What causes headaches?
Understanding the True Burden of Headaches
Headaches are among the most common health complaints worldwide—around 90% of people will experience one at some point in their lives, and in 2021, an estimated 3.1 billion people were affected globally.
But headaches are more than just a temporary discomfort. According to the 2019 Global Health Estimates, headache disorders were the third leading cause of disability-adjusted life years (DALYs) worldwide—ranking just behind stroke and dementia. To put that in context, one DALY represents the loss of a full year of healthy life. The toll headaches take isn’t limited to physical pain; they can disrupt family life, strain social connections, and significantly impact work performance.
What many people don’t realize, however, is that the three most common types of headaches are highly treatable—often without the need for medication. In this blog, we’ll explore how Chiropractic care can effectively address these common headache types by targeting their underlying causes.
Types of headaches
Headaches are generally classified as either primary or secondary headaches. Primary headaches are not associated with an underlying condition and include migraine, tension-type headache, and cluster headache. Secondary headaches can be traced back to a local or systemic pathology, such as a trauma, infection or haemorrhage (3,4).
The most frequent types of headaches that Chiropractors come across include primary headaches such as tension type headaches and migraines, and secondary headaches such as cervicogenic headaches and medication overuse headaches (5). It’s important to know that headache types can overlap. For example, another cause of headache can overlap with migraine and either precipitate or aggravate a migraine attack (4).
Headache types can overlap, for example another cause of headache can overlap with migraine
Cervicogenic headaches
Cervicogenic headaches are secondary headaches that arise from a disorder of the head or neck (4). This is an extremely common presentation to Chiropractors as patients often complain of both neck and head pain. They are usually felt as mild to severe pain radiating from the neck and base of the skull into the head or face (5). The source of pain from cervicogenic headaches originates from structures in the upper neck, including joints, muscles, ligaments, joint capsules, and discs (6).
Risk factors for cervicogenic headaches include:
Previous neck trauma
Dysfunction of the cervical (neck) vertebrae
Sustained or repetitive neck postures/positions
Cervicogenic headaches respond extremely well to standard Chiropractic care, because structures innervated by the upper branches of the spinal cord (C1-C3) are often found to be the painful source of the headache. The sensory information from this area converges on the same part of the spinal cord as sensory information from the face and back of the skull, leading to referred pain (6).
Previous neck trauma is a risk factor for headache
Migraines
One of the most common types of headaches, migraine affects around 1 in 7 people worldwide and around 10 million people in the UK (3). Migraine ranks as the seventh most common cause of disability worldwide, and the third most common cause of disability in people under 50. An estimated 3 million workdays are lost per year to people suffering from migraines (3).
Migraines are pulsating or throbbing, one-sided headaches, which can often last between hours to days. The headache is accompanied by nausea, sensitivity to light and sounds, and in around 1/3 of sufferers the onset of headache is preceded by an aura with visual, sensory or motor symptoms (2,3).
The cause of migraine is unknown, but it is thought to be related to the release of inflammatory substances around the nerves and blood vessels of the brain (2). It has also been described as a dysregulation in the brain which can cause the brain to perceive non-painful stimuli as noxious (3).
Migraines have common triggers such as:
Stress
Lack of sleep
Caffeine or alcohol intake
Certain foods
Menstruation
Migraine treatment often involves analgesics, anti-emetics and certain specific anti-migraine and prophylactic medications to prevent migraines before they start. The WHO recommends lifestyle modifications such as maintaining sleep schedules, avoiding alcohol, healthy diets and staying hydrated to prevent migraines (2). Manual therapies, including those offered by Chiropractors, are also an effective way to reduce the frequency of migraines without the need for medications (7).
Did you know? Chiropractic treatment is shown to be helpful in the prevention of migraines
Tension type headaches
Tension type headaches are mild-to-moderate, pressing, tight, or vice-like headaches that can often feel like a band around the head, and sometimes spread into the neck. Women are affected 50% more than men (2). The cause of tension headache can usually be traced back to muscles in the neck that are tight or hyperactive - Muscles which are placed under too much load or repetitive strain develop painful muscle knots which refer pain into the head. This type of headache can overlap with cervicogenic headache and other types of headache, and lasts from a few hours to a few days (1,5).
Tension type headaches respond best to rehabilitation, re-education, as well as manual therapies, which are all offered at CH Chiropractic (5). Chiropractic can also reduce the likelihood of a tension type headache overlapping with a different type of headache by addressing musculoskeletal dysfunctions.
Tension type headaches are caused by tight head and neck muscles
Medication Overuse Headaches
Medication overuse headache is a type of secondary headache which occurs on 15 days or more per month and can vary in location and severity. As the name suggests, they are characterised by the worsening of a pre-existing headache due to the regular use of medications used to treat headaches (2,5).
Certain medications, such as triptans, which are used to treat migraines and cluster headaches, are more likely to lead to medication overuse headache. The risk of getting medication overuse headache increases if you use triptans, opioids or combination analgesics 10 or more days per month, and simple analgesics like paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin 15 days or more per month. Fortunately, it usually resolves after the medication is stopped.
Medication overuse headaches occur on 15 or more days a month and are caused by the overuse of medications used to treat headaches.
The role of Chiropractors to treat headaches
Chiropractors are uniquely equipped to help patients manage and overcome headaches. With advanced training in manual therapies, and a deep understanding of the musculoskeletal and nervous systems, they can effectively address many of the underlying causes of common headache types.
Scientific research supports the use of manual therapies—including spinal manipulation, joint mobilisation, and soft tissue techniques—in combination with patient education and targeted rehabilitative exercises for the treatment of migraines, cervicogenic headaches, and tension-type headaches (5,7).
In addition to these hands-on therapies, many Chiropractors are trained in acupuncture, which is recommended by the National Institute for Health and Care Excellence (NICE) for managing both migraines and chronic tension-type headaches (1,3).
Chiropractic care is generally considered safe, with a low risk of adverse effects, and offers a drug-free option for those looking to reduce or avoid medication. There is also growing evidence that Chiropractic treatment may help prevent migraine attacks when used as a long-term, prophylactic approach (7).
My personal experience
When I was training as a Chiropractic student in Bournemouth, I began experiencing cervicogenic headaches. Hours spent hunched over a desk were taking a serious toll on my neck and shoulders. The headaches became so frequent and intense that I had to interrupt my study sessions just to manage the pain with ice packs and paracetamol.
Fortunately, I was able to begin Chiropractic treatment, which quickly relieved much of the tension in my neck—and, over time, completely resolved the headaches.
Today, I continue with regular preventative (prophylactic) care to stop them from returning. I can personally attest to how disruptive headaches can be to daily life. Through researching this blog post, I also learned just how widespread their impact is—headaches are one of the leading causes of disability worldwide and a major contributor to lost productivity.
Chiropractic care has been transformative for me. It effectively addresses the structural causes of pain and offers results that are not just noticeable but genuinely satisfying. If you're struggling with headaches, I highly recommend considering Chiropractic treatment as part of your recovery plan.
References:
NICE CKS - headache https://cks.nice.org.uk/topics/headache-assessment/background-information/prevalence/
WHO factsheet on Migraine and other headache disorders https://www.who.int/news-room/fact-sheets/detail/headache-disorders
NICE CKS - migraine https://cks.nice.org.uk/topics/migraine/background-information/prevalence/
International Headache Society The International Classification of Headache Disorders, 2nd Edition https://ihs-headache.org/wp-content/uploads/2020/05/1477_ichd-iir1final-1.pdf
Royal College of Chiropractors, Chiropractic Quality Standard: Headache (2020)
Clinical Chiropractic, Vizniak 2018
Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011 Apr;12(2):127-33. doi: 10.1007/s10194-011-0296-6. Epub 2011 Feb 5. PMID: 21298314; PMCID: PMC3072494.
NICE CKS: Medication overuse headache https://cks.nice.org.uk/topics/headache-medication-overuse/background-information/causes/
