Conditions · Headaches
Headaches that
start in the neck.
Not every headache comes from your head. Some are referred from the joints and muscles of the upper neck, which share nerve supply with the areas you feel them in — typically the back of the skull, behind the eye, or across the temple.
These are called cervicogenic headaches, and the useful thing about them is that they behave differently from the other common types. Telling them apart is most of the work, because it decides whether this is a job for me at all.
01 · The differential
Which kind of headache is it?
Most headaches fall into a few recognisable patterns. None of this replaces a proper examination, but it gives you a sense of what I'm listening for when you describe yours.
Suggests the neck
Usually one-sided and staying on that side. Often begins at the base of the skull and spreads forward. Provoked or worsened by neck movement, or by holding one position for a long time. Neck movement is often restricted, and pressing certain spots in the upper neck can reproduce your familiar headache.
Suggests migraine
Often throbbing and more severe, with nausea, or sensitivity to light and sound. It may be preceded by visual disturbance. It can swap sides between attacks, and typically comes as distinct episodes rather than a constant background. Migraine is a neurological condition and belongs with your GP.
Suggests tension-type
Band-like pressure across both sides, more tightening than throbbing, without nausea, and not usually made worse by ordinary activity. Very common, often stress- and posture-related, and frequently overlapping with neck-driven headache rather than separate from it.
Suggests something else entirely
Some headaches have nothing to do with any of the above — medication overuse, dental or jaw problems, eye strain, or a medical cause needing investigation. If your history points that way I'll say so and send you to the right person.
02 · The appointment
What actually happens.
A new patient appointment is 45 minutes, and with headaches an unusual amount of that is the history: where it starts, where it travels, what brings it on, how long it lasts, what you've noticed helps, what you're taking for it, and whether anything has changed recently. The pattern narrows the field before I examine anything.
Then the examination: how the neck moves and what limits it, joint-by-joint assessment of the upper neck in particular, how the muscles of the neck and shoulder girdle are behaving, and neurological testing where warranted. A key question is whether pressure on specific structures in the upper neck reproduces the headache you actually get — not just tenderness, but your headache.
If the examination doesn't support a neck origin, I'll tell you that, and it's the most useful thing I can do that day.
03 · The treatment
What treatment involves.
Where the assessment does point to the neck, treatment is directed at the neck rather than at the headache itself: specific joint work in the upper neck and upper back, soft-tissue work to the muscles involved, and — usually the part that determines whether it lasts — addressing what keeps loading it. Desk setup, screen height, sleep position and how much sustained static posture your day involves.
Progress is best judged over a few weeks by frequency and duration rather than by how any single day felt, so I'll usually ask you to keep a simple record between appointments.
04 · The limits
Headaches that need a doctor, not me.
Headache is one area where knowing what not to treat matters more than technique. I screen for these at the first visit, and some of them need attention the same day.
Go to A&E now
A headache that comes on suddenly and severely, peaking within a minute or two. Headache with fever, a stiff neck or a rash. Headache with weakness, numbness, confusion, difficulty speaking or changes to your vision. Headache after a significant blow to the head.
See your GP first
A new or clearly changed headache if you're over 50. A headache that is steadily getting worse over weeks. One that is worse when you lie flat, wakes you from sleep, or is aggravated by coughing or straining. Any headache alongside scalp tenderness or jaw pain when chewing.
If it's migraine
Migraine is a neurological condition, and managing it sits with your GP or a neurologist. Where a neck problem coexists I can help with the neck — but I won't present that as treating your migraine, because it isn't.
Patients who came in with this
…After working couple of years in the office and not looking after my posture, developed chronic neck pain which was causing me headaches. Even after the first session I started feeling much better. Dr. Spice did an amazing job and made me feel very comfortable during the sessions.
Often connected
Where to see me
Two London clinics, same practitioner at both. A new patient appointment is 45 minutes and includes your first treatment where that’s appropriate.