Is it true that my headache could be coming from my neck?

As Physio’s we often have patients complaining of neck issues such as stiffness or pain which they believe is accompanied by some sort of ache or tension around their head or face…. So is it true that some types of headaches are actually caused by some dysfunction in the neck?

It seems to be more common knowledge now that yes your neck can be the source of your headache, so in this blog we’ll explore neck related headaches and how likely it is that your headache is one of these!

We’ll also give you some tips for treatment and some things you can try at home to help ease your pain!

Remember if you’re concerned about your pain or have experienced your pain for a few consecutive days make sure you consult your Physio or GP!





What is it?

Cervicogenic headache is a syndrome characterised by pain around the head or face that is referred from a source in the neck. Often this pain is referred from the soft tissue or bony structures.

The prevalence of this type of headache in the general population is only around 2-4%. They are most common around the age of 40 and are 4 times more likely in females than males. They can also affect quality of life to the same extent as migraines! The most common factors related to these headaches are mental stress and poor neck position (posture, weak or tight muscles).


The mechanism of this pain is thought to arise from a crossover of information from the nerves supplying the neck and those that supply the head and face. This occurs with a convergence between the sensory fibres from the upper cervical nerve roots and trigeminal nerve fibres.  This basically means that although the source of pain is a joint, muscle or ligament in the neck, your body is PERCEIVING the pain in the head or face!


How do I know if my headache is coming from an issue in my neck?

The features of cervicogenic headaches can be similar to that of other headache disorders such as tension type or migraine. So how do we determine if the source of pain is from the neck?

The following criteria are more likely associated with cervicogenic type headaches but it is important to remember that you may be suffering from more than one type of headache at any given time.



Cervicogenic headache signs/symptoms:

  • Head pain is aggravated by neck movement or poor neck postures
  • Head pain is exacerbated by external pressure over the upper cervical/occipital region
  • Reduced neck movement
  • Neck/shoulder/arm pain on the same side as the headache
  • One sided head or face pain without change of sides
  • Intermittent attacks of pain lasting hours to days
  • Moderate to severe pain intensity that is non-throbbing






To successfully treat cervicogenic headaches your physiotherapist will perform a complete assessment to determine the source of the pain and whether there may be a secondary source.  It is relatively common to suffer these headaches along with other non-specific neck pain as well as other headache types.

Successful treatment often involves the combination of pharmacologic and physical/manual therapy. Studies support the use of therapeutic exercise along with soft tissue therapy in the short term treatment of this condition as well as good results in the long term prevention and control of headaches.


How can a physiotherapist help with my headaches??

  • Mobilisation and manipulation aimed at restoring the range of motion in cervical spine joints particularly in the upper joints
  • Soft tissue techniques to alleviate tight musculature or release responsive muscles
  • Dry needling
  • Targeted exercise program aimed at restoring range of motion, stretching tight musculature, improving strength
  • Pilates
  • Posture correction
  • Ergonomic assessment


What can I do myself to help decrease my pain?

  • Avoid prolonged positions eg sitting at work
  • Maintain good posture in standing and sitting
  • Maintain adequate strength and flexibility in the shoulder and neck region
  • Self-release upper back/neck muscles
  • Try to manage mental stress   


So where to from here? Do your symptoms appear similar to what we’ve talked about in this blog? Maybe your headaches are actually coming from a neck issue instead of just a chronic headache which seems to keep coming back. Instead of reaching for the pain killer next time, try Physio!

Shin Splints? The secrets to reducing your pain!

Chances are you’ve heard the term shin splints before… Over the past few weeks I have noticed a spike in the number of patients coming in to the clinic with what is most commonly known as ‘shin splints’. This could be due to the fact that we are coming to the end of the winter sport season or maybe because we are sitting in the middle of the running season!
In the physio world ‘shin splints’ is actually a broad term used for a number of conditions which fall under medial tibial stress syndrome (MTSS) and is any pain experienced in the front of the lower leg.
In this post I am going to give you a guide on how to identify this condition and give you 3 simple exercises to help reduce your symptoms and get you back on the track!

So what are they…?
Medial tibial stress syndrome could be caused by a number of tibial injuries including tendinopathy, inflammation of the periosteum (connective tissue surrounding bone), stress reaction of the bone and remodelling of the periosteum.
The most common complaint we hear in the clinic from someone suffering this condition is a general, dull ache in the mid-lower part of the shin bone and is most commonly associated with increasing activity. The diagram to the right displays the usual area of pain for this condition.

The condition commonly presents in both legs at the same time but the pain may be greater on one side. At first it may only present at the beginning of exercise and once the body is ‘warm’ the symptoms disappear but then return as the body ‘cools’ down. As the condition progresses, the pain tends to stay throughout the whole event, including afterwards. Like the name suggests, shin splints are a stress reaction to chronic, repetitive loads going through the tibial bone.



What increases my risk of getting shin splints?

  • Females 2-3x more likely than males
  • Sudden increases in training (frequency, duration, intensity)
  • Running or playing sport on hard surfaces
  • Recent change in footwear
  • Fat fleet (Pes planus)
  • Weak or inactive core muscles
  • Biomechanical abnormalities and training errors

I think I’ve got shin splints… What can I do??

Most people will probably tell you to stretch or foam roll your calves if you’re suffering from shin splints… but this is only part of the answer.

Here we’ll look at 3 simple exercises which can help manage pain coming from the shin bone region. Remember this is a complex condition and ideally requires a physiotherapy assessment which is directly tailored to you and the causes of your tibial stress! If your symptoms aren’t improving or are getting worse, make an appointment with your trusted physio!


  1. Attack the source

Calf raises with eccentric focus

Studies show that weak calf muscles are more prone to muscle fatigue, leading to altered running mechanics and in turn extra strain on the tibia. This exercise is to start as soon as the acute painful stage has subsided and the exercise is tolerable.


  1. Attack contributing factors

Glute med

Crab Walks

The glutes are extremely important muscles which sit on the side/back of the hip and contribute to lower limb stability and alignment. Although this muscle is higher up the chain, weakness of the glute medius will result in torsion of the tibia and in turn greater stress on the bone!

It also allows you to start the rehab process early as these exercises do not cause excessive stress on the painful area of the shins.


  1. Attack poor foot biomechanics

Toe Swapping

When it comes to the lower limb, the inner foot muscles are extremely important in keeping the foot, in particular the arch, placed in an optimal position. These muscles often become weak or underactive leading to collapse or poor stability through the arch.

This exercise can be made easier and harder by performing in standing or on unstable surfaces.



What else could my pain be coming from…?

Stress Fracture: thought to be caused by similar processes to MTSS this is a more progressed condition in which small fractures start to appear in the tibial bone.

Chronic Exertional Compartment Syndrome: also occurs from repetitive loading or exertional activities. Can present with symptoms that indicate nerve involvement such as weakness or numbness in the lower leg. More commonly affects the outer region of the lower leg.


Galbraith, R. et al. (2009) Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. Sep; 2(3) 127-133.


The Road to Recovery for Marion

Marion walked into PPS Physiotherapy Kellyville in February 2017 after fracturing her Left patella (knee cap) tripping over at home in late 2016. She underwent surgery to have a wire threaded through the patella to assist in the fracture healing.

Marion xray edited          20170104_185037

When Marion first attended the clinic she was wearing a knee brace, using a 4 wheeled walker and had high hopes I was about to fit her with a more comfortable knee brace.Unfortunately, the brace Marion was instructed to go into “just for comfort”, was bigger, bulkier and more uncomfortable than her previous brace. I said to Marion I’ll give you a few days and you will be begging to come out of it.


Sure enough 2 days later Marion returned ready to commence physiotherapy and the first thing she said was “you can have the brace back.”  Marion started physio with a long rehabilitation road ahead. The first priority was to increase her amount of flexion (bend) and extension (leg straight). On her first session, Marion was able to bend up to 45 degrees and extend out long to -4 degrees from straight. As a bit of a guide against what we would usually see, ideal range is between 125 degrees and 140 degrees of bend. You also need a minimum of 110 degrees to use stairs or complete a full revolution on a bike.


marion brace 1


Gradually we began to introduce strengthening exercises, balance tasks, learning to walk again and performing functional exercises.


In March 2017, Marion’s progressed plateaued due to the surgical wire limiting her ability to move and at times it would catch in the knee causing her considerable pain. The surgeon agreed to remove this wire, a few months earlier than desired, to reduce the pain and increase her function. At the same time, a small non-harmful lump was removed from the right knee which we commonly referred to as ‘Lawrence the lump’…so maybe we should make that 3 surgeries now!   20170412_154455

When Marion returned post her second round of surgery her progress again picked up and we were able to make greater achievements. These included;

– cracking the 90 degrees of flexion (bend) mark and beyond

– completing a full resolution on the bike

– walking without an aid

–  being able to return to driving

– becoming more confident using stairs

Today Marion has exceeded expectations and is now able to bend her knee to 137 degrees and extend all the way. She still has some difficulty going downstairs but is working hard on this and is regaining her confidence. Marion is also backMarion knee bend to most activities and is enjoying her ongoing improvements.


Marion was very diligent with sticking to her appointments, rehabilitation plan and home exercises.


The team at PPS Physiotherapy are very proud to have helped Marion throughout her journey with us and we wish Marion all the best for the future.

Kim and Marion