Headaches are an all-too-common and disabling condition that are often accompanied by neck pain and stiffness, leading patients to try chiropractic care to see if a neck adjustment can help. The good news is that many headache sufferers do experience some degree of relief after chiropractic treatment, but why does care focused on the neck help headaches?

Interestingly, 73% of migraine patients and 90% of tension-type headache patients experience co-occurring neck pain. There’s also another type of headache called cervicogenic headache that is secondary to a neck disorder. Neck pain can arise from any number of causes including injury to the facet joints, disk herniation, and strain to the muscles, tendons, and ligaments in the neck and upper torso. If one or more of these issues irritate the trigeminal nerve (the fifth cranial nerve) where it interacts with the upper cervical nerve roots, then it may exacerbate or even trigger headache symptoms.

When chiropractors manage patients with headaches thought to involve a musculoskeletal disorder of the neck, they will often employ a multimodal treatment approach that combines several therapies known to improve neck pain and disability. Within the office, this may include manual therapies and physiotherapy modalities. Outside the office between visits, patients may receive instruction on exercises to perform to facilitate the healing process and (hopefully) reduce the risk of recurrence. There are many types of exercises to choose from such as general aerobic exercises to more neck-specific posture-based exercises, muscle strengthening exercises, and cranio-cervical flexion exercises. But is there a best form of exercise for this type of patient?

In 2024, researchers set off to investigate if a comprehensive exercise program aimed at improving posture, mobility, flexibility, and strength in the superficial and deep neck muscles, as well as the mid-back, upper extremities, and core may best benefit the headache patient. Among a group of 90 patients, those assigned to the comprehensive stabilization exercise program (CSEP) performed exercises three times a week for eight weeks while the rest served as a control group not given any exercise advice. The research team found that those in the CSEP group experienced more significant improvement in headache frequency, duration, intensity; neck pain intensity; sagittal (from the side) posture; activation, endurance, and strength of the deep cervical muscles; and mood, sleep quality, and quality of life.

The findings suggest that such an exercise approach should be considered for patients with headaches and co-occurring neck pain; however, which exercises a chiropractor will recommend will also take into account the patient’s unique case as well as their doctor’s clinical experience and training.