When a headache is a real pain in the neck

Written by Rita Chorba, DPT

Originally published in The Raider Patch: Magazine of the U.S. Marine Raider Association

I once worked with a very grumpy client who had a long and painful history of headaches. He had sustained a whiplash injury in a humvee rollover accident years earlier. He was taking the prescription medication Imitrex, but the results were inconsistent. The drug worked for the debilitating, fast-onset headaches, but seemed useless for the dull, achy ones that lasted for days or longer. 

Grumpy’s fast headaches were diagnosed as migraines, and he had a suitable medication for that problem. So why didn’t the drug work for the dull headaches? Despite the thorough attention paid to his head – bloodwork, MRIs, and CT scans, to name a few – the simple mechanics of the injury were overlooked. Grumpy had two different types of headaches, and only a solution for one. 

In this article, we’ll go over headache basics, key features for you to know, and how to find treatment options. The information contained in this article is for your informational purposes only and should not be taken as medical advice. Only a qualified healthcare provider who has examined you can provide a diagnosis and treatment recommendations.

Headaches – the very basics  

Headaches are a huge cause of disability, ranking as the #2 cause worldwide (#1 low back pain, #3 depression). Despite an International Headache Society dedicated to this problem, there are still many barriers to action. Most medical providers receive little training in headache disorders, and the general public doesn’t know that diagnosis and effective treatment options exist.

Another difficulty in treating headaches involves sorting out the many types and causes, especially when symptoms overlap. Direct head trauma, hunger, work stress, sinus infections, screaming children in the back seat, and even sensitivity to headache medicines can cause headaches! So, “mixed type” headache disorders are common, requiring a mix of different treatments. 

There are three major headache types likely to cause persistent problems, outlined in the following table: 

Head pain – neck problem 

Although he didn’t hit his head directly, Grumpy’s head was whipped around during the humvee accident. Not only did this cause nerve and blood vessel injury in the brain, but it also injured neck segments that tether the skull to the rest of the spine. 

Cervico-genic headaches, literally meaning “neck- origin,” are caused by a mechanical problem in the upper neck where it attaches to the skull. The nerves in and around the neck joints “refer” pain to the head when there is joint stiffness, muscle imbalance, weakness, or nerve irritation in the surrounding area. Referred pain means pain felt in a part of the body other than its actual source, like a fire alarm sounding in a building far away from the fire. 

How to get started with seeking headache treatment  

Finding the right solution for your headaches should begin with having a conversation with a healthcare provider you trust. However, I want you to know that it may be a process. You will likely need to travel a pipeline of several different professionals to find effective treatment (or several treatments if you suffer from multiple headache types). 

If you think you might have cervicogenic type headaches (head pain-neck problem), use that specific terminology when searching for a professional. Ask your dentist or primary care provider who they know. Their recommendations can save you time and avoid unnecessary delays in referral to the right specialist or therapist. 

During the discovery process, each provider you see will help you eliminate what’s not the problem. Communicate this information with the next provider so they can save time in their work to find the root cause. Whoever you see about headaches, you’ll know if treatment is working if you notice more extended periods between pain episodes. 

Headaches are a pain, but effective treatments exist for those who persist. Don’t give up!

If you have any questions, reach out to us. We answer every question. If you know anyone who might benefit from reading this, please share it with them. Thank you!


  1. Global Burden of Disease Study 2017. Institute of Health Metrics and Evaluation. www.healthdata.org
  2. International Headache Society. www.ihs-headache.org
  3. Zito et al. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Manual Therapy. 2006. 

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