Most Headaches Start in Your Neck —
Here's What to Do About It

Headaches are one of the most common reasons people visit a doctor — and one of the most commonly under-treated conditions I see in clinical practice. Not because effective treatment doesn't exist, but because the underlying cause is frequently misidentified, leading to a cycle of painkillers that manage the symptom without ever addressing what's driving it.

For the majority of people who experience regular headaches — particularly those who work at a desk, spend long hours on screens, or carry significant stress — the problem starts in the neck. Understanding why, and what can be done about it, is the purpose of this article.

The three types of headache most commonly seen in desk workers

Why the neck is so often involved

The upper cervical spine — the top three joints between the skull and the neck — has a direct anatomical relationship with the trigeminal nerve, which is responsible for sensation in the face and head. This is why irritation or restriction in the upper cervical joints can produce referred pain directly into the head. The phenomenon is well-documented and is called the trigeminocervical complex.

The muscles of the upper neck — particularly the suboccipital muscles at the base of the skull, the upper trapezius, and the sternocleidomastoid — are among the most commonly overloaded muscles in the human body in the modern working environment. Sustained forward head posture at a screen places these muscles under continuous load, far beyond what they were designed to sustain. Over time they develop chronic tension and trigger points that directly refer pain into the head.

Why painkillers often make things worse over time

This is critically important and widely misunderstood: taking pain relief for headaches more than 10–15 days per month, for 3 or more consecutive months, leads to a condition called medication overuse headache (MOH) — also known as rebound headache.

MOH is now thought to be one of the most common causes of chronic daily headache. The analgesics that initially relieve pain actually sensitise the pain pathways over time, lowering the threshold for headache and increasing frequency. Patients in this cycle often find their headaches progressively worsening despite, or because of, increasing medication use.

If you are taking over-the-counter painkillers for headaches more than twice a week, this is worth discussing with a healthcare provider — both to address the underlying mechanical cause and to manage the gradual medication withdrawal that may be needed.

What osteopathic treatment involves

Treatment for cervicogenic and tension headaches focuses on the upper cervical spine, the base of the skull, and the surrounding musculature. A typical approach includes:

• Mobilisation of the upper cervical joints — gentle, rhythmic movement to restore normal range and reduce joint irritation
• Soft tissue release of the suboccipital muscles — the small muscles at the base of the skull that are almost universally tight and tender in headache sufferers
• Trigger point treatment — releasing active myofascial trigger points in the upper trapezius, SCM, and levator scapulae that are directly referring pain into the head
• Thoracic mobility work — the thoracic spine and rib cage profoundly influence neck mechanics; a stiff thoracic spine forces the cervical spine to compensate
• Postural advice — specific guidance on workstation setup and postural habits that contribute to recurrence

The evidence base for manual therapy in cervicogenic and tension headache is strong. Most patients with cervicogenic headache see meaningful improvement within 4–6 sessions. Some see dramatic improvement after just 1–2 sessions.

Practical steps you can take today

While treatment addresses the accumulated restriction, these habits help slow its recurrence:

• Check your screen height — the top of your monitor should be roughly at eye level, not below it. Looking down all day is one of the fastest routes to suboccipital tension.
• Bring your phone up to eye level when reading. "Text neck" is real and contributes significantly to headache patterns.
• The neck side-bend stretch described in our desk stretches article targets the upper trapezius directly — do it 2–3 times daily.
• Ensure you're drinking enough water — even mild dehydration lowers the headache threshold significantly.
• If you're wearing reading glasses that don't properly correct your vision at screen distance, you may be unconsciously craning your neck to see more clearly — an eye test is worth ruling out.