Three headache types — and why the distinction matters
Tension headaches present as a band-like pressure around the head, often building through the day. Cervicogenic headaches start at the base of the skull and refer into the head — they're caused by upper cervical joint restriction and are frequently mistaken for migraines. Migraines involve neurological changes and are a distinct condition — though cervical factors can be a trigger. Identifying which type you're dealing with is essential, because the management approach differs significantly.
The upper cervical connection
The top three cervical vertebrae (C1, C2, C3) have a direct referral pathway to the head via the trigeminal nucleus. When these joints are restricted or irritated — from poor posture, sustained screen use, or accumulated stress — they generate referred pain that presents as a headache. This is the mechanism behind cervicogenic headache and many tension headaches that don't respond to medication.
Why pain medication isn't enough
Medication manages the symptom. It doesn't address the cervical joint restriction, muscle tension pattern, or postural driver that's triggering the headache. For recurring headaches — especially those that follow a predictable pattern, start at the base of the skull, or are associated with neck stiffness — a mechanical assessment is a more useful starting point than another box of ibuprofen.
Who this affects most
Desk workers spending 6–8 hours at a screen are the most common presentation. Teachers, drivers, healthcare workers, and anyone in sustained forward-head postures are also high-risk groups. Headaches typically build through the afternoon — which is consistent with cumulative postural loading rather than a systemic cause.
How we assess and manage it
Assessment focuses on the upper cervical spine — C1 to C3 joint mobility, surrounding muscle tension, and postural alignment. Treatment combines manual therapy to the restricted segments, soft tissue work to the suboccipital and upper trapezius musculature, and a targeted home programme to address the postural driver between visits.