What Is It?
Tension-type headache (TTH) is the most prevalent primary headache disorder, characterised by bilateral, pressing or tightening pain of mild-to-moderate intensity. It is strongly associated with pericranial muscle tenderness — particularly in the suboccipitals, upper trapezius, SCM, and temporalis. TTH is not a neurological headache; its mechanism is primarily musculoskeletal and nociceptive.
Cervicogenic headache (CGH) originates from dysfunctional structures of the upper cervical spine (C0–C3), referring pain into the head via the trigeminocervical nucleus. It is often unilateral, tends to start in the neck before spreading forward, and is reproduced by pressure on upper cervical segments or neck movement. CGH is frequently misclassified as migraine. Migraine involves central sensitisation and trigeminal pathway involvement — myotherapy can reduce trigger factors but does not directly address the neurological mechanisms of true migraine.
Common Causes
- Active trigger points in the suboccipital muscles (rectus capitis, obliquus capitis) referring pain into the occiput, temples, and eye
- Trigger points in the upper trapezius and SCM generating temporal and retroorbital referred pain
- Cervical joint dysfunction at C0–C3 irritating the trigeminal pathway
- Forward head posture increasing compressive load on the upper cervical spine
- Jaw clenching or temporomandibular joint (TMJ) dysfunction
- Sustained screen use and poor workstation setup
- Sleep disruption and psychological stress — which amplify central pain sensitivity
How Myotherapy Can Help
- Trigger point therapy — manual deactivation of suboccipital, SCM, upper trapezius, and temporalis trigger points; often produces immediate headache reduction
- Dry needling — particularly effective for TTH and CGH; randomised trials demonstrate significant reductions in headache frequency and intensity
- Cervical joint mobilisation — addressing C0–C3 hypomobility to reduce cervicogenic referral; strong evidence base for CGH specifically
- Deep cervical flexor strengthening — progressive exercise to restore neuromuscular control of the cervical spine and reduce mechanical loading of upper cervical structures
- Postural correction — forward head posture management reduces compressive load on C0–C3
Expected Outcomes
Cervicogenic headache has strong evidence for manual therapy combined with exercise — the landmark Jull et al. (2002) RCT demonstrated that combined manipulation and exercise was significantly superior to either intervention alone. TTH typically shows measurable reduction in frequency and intensity within 4–6 sessions. Migraine: myotherapy may reduce the frequency of musculoskeletal trigger factors but should be used alongside medical migraine management, not as a replacement.
Likely Symptom Changes
Many clients report headache onset or worsening immediately following the first 1–2 sessions, particularly after dry needling to suboccipitals — this is a recognised post-treatment response. From session 3 onwards, headache frequency should begin declining. By session 6, most TTH and CGH presentations show a clear downward trend. Exercise compliance is the primary predictor of sustained benefit beyond the treatment course.
References
- Jull, G., et al. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 27(17), 1835–1843.
- Fernández-de-las-Peñas, C., et al. (2006). Trigger points in the suboccipital muscles and forward head posture in tension-type headache. Headache, 46(3), 454–460.
- Becker, W. J. (2010). Cervicogenic headache: Evidence that the neck is a pain generator. Headache, 50(4), 699–705.
Recurring headaches affecting your work or daily life?
Shaun will identify whether your headache has a musculoskeletal component — and treat it directly.