Tension Headaches vs Cervicogenic Headaches: How to Tell the Difference

8 July

Not all headaches feel the same, and not all headaches come from the same place. Tension headaches and cervicogenic headaches can produce similar symptoms, but they involve different mechanisms and may respond to different approaches.

One is classified as a primary headache, meaning it's the condition itself. The other is a secondary headache, meaning it originates from a problem elsewhere. Understanding the difference can help guide appropriate assessment.

General information only. Symptoms vary and diagnosis requires assessment by a qualified health professional.

What Is a Tension Headache

Tension headache is the most common primary headache disorder. Lifetime prevalence ranges from 35% to 80% according to research published in the Handbook of Clinical Neurology, making it far more common than migraine or cervicogenic headache.

Tension headache symptoms typically include a dull, pressing or tightening sensation that affects both sides of the head. Many people describe it as a band wrapped around the forehead or pressure at the back of the skull. The pain is usually mild to moderate and doesn't throb or pulse.

Unlike migraine, tension headaches don't usually cause nausea, vomiting, or sensitivity to light and sound. Physical activity doesn't typically make them worse. They can last anywhere from 30 minutes to several days.

The exact cause isn't fully understood. Muscle tension in the trapezius and suboccipital muscles, stress, fatigue, and poor posture are all associated factors.

What Is a Cervicogenic Headache

A cervicogenic headache is a secondary headache, meaning the pain is referred from structures in the cervical spine. The upper cervical joints (C1, C2, C3) are the most commonly implicated levels.

So can neck pain cause headaches? Yes. The nerves that supply the upper neck converge with nerves that supply the head and face in an area called the trigeminocervical nucleus. This convergence means that dysfunction in the upper neck can produce pain that's felt in the head.

Cervicogenic headache symptoms often include pain that starts at the base of the skull and spreads forward, sometimes reaching the forehead or area behind the eye. The pain is typically one-sided and may be triggered or worsened by neck movement or sustained postures.

Research estimates prevalence at 0.4% to 4% of the general population, though some studies report higher rates among people with chronic headache. The occipital nerve region is often tender to palpation.

How to Tell the Difference

When comparing tension headache vs cervicogenic headache, several features can help distinguish them, though there's often overlap and both conditions can coexist.

Location. Tension headaches usually affect both sides of the head. Cervicogenic headaches are typically one-sided, at least initially, and often start in the neck before spreading forward.

Triggers. Headache from neck movement or sustained postures suggests cervicogenic involvement. Tension headaches are more commonly triggered by stress, fatigue, or emotional factors.

Associated symptoms. Headaches at the base of the skull with tenderness in the upper neck, reduced neck movement, and pain that refers to the forehead or behind the eye are more typical of cervicogenic presentations.

Both types can involve muscle tightness in the neck and shoulders. Our neck pain page explains how cervical dysfunction can contribute to various symptoms.

When Headaches Require Urgent Assessment

Certain headache features warrant prompt medical review rather than a routine physiotherapy booking. These include sudden severe headache reaching maximum intensity within seconds (sometimes called a thunderclap headache), headache with fever and neck stiffness, headache with confusion or changes in consciousness, and headache with neurological symptoms like weakness, numbness, or visual changes.

New headache patterns after age 50, headache following head trauma, and headache that's progressively worsening over days or weeks also warrant GP review or emergency assessment.

Physiotherapy Assessment in Adelaide

For headaches with a musculoskeletal component, physiotherapy assessment can help clarify contributing factors. This is particularly relevant for cervicogenic headaches, where dysfunction in the cervical spine may be contributing.

Research published in PM&R journal found moderate-certainty evidence that manual therapy may reduce headache frequency in the short term for cervicogenic headache, and that neck exercise may be beneficial in the longer term. Individual responses vary, and not all headache presentations are suitable for physiotherapy.

Assessment typically includes examining upper cervical joint mobility, muscle tension in the suboccipital and trapezius regions, posture, and movement patterns. Treatment approaches may include joint mobilisation, soft tissue techniques, and exercise prescription.

Ducker Physio provides assessment for headache presentations at both Adelaide locations. No GP referral is required, and both clinics provide the same assessment.

Physiotherapy isn't suitable for all headache presentations, and individual responses to treatment vary.

Book an appointment at the most convenient clinic.

Frequently Asked Questions

Can a physio help with headaches?

For headaches with a musculoskeletal component, physiotherapy may be beneficial. This is particularly relevant for cervicogenic headaches, where dysfunction in the cervical spine may be contributing. Research suggests manual therapy and neck exercises may reduce headache frequency for some people, though individual responses vary.

How do I know if my headache is from my neck?

Headaches originating from the neck often start at the base of the skull and spread forward, may be triggered by neck movement or sustained postures, and are typically one-sided. Tenderness in the upper neck is common. A physiotherapy assessment can help clarify whether cervical dysfunction may be contributing.

Can tension headaches cause neck pain?

Yes. Tension headaches are often associated with muscle tightness in the neck and shoulders. The relationship can work both ways, with neck tension contributing to headaches and headaches contributing to neck discomfort.

Where can I find a headache physio in Adelaide?

Ducker Physio offers headache physio sevices in Adelaide at clinics in Magill and Salisbury. For a neck headache physio in Magill or cervicogenic headache treatment in Adelaide, no GP referral is required.

Do I need a scan before seeing a physio for headaches?

Imaging is not usually required before a physiotherapy assessment for headaches. A clinical assessment can help determine whether imaging or referral may be appropriate.

How long does it take for cervicogenic headaches to improve?

This varies considerably between individuals. Some people notice improvement within a few sessions, while others require longer management. Factors like how long symptoms have been present and what's contributing to them can influence the timeline.

Ducker Physio Magill
465/467 The Parade, Magill SA 5072
Phone: 08 7092 5962

Ducker Physio Salisbury
9 Mary Street, Salisbury SA 5108
Phone: 08 7092 5964

General information only. Individual symptoms and appropriate treatment vary. If you experience sudden severe headache, headache with fever and neck stiffness, or headache with neurological symptoms like weakness or visual changes, seek emergency medical attention.