Could your headache start in your neck?
Recognize the signs, understand when to seek care, and explore exercises your physical therapist may recommend.
Can a headache start in your neck? Yes—but neck pain alone doesn’t tell the whole story. Understanding the pattern can help you find the right care and a more useful exercise plan.
Cervicogenic headaches are headaches caused by a neck disorder. A clinician can help determine whether your neck is contributing and choose exercises that fit your symptoms.
What is a cervicogenic headache?
A cervicogenic headache is a secondary headache: pain is referred to the head from a disorder involving structures in the neck. Neck pain is common, but isn’t always present. [1]
Possible clues include pain that stays on one side, spreads from the back of the head toward the forehead or eye, or becomes worse with certain neck movements. Reduced neck motion can also be part of the pattern.
These findings are not unique to cervicogenic headache. Migraine and other headache types can overlap, so neither a stiff neck nor an abnormal scan confirms the diagnosis on its own. [1]
When should you get medical help?
Some headaches need urgent attention
Seek emergency care for a sudden, extremely severe headache, or a headache with new weakness or numbness, trouble speaking or walking, confusion, loss of vision, or fever with a stiff neck. In the U.S., call 911 for emergency symptoms. [2]
Arrange a medical assessment for a new or changing headache pattern, recurring headaches, worsening symptoms, or a headache after a head injury. Arm tingling, numbness, or weakness deserves assessment; don’t assume it is a routine part of a neck-related headache.
How can physical therapy help?
Your physical therapist can assess neck movement, muscle function, symptom behavior, and the demands of your daily activities. The plan may include education, mobility work, and exercises for neck and shoulder strength or endurance.
Clinical guidelines support exercise and, when appropriate, clinician-delivered manual therapy for neck pain with headache. Treatment depends on the presentation and duration of symptoms; there isn’t one program that fits everyone. [3]
A randomized trial found that a specific low-load exercise program reduced headache frequency and intensity in people with cervicogenic headache. That supports an individualized exercise approach—it does not mean every neck exercise is equally effective. [4]
Exercise options to discuss with your physical therapist
These examples illustrate movements a clinician might select after assessment. They are not a diagnostic test or a complete treatment plan. Follow the range, resistance, repetitions, and frequency prescribed for you. The clearest rationale is for specific neck muscle training; shoulder exercises and gentle movement can complement the plan, but these four exercises have not been established as a single superior protocol.
Keep movements comfortable and controlled. Stop if an exercise worsens your headache or causes dizziness, visual changes, new tingling, numbness, or weakness. Seek care appropriate to the symptoms rather than pushing through.
Gentle supine chin tuck
Lie on your back with your head comfortably supported. Make a small, slow “yes” nod, gently bringing your chin toward your throat. Keep your head resting on the surface, your jaw relaxed, and your breathing easy. Release slowly.
Focus: A subtle nod rather than pressing your head backward, lifting it, or forcing your chin down. Your therapist can help you find the movement and choose an appropriate hold time.
This targets the control of the deep muscles at the front of the neck. Research supports specific deep cervical flexor training, often with pressure biofeedback; the exercise name alone does not guarantee the same technique. [6]
Gentle neck rotation
Sit comfortably and slowly turn your head toward one side, staying within a comfortable range. Return to the middle and repeat on the other side. Keep your shoulders relaxed and avoid forcing the end of the movement.
Focus: Easy motion, without reproducing or increasing your headache.
Gentle neck extension isometric
With your head in a comfortable neutral position, place your hand behind your head. Gently press backward into your hand without allowing your head to move. Keep breathing and release slowly.
Focus: Light effort rather than a maximum-strength push. Your therapist can adjust the direction and hold time.
Light resisted shoulder-blade retraction
Using the setup and resistance shown by your therapist, gently draw your shoulder blades toward one another. Keep your neck relaxed, avoid shrugging, and return slowly.
Focus: Controlled upper-back muscle work without straining your neck.
YOUR PT MAY RECOMMEND
Towel-assisted neck rotation (self-SNAG)
A self-SNAG is a specific neck mobilization technique. A small controlled trial found benefit in selected people with cervicogenic headache. It requires the right selection, positioning, and direction of force. Ask a trained clinician to assess and teach it before trying it yourself. [5]
Your therapist may select this when upper-neck rotation is restricted and the technique improves comfortable movement. Follow their specific instructions for strap placement, direction, and dose; do not pull forcefully into pain.
A 2024 trial also found benefit from adding clinician-delivered Mulligan manual therapy to exercise. That supports a tailored combined approach, but does not mean every towel-assisted exercise has been tested or suits every headache. [7]
Make your plan fit your day
If a sustained position brings on symptoms, discuss ways to adjust the task, support your arms, and add comfortable movement breaks. Aim for tolerable positions and regular movement rather than holding your neck rigidly in a single “perfect” posture.
A simple headache diary can make follow-up more useful. Record when symptoms start, how long they last, what you were doing, and how you respond to your exercises. Share meaningful changes with your clinician.
FOR CLINICIANS & STUDENTS
Build a program around the person.
Use the assessment to select exercises, set the dose, and decide what to monitor. Explain the purpose of each movement and what should prompt your patient to stop or contact you.
Library selections: Chin Tuck — Supine or Supine with Hold; Cervical Rotation — AROM; Cervical Extension — Isometric; and Scapular Retraction — with Resistance Band. Consider Cervical Rotation — SNAG separately when assessment supports it.
Verify the chin-tuck demonstration before prescribing it as craniocervical flexion training. A small supported nod differs from forceful cervical retraction or a head lift. Progress cervical and scapular loading to the patient’s capacity and track headache days, intensity, and activity tolerance. A small 2024 trial supports progressive craniocervical flexor and extensor training, but does not isolate the effect of the extension-isometric exercise shown here. [8]
In TheraXPro, you can combine exercise instructions, videos, and patient-specific guidance in one home exercise program.
This is the original article’s shared template, not a newly updated protocol. It has not been updated to match the four featured exercises above. Review and edit its exercises and dosage before using it.
Sources
- International Headache Society. ICHD-3: Cervicogenic headache.
- NHS. Headaches: when to get medical help. Emergency contact wording adapted for U.S. readers.
- Blanpied et al. Neck Pain: Revision 2017. JOSPT.
- Jull et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002.
- Hall et al. Efficacy of a C1–C2 self-SNAG in the management of cervicogenic headache. JOSPT. 2007.
- The Efficacy of Manual Therapy and Pressure Biofeedback-Guided Deep Cervical Flexor Muscle Strength Training on Pain and Functional Limitations in Individuals with Cervicogenic Headaches: A Randomized Comparative Study. 2023.
- Mulligan manual therapy added to exercise improves headache frequency, intensity and disability more than exercise alone in people with cervicogenic headache: a randomised trial. 2024.
- Is device guided training targeted to the craniocervical flexor and extensor muscles efficacious? A preliminary randomized controlled trial in a cervicogenic headache population. 2024.