Tension Headache and Neck Pain Physio

By Laura Munyard, Senior Physiotherapist and Dry Needling Specialist, Malvern Physiotherapy Clinic

Yes, many headaches, particularly tension-type and cervicogenic (neck-related) headaches, can be helped by physiotherapy. A physiotherapist assesses the neck joints, muscles and jaw that can refer pain into the head, then uses hands-on treatment and specific exercises that may help reduce how often and how intensely the headaches occur.

If your headaches build through the day, sit like a band of pressure around your head, and arrive alongside a tight, achy neck and shoulders, there is a reasonable chance your neck is part of the story. That is a treatable situation, and it is one of the more common presentations we see at our Malvern East clinic.

Here is what is actually going on, what an assessment involves, and when a headache needs a doctor rather than a physiotherapist.

What is a tension headache?

A tension-type headache is the most common kind of headache. The Better Health Channel describes it as feeling like a tight band of pressure around the head, and notes that around two-thirds of people experience one at some point in their lives.

It is usually felt on both sides, it is more of a dull ache or pressure than a throb, and it does not typically come with nausea or visual disturbance. Stress, computer work and tightness through the connective tissue in the head are common triggers for tension headaches, which is why they are sometimes called stress headaches. Neck, shoulder and jaw tightness often come along with it.

What is a cervicogenic headache, and how is it different?

A cervicogenic headache is a headache that originates from structures in the neck, most often the upper cervical joints and the muscles around them. The pain is referred into the head rather than originating there.

Typical features include:

Pain that is usually one-sided and does not swap sides within an episode
Pain that starts at the base of the skull and spreads forward toward the temple, eye or forehead
Neck stiffness and reduced neck rotation, most commonly on the painful side
Headaches provoked by sustained neck positions, such as a long stint at a screen or a night on an unfamiliar pillow

Tension-type and cervicogenic headaches overlap in practice, and plenty of people have features of both. That is one reason a thorough assessment matters, rather than self-diagnosing from a list. We have written previously about headaches and neck pain and specifically about cervicogenic headaches if you would like more background.

What is the difference between a tension headache and a migraine?

They are different conditions, and the distinction matters because the management is different.

A tension-type headache usually involves:

Pain across both sides of the head, often described as a band of pressure
A dull ache or tightness rather than a throb
Mild to moderate intensity
Few other symptoms beyond the head and neck discomfort itself
Pain that is often much the same whether you are moving or sitting still

A migraine usually involves:

Pain more often on one side of the head
A throbbing or pulsating quality
Moderate to severe intensity
Nausea, sensitivity to light and sound, and for some people a visual aura beforehand
Pain that typically gets worse with movement, which is why people often want to lie down in the dark

Migraine is a neurological condition and is generally managed medically, often with a general practitioner or neurologist. That said, many people with migraine also have neck symptoms that contribute to their overall load, and physiotherapy may form part of a broader plan alongside medical care. Your physiotherapist will assess your presentation and refer you on if that is the more appropriate path.

Why do I get headaches from my neck and shoulders?

Several things tend to stack up together.

Sustained positions. The neck copes well with movement and less well with prolonged postures. Long periods in one position, whether that is a desk, a laptop on the couch or a car seat, overload the small joints and deep muscles of the neck.

Reduced movement variety. It is less about a single “correct” posture and more about how long you stay in any one. Our post on neck and shoulder pain from desk work covers this in detail, and we have also written about whether posture causes pain.

Muscle tension and stress. The Better Health Channel notes that stress triggers a fight-or-flight response involving shallow breathing and raised muscle tension. Anyone who has finished a demanding fortnight at work with a sore neck will recognise this.

Jaw involvement. Clenching and grinding load the jaw muscles, which sit right alongside the structures that refer pain into the temples and head. Temporomandibular joint (TMJ) contributors are commonly missed, and they are a particular clinical interest of mine.

Sleep and load. Poor sleep, a pillow that does not suit you, dehydration and a sudden jump in training all lower the threshold at which a headache appears.

Neck muscle weakness after whiplash. A recent whiplash injury, or a history of more than one, often leaves some ongoing dysfunction in the neck, known clinically as whiplash associated disorder (WAD). The most common finding is weakness in the deep neck muscles. When those muscles are not giving the neck the support it needs, more load falls on the small joints and deep muscles of the upper neck, which can contribute to neck-related headaches. Healthdirect lists headache as a common whiplash symptom. Whiplash and chronic neck pain are areas I have worked in closely, including at the Melbourne Whiplash Centre, and it is one reason the assessment below includes testing the strength and endurance of your deep neck muscles.

What does a physiotherapy assessment for headaches involve?

Your physiotherapist will assess more than the sore spot. A typical assessment includes:

A detailed history: where the headache starts and spreads, how long episodes last, what brings them on and what eases them, and how the pattern changes
Screening questions to identify headaches that may need medical review rather than physiotherapy
Examination of neck movement and the upper cervical joints, including gentle manual testing to see whether your familiar headache can be reproduced and eased
Assessment of the deep neck flexors and shoulder girdle muscles for strength and endurance
Assessment of the jaw where relevant
A look at your work set-up, sleep position and daily load

Reproducing your familiar headache from the neck during examination is a useful sign that the neck is contributing, and that physiotherapy may help.

How can physiotherapy help tension and cervicogenic headaches?

Following an assessment, treatment often includes a combination of:

Hands-on treatment. Gentle mobilisation of the upper cervical joints and soft tissue work through the neck, jaw and shoulder girdle can help reduce symptoms and improve movement. For some people, dry needling is offered as part of this, depending on their presentation and their preference. It is not right for everyone, and it is always a conversation rather than an assumption.

Specific exercise. Deep neck flexor endurance work and shoulder girdle strengthening are well established in the management of neck-related headaches. These exercises are usually small, unglamorous and done often, and they tend to be the part that sustains improvement.

Practical load management. Adjusting your workstation, building in movement breaks, and reviewing your pillow and sleep position. Small changes repeated all day usually beat big changes done once.

Education and self-management. Knowing your own early warning signs and what to do about them is genuinely useful.

For people who want to keep building neck and shoulder capacity in a supervised setting, Clinical Pilates can be a useful complement. Whether it suits you depends on your presentation, and your physiotherapist will advise.

Treatment recommendations will depend on your individual presentation, and responses vary from person to person.

When should I see a physiotherapist for headaches?

Consider booking an assessment if:

Your headaches come with neck stiffness or shoulder tension
They are worse after long periods at a screen or driving
They tend to start at the base of your skull
You are relying on over-the-counter pain relief more often than you would like
Headaches are affecting your work, sleep or exercise

You do not need a referral. Healthdirect confirms you do not need to see a doctor for a referral to see a physiotherapist in Australia.

When should I see a doctor instead?

Some headaches need medical assessment first, and it is important to be clear about that. Please see a doctor promptly, or seek emergency care, if you experience:

A sudden, severe headache that comes on like a thunderclap
Headache with fever, neck rigidity, rash, confusion or a seizure
Headache after a head injury
A headache that is clearly different from your usual pattern, or that is steadily worsening
Headache with weakness, numbness, slurred speech or visual loss
A new headache pattern beginning after the age of 50

Physiotherapy is not the right first step in those situations. Your physiotherapist also screens for these features and will refer you on if anything in your history warrants it.

Frequently asked questions

Can physiotherapy help tension headaches?

It can assist many people, particularly where the neck, shoulder girdle or jaw are contributing. Treatment usually combines hands-on techniques with specific exercise. Responses vary, and a thorough assessment is important to determine the most appropriate treatment approach.

Why do I get headaches from my neck and shoulders?

Sustained positions, reduced movement variety, raised muscle tension, jaw clenching and neck muscle weakness after a whiplash injury can all load the structures in the upper neck, which can refer pain into the head. Stress, poor sleep and a sudden increase in workload commonly lower the threshold.

What is the difference between a tension headache and a migraine?

A tension headache is usually a band-like pressure across both sides with few other symptoms. A migraine is typically one-sided, throbbing, more severe, and often accompanied by nausea and sensitivity to light and sound. Migraine is generally managed medically.

Can poor posture or stress cause headaches?

Neither is a simple cause on its own, but both contribute. It is generally the length of time spent in one position rather than the position itself that matters, and stress raises muscle tension across the neck and jaw.

When should I see a physio for headaches?

If your headaches are recurring, come with neck symptoms, or are linked to desk work and stress, an assessment is a reasonable next step. See a doctor first for sudden severe headache, headache with fever or neurological symptoms, or any headache after a head injury.

Can whiplash cause headaches?

It can. Headache is a common symptom after a whiplash injury, and some people go on to have neck-related headaches, often linked to weakness in the deep neck muscles that support the upper neck. A physiotherapy assessment can check whether your neck is contributing. If the headache started after a recent car accident or a knock to the head, see a doctor first.

How many sessions will I need?

That depends on how long the pattern has been present and what is contributing. Your physiotherapist will discuss a realistic plan with you after assessing you, and review it as you respond.

Book a headache and neck assessment in Malvern East

If headaches have become a regular part of your week, it is worth finding out whether your neck is contributing. An assessment will tell us quickly.

Book online at malvernphysio.janeapp.com or call our team on 03 9078 8434. We are at 299 Wattletree Road, Malvern East VIC, convenient to Malvern, Armadale, Toorak, Glen Iris and the wider Stonnington area. No referral is needed.

About the author

Laura Munyard is a Senior Physiotherapist and Dry Needling Specialist at Malvern Physiotherapy Clinic, with over 16 years of experience in musculoskeletal and sports physiotherapy. She graduated with honours from the University of Sydney in 2008 and has been a Dry Needling Instructor with the Global Education of Manual Therapists since 2019. Laura’s clinical interests include neck pain and whiplash injuries and temporomandibular joint (TMJ) conditions, developed in part through her earlier work at the Melbourne Whiplash Centre treating acute whiplash and chronic neck pain. She is currently the rehab physiotherapist for the AFLW Saints and previously spent three years as Head Physiotherapist for the VFLW Saints, alongside earlier work with the Scottish Cricket Team and the Australian Kyokushin Karate Team. She sees patients at the clinic’s Malvern East practice.

This article is general information only and is not a substitute for individual assessment or advice. Please book an appointment so we can tailor recommendations to you. All practitioners at Malvern Physiotherapy Clinic are registered with the Australian Health Practitioner Regulation Agency (AHPRA).