base of the skull and across the shoulders
• Exercises to strengthen the deep neck muscles and improve posture, so the neck can hold up through a full workday
• A headache diary so we can measure what's changing: how often, how bad, how long
• Help with triggers like screen setup, sleep position and jaw clenching. If your jaw is involved, our TMJ care may be part of the plan.

We re-examine along the way. If the numbers aren't moving, we change the plan or refer you out.

Red flags: get medical care right away

Some headaches are emergencies. Go to the ER or call 911 if you have:

• A sudden, severe headache, the worst of your life, that peaks within a minute
• Headache with weakness, numbness, slurred speech, confusion, or vision loss
• Headache with fever, a stiff neck, or a rash
• A headache after a head injury, especially with vomiting, drowsiness or confusion

See your doctor or a neurologist promptly if:

• Your headaches are new and you're over 50
• The pattern has clearly changed: more frequent, more severe, or different from your usual
• Headaches wake you up or are worst first thing in the morning and keep getting worse
• You're relying on pain relievers most days of the week

The bottom line

If your headaches start in your neck, there's a good chance we can help, and we'll measure it. If they're true migraines, chiropractic care may be one useful piece of a bigger plan, alongside your medical provider. Either way, it starts with finding out which headache you actually have.

Learn more about our headache and migraine care in St. Louis, see how we treat neck pain, or book an exam.