Not All Headaches Are the Same, and That Changes Everything
Last month I had a patient in her early forties come in after seeing two GPs and a neurologist over the course of a year. She’d been getting headaches three or four times a week, almost always starting at the base of her skull and spreading forward over one eye. She’d had an MRI. It was clear. She’d tried two different preventive medications. Neither had made much difference. What she hadn’t had was a thorough assessment of her cervical spine.
Within a few minutes of examining her neck, specifically her upper cervical mobility and joint behaviour at C1 and C2, it was obvious the headaches were almost certainly cervicogenic in origin — coming from her neck, not her head.
Three Types of Headache, and Why the Distinction Matters
Tension-type headache is the most common kind — a dull, band-like pressure around the forehead or back of the head, associated with stress, poor posture, and muscle tension in the neck and shoulders.
Cervicogenic headache originates in the cervical spine, usually from joints, muscles, or soft tissues in the upper neck. It almost always presents on one side and can closely mimic migraine, including nausea and sensitivity to light.
Migraine is a neurological condition involving changes in brain chemistry and vascular activity — not a structural one. True migraines involve moderate to severe throbbing pain, nausea, vomiting, and significant sensitivity to light and sound.
Chiropractic, and specifically cervical spine adjustment, has reasonable evidence for tension-type and cervicogenic headaches, but is not a primary treatment for migraine.
What the Evidence Actually Says
The evidence for cervicogenic headache is the strongest: several well-designed trials found that cervical spine adjustment produces clinically meaningful reductions in headache frequency and intensity. For tension-type headaches, the evidence is positive but more modest. For migraine, chiropractic care may reduce musculoskeletal triggers, but is not a standalone treatment. If you have a confirmed migraine diagnosis, you need to be working with a neurologist or GP as your primary provider.
When to See a GP — Red Flag Headaches
- A sudden, severe “thunderclap” headache that peaks within seconds
- Headache associated with fever, neck stiffness, and sensitivity to light (possible meningitis)
- Headache following a head injury
- New or changed headache pattern in someone over 50
- Headache with progressive neurological symptoms: weakness, vision changes, confusion, or speech difficulty
If any of these apply, see a GP or go to an emergency department first. My job is to identify and treat cervical contributors to headache — not to substitute for a thorough medical workup when one is needed.
Book with Dr Gordon: Call Gordon Chiropractic & Exercise Physiology on (02) 9371 7774 or book at gordonchiropractic.com.au.