Headaches that start in the neck, and the ones that do not

The headache does not always start where you feel it. For some people it starts when the neck turns: a catch at the base of the skull, then a one-sided ache that settles behind the eye or at the temple and takes the blame. Checking a blind spot, reading in bed with the chin poked forward, or a long drive with the head held still can bring the same pain up the same side. The neck rotation on that side is short. Pressing the upper neck or holding the head in the offending position reproduces the headache, which feels like a confession. That pattern is the one clinicians call cervicogenic, meaning the neck is generating it. It is one headache. It is not all headaches, and it is not a license to treat migraine as if it were a stiff joint.

Headaches that go to the emergency department

Four patterns skip the clinic and go to emergency care. A thunderclap headache, a sudden severe pain that hits its peak in seconds to a minute, can be a bleed. It is an emergency even if your neck has been sore for years and you would like this to be the neck again. A headache with fever and a stiff neck, the kind that resists bending the chin toward the chest, can be meningitis. That is an emergency. A new headache that breaks your usual pattern, especially later in life, and that arrives with neurologic signs such as weakness, trouble speaking, confusion, a seizure, or a change in vision that does not behave like your familiar aura, needs emergency evaluation. A headache after a head injury, including one that seemed mild at the time, needs medical assessment, and it needs it urgently if vomiting, worsening pain, confusion, or unequal pupils show up.

Those four are not a complete list of dangerous headaches, and they are the ones this page will not bury. Jaw pain or head pain with exertion, sweating, and shortness of breath can be the heart, not the neck. Sudden neurologic loss of any kind with a headache is an emergency even if it does not fit the sentences above neatly. Call emergency services. Do not drive yourself in hope that an adjustment will break the pain.

MedlinePlus treats headache as its own topic, with causes that run from tension and migraine to infections and bleeding, and it keeps neck injuries and disorders on a separate page. The breadth is the point. A license to examine a neck in California comes through the Board of Chiropractic Examiners; that license is not a license to sit on a thunderclap headache. A chiropractic office is a reasonable place to examine a neck-driven pattern. It is the wrong first stop for the emergencies just named.

Three buckets, so the plan has a chance

Cervicogenic headache is the bucket this office can actually examine. The pain is often one-sided. It starts in the neck or the back of the head. Neck position or neck pressure reproduces it. Rotation or other motion is limited on the painful side. The arm may be uninvolved, which helps separate it from a nerve-root pain that happens to reach the head. The upper neck and the muscles at the skull base are part of the exam, and so is the mid-back, because a stiff thorax changes how the neck holds your head through a day of screens. Text neck is the load version of that story. What a chiropractor does for neck pain is the visit version, including the fact that an adjustment happens only when the exam says it is appropriate.

Migraine is a different bucket. It often throbs. Nausea, sensitivity to light, or sensitivity to sound may come with it. Some people have aura: a spreading visual change, tingling, or trouble finding words, followed by headache. Migraine can last hours to a few days. Neck pain frequently rides along, because people guard, clench, and sleep badly, and because the same nervous system is loud. That companionship does not make the migraine cervicogenic. A neck exam can look for a real cervical contribution. It cannot be offered as a cure for migraine, and this page will not say otherwise. Migraine care, including medicines that prevent attacks or stop them, belongs with the clinician who manages that diagnosis. Do not stop those medicines because a neck felt looser after a visit.

The third bucket is everything else that deserves a name: tension-type pain that is pressing and both-sided and milder, headaches tied to medicines used too often, sinus disease, jaw clenching that refers upward, and the dangerous causes already listed. Jaw-related ache has its own page, jaw pain and the upper neck, and it should not be forced into a migraine label or a neck label without looking at opening, clicking, and dental causes. If your headache does not reproduce with neck position, does not match migraine features, and is new, the honest result of a visit may be a medical referral rather than a series.

What the exam tries to reproduce

The history is a timeline, not a adjective. Where does it start? How long to full pain? One side or both? Nausea, light, sound, aura? Does a particular neck position bring it on, and does a different position settle it? How many days a month? What medicines, and how often? A blank intake card is more useful than a dramatic retelling, which is why the photograph for this page is a clipboard and not a person in distress. Then the neck is moved, actively and with the clinician's guidance, to see whether a position recreates the familiar head pain. Upper cervical joints are palpated. Rotation is compared left to right. The jaw is screened with a few open-and-close movements so a temporomandibular problem is not missed. Blood pressure may be checked, because a number that is extremely high with a new headache is a medical problem, not a manipulation problem.

If the exam reproduces a one-sided headache from the neck, and the emergency patterns are absent, neck and upper-back care is a coherent plan. That can include joint treatment when a segment is stiff and safe to treat, changes to the postures that feed it, and a recheck to see whether the headache days actually fall. Safety is not assumed. The questions about risk live on is chiropractic safe. A headache that was mislabeled, and was actually a warning bleed or an infection, is harmed by delay. Screening is the first procedure.

What will not be claimed

This office will not claim to cure migraine. It will not quote a success rate for headaches, because it has not published one, and a borrowed number from a different condition would be fiction. It will not tell you that every one-sided headache is the atlas. It will not suggest you abandon medical care that is working. Dr. Matthew Richter, DC, and Dr. William Choi, DC, can examine the neck and treat joints their exam supports. The meet the doctor page introduces them in the clinic's voice, and the chiropractic care page describes the work. Their training makes them appropriate clinicians for a mechanical neck. It does not make a chiropractic visit the right home for thunderclap pain, meningitis symptoms, or a new neurologic deficit.

A first visit, for someone who has not been seen here, is an examination and a history of the kind just described. What that first visit includes, and how to prepare, is laid out on your first chiropractic visit. Come with a short diary: the last month of headaches, what they felt like, and what the neck was doing at the start. That diary outperforms a single dramatic adjective.

Holding the buckets apart on purpose

Neck-driven headache is worth treating when the exam can turn it on and off with the neck. Migraine is worth respecting as its own disorder, including the times the neck is sore and still not the cause. Dangerous headache is worth recognizing in the first minutes of the story. If you are unsure which bucket you are in, choose the urgent one until a medical evaluation moves you out of it. A stiff neck that reproduces a familiar, one-sided ache, with a normal neurologic screen and no fever, no thunderclap, and no recent head injury, is the presentation a chiropractor can sit with and examine. Everything else asks for a wider net than a joint can provide.