Common causes we assess
- Desk and screen posture with sustained forward head position
- Cervical joint stiffness and restricted rotation
- Deep neck flexor weakness and shoulder blade control
- Whiplash and injury after a fall or collision
- Cervicogenic headaches, usually one-sided and starting at the neck
- Referred pain into the shoulder blade, arm or hand
When the headache comes from the neck
Cervicogenic headache is pain referred from the upper neck joints and muscles. It is usually felt on one side, starts at the base of the skull, and changes with neck movement or sustained positions. It is not the same as migraine, and it is not diagnosed by a scan.
A physiotherapy assessment tests neck movement, joint behaviour and muscle control, and looks for the pattern that reproduces the headache. If the presentation fits migraine or another cause, we will say so and refer you on.
What treatment involves
- 1Assess neck movement, strength, nerve signs and headache behaviour.
- 2Reduce joint and muscle irritation with manual therapy and load changes.
- 3Retrain deep neck flexors and shoulder blade control.
- 4Adjust screen, pillow and desk setup where it matters.
- 5Progress to strength and tolerance for long sitting, driving and training.
Red flags that need medical review
Seek medical review for neck pain after significant trauma, progressive arm weakness or numbness, unsteadiness, severe headache with fever or neck stiffness, or any loss of bladder or bowel control. These are not physiotherapy-first presentations.
How long it takes
Acute neck pain often settles within two to four weeks. Long-standing pain and cervicogenic headaches usually need six to ten sessions with a home program. Progress is measured by rotation range, headache frequency and how long you can sit or drive without symptoms.
About this guidance
This page is general information about physiotherapy for this problem, not a diagnosis. An assessment is the only way to know what is driving your symptoms and what treatment suits you.
Reviewed by Dr. Sneha Ramchandani, PT, BPTh, MIAP, Founder and physiotherapist at Muscle Lab, Andheri East.
Questions people ask
Can physiotherapy help headaches?
Yes, when the headache is cervicogenic, meaning it comes from the neck. Physiotherapy does not treat migraine, but neck-related headaches often improve with manual therapy, exercise and posture changes.
Do I need an X-ray or MRI for neck pain?
Usually not. Imaging is considered when there is trauma, progressive weakness, nerve signs that do not improve, or another red flag. Most neck pain is assessed clinically.
Is a cervical pillow or brace useful?
A supportive pillow can help comfort, but it does not fix the underlying problem. Collars are for specific short-term situations and should not be used routinely without advice.