What type of headache are you actually dealing with?
Most headaches fall into three categories: cervicogenic (originating from the neck), tension-type, and migraine. Identifying which type is driving your symptoms is the single most important step in treatment, because each responds to different interventions. Misdiagnosis is common and leads to years of ineffective medication use.
Cervicogenic headaches are frequently mistaken for migraines, yet they’re a well-recognised and treatable cause of chronic head pain. The distinguishing feature is that cervicogenic headache pain starts in the neck and refers upward, typically wrapping around one side of the head to behind the eye or the temple. It worsens with sustained postures and responds to pressure on specific neck joints. Crucially, it responds to manual therapy, something migraines generally don’t.
Tension-type headaches feel like a band of pressure around the head. They’re bilateral, meaning both sides are affected. The pain is dull rather than throbbing, and it doesn’t come with the nausea or light sensitivity that characterises migraine. Most adults experience tension headaches at some point, and they’re strongly linked to stress, poor posture, and jaw clenching.
Migraine is a neurological condition, not just a bad headache. It produces moderate to severe throbbing pain, usually on one side, and comes with sensory disturbance: light sensitivity, sound sensitivity, nausea, and sometimes visual aura. A migraine attack can last anywhere from four hours to three days. The World Health Organisation ranks migraine as the sixth most disabling condition globally.
Why do so many headache sufferers get the wrong diagnosis?
The overlap in symptoms between headache types is genuine. A patient with a stiff upper cervical spine may describe throbbing one-sided pain with light sensitivity, ticking several migraine criteria. But if the pain reproducibly worsens when pressure is applied to the C1-C2 segments and improves with cervical mobilisation, the neck is the primary driver, not migraine neurology.
Flora Muijzer, physiotherapist at Costa Health (BSc Physiotherapy, Colfisio 13635), routinely assesses patients who’ve been prescribed triptans for presumed migraines when the real culprit is a stiff upper cervical spine. The medication manages symptoms temporarily, but the headaches keep returning because the mechanical cause hasn’t been addressed.
Edge case worth noting: some patients have both. A cervicogenic trigger can lower the threshold for migraine activation. Treating the neck reduces overall headache frequency even when true migraines are also present. This dual-diagnosis pattern is something clinicians miss when they focus exclusively on one category.
How does manual therapy help headaches?
For cervicogenic headaches, the evidence is strong. A 2001 randomised controlled trial by Jull et al., published in Spine, found that a combination of cervical spine mobilisation and specific neck exercises reduced headache frequency by 50% or more in the majority of participants, with effects sustained at 12-month follow-up.
Chiropractic adjustments target restricted segments in the upper cervical spine, particularly C1, C2, and C3, which share nerve supply with the head and face via the trigeminocervical nucleus. Restoring normal joint movement at these levels reduces the barrage of afferent signals that the brain interprets as head pain. Sarah Monaghan, chiropractor with over 20 years of experience, uses specific upper cervical techniques tailored to each patient’s presentation.
Osteopathy takes a broader view, assessing how thoracic spine stiffness, rib restriction, and even diaphragm tension contribute to cervical dysfunction. A stiff mid-back forces the neck to compensate, loading the upper cervical joints beyond what they’re designed to handle.
Physiotherapy addresses the muscular component directly. Deep neck flexor weakness is present in virtually all chronic cervicogenic headache patients. Retraining these small stabilising muscles, through specific low-load exercises, reduces recurrence rates significantly. Trigger point release in the suboccipital muscles, upper trapezius, and sternocleidomastoid provides immediate relief for many patients.
Sports massage works particularly well for tension-type headaches, where sustained muscle contraction in the neck and shoulders is the primary mechanism. Regular soft tissue work breaks the cycle of tension, restriction, and pain.
What red flags should make you seek urgent care?
Not all headaches are benign. Certain patterns require immediate medical attention. A sudden, severe headache described as the worst of your life, sometimes called a “thunderclap headache,” could indicate a subarachnoid haemorrhage and warrants emergency assessment.
Headaches that wake you from sleep, worsen progressively over days or weeks, or are accompanied by fever and neck stiffness need urgent investigation. New headaches in patients over 50, headaches with neurological symptoms such as slurred speech, visual loss, or limb weakness, and headaches following head trauma all require prompt medical review.
Any headache that changes in character from your usual pattern deserves attention. Patients who’ve always had tension headaches but suddenly develop a different type of pain should consult a clinician rather than assuming it’s more of the same.
How does living on the Costa del Sol affect headache patterns?
Bright sunlight is a known migraine trigger for roughly 40% of migraine sufferers. The intensity of Mediterranean light, particularly the reflection off white buildings and water, catches many expat patients off guard. Polarised sunglasses and consistent hydration in the heat aren’t just comfort measures; they’re genuine preventive strategies.
Dehydration is more significant than most patients realise. Moving from a northern European climate to southern Spain, many people underestimate their fluid needs. Even mild dehydration, a 1-2% reduction in body water, can trigger both tension headaches and migraines. Costa Health clinicians consistently find that adequate water intake reduces headache frequency in patients who were previously chronic sufferers.
Screen time is the modern epidemic. Remote workers living on the coast often spend eight to ten hours at improvised desk setups, then wonder why they develop daily headaches. Ergonomic assessment and regular postural breaks make a measurable difference.
What does a headache assessment at Costa Health involve?
Assessment begins with a detailed history: onset, duration, location, character, associated symptoms, triggers, family history, and medication use. The clinician then performs a thorough examination of the cervical spine, jaw, and thoracic region, testing range of motion, segmental mobility, muscle strength, and specific provocation tests for each headache type.
Treatment is rarely single-discipline. A typical management plan might combine chiropractic upper cervical adjustments to restore joint mobility, physiotherapy exercises to build deep neck flexor endurance, and periodic sports massage to manage the muscular tension that accumulates between sessions. For patients with neck pain alongside headaches, or those with identified cervical facet syndrome, the treatment plan addresses both conditions simultaneously.
The goal isn’t to create dependence on treatment. It’s to identify the drivers of each patient’s headaches, treat them effectively, and equip the patient with strategies, exercises, ergonomic adjustments, trigger awareness, to manage the condition independently.