Head and neck pain is the second most common area of chiropractic practice, after back pain.

Head and neck pain is the second most common area of chiropractic practice

The most important step for a headache sufferer is to initially obtain a correct diagnosis. There are many types of headache, but the International Headache Society (IHS) has classified and defined them under the following major categories:

  • Migraine
  • Tension-type headache
  • Cervicogenic headache (arising from the neck).

Dysfunctional structures in the neck, in some instances, may play a role in these headaches.

Two recent discoveries relating to the neck or cervical spine are of particular interest:

  1. The facet joints of the cervical spine are a source of head and neck pain.9
    • The facet joints, found in pairs on the back of the cervical vertebrae, are rich in pain receptors. Chiropractic cervical manipulation is aimed primarily at gapping these facet joints to restore normal mechanics or movement.
  2. The existence of bridges of connective tissue between the muscles and ligaments of the upper cervical spine and the dura of the base of the skull. This discovery by dental researchers in the U.S.10 and chiropractic researchers in the U.K.11 in 1995 and 1998 provides a much clearer anatomical basis for tension in the cervical spine as a cause of headache. The dura (thick covering of the brain and spinal cord) encloses the central spinal cord and is extremely pain sensitive. It is now known to be directly connected to muscles and ligaments in the neck.

Obviously there are also many lifestyle and behavioural factors that may also play a role and can even trigger neck pain as well as headache. Some examples include:


  • Repetitive posture
  • Prolonged activity
  • Clenching of teeth (jaw problems)


  • Food allergies or sensitivities (e.g. chocolate, sugar, orange juice, coffee, smoking, milk, wheat, gluten, alcohol)
  • Sinus related problems
  • Hormonal changes


  • Stress related to work or home
  • Tension

It is now also known that medication over-usage headache (MOH) may be a significant cause of frequent headaches. This article also describes a pattern of headache where the sufferer has frequent tension-type headaches with occasional migraine headaches. It describes the two types of headache as fitting on the one spectrum.


  1. Parker, G., Tupling, H., Pryor, D. (1978) A controlled trial of cervical manipulation for migraine. Aust. NZ. J. Med. 8: 589-593.
  2. Parker, G.B. et al. (1980) Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine. Aust. NZ. J. Med. 10: 192-198.
  3. Nelson, C.F., Bronfort, G. et al. (1998) The efficacy of spinal manipulation, amitryptiline and the combination of both therapies for the prophylaxis of migraine headache. J. Manip. Physiol. Ther. 21: 511-519.
  4. Boline, P., Kassak, K., Bronfort, G., Nelson, C., Anderson, A. (1995) Spinal manipulation vs amitryptiline for the treatment of chronic tension-type headaches. J. Manip. Physiol. Ther. 18: 148-154.
  5. Nilsson, N., Christensen, H.W., et al. (1997) The effect of spinal manipulation in the treatment of cervicogenic headache. J. Manip. Physiol. Ther. 20: 326-330.
  6. Tuchin, P.J., Pollard, H., Bonello, R. (1999) A randomised controlled trial of chiropractic spinal manipulation therapy for migraine. Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic. 183-184, Abstract.
  7. Whittingham & Nilsson (2001) Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil). J. Manip. Physiol. Ther. 24: 552-555.
  8. Chapman-Smith, D. (2002) Notes for state association; Jan: 4.
  9. Lord, S.M., Barnsley, L. et al. (1996) Chronic cervical zygapophyseal joint pain after whiplash. A placebo controlled prevalence study. Spine 21: 1737-1745.
  10. Hack, G.D., Koritzer, R.T. et al. (1995) Anatomic relation between the rectus capitus posterior minor muscle and the dura mater. Spine 20: 2484-2486.
  11. Mitchell, B.S., Humphreys, B.K., Sullivan, E. (1998) Attachments of the ligamentum nuchae to posterior to cervical posterior spinal dura and the lateral part of the occipital bone. J. Manip. Physiol. Ther. 21: 145-148.