Short answer: A headache at the base of the skull is commonly linked to the upper neck. Irritated joints at the top of the neck can cause a cervicogenic headache, and tight muscles in the neck and shoulders are a common feature of tension-type headaches. Screen posture, stress, poor sleep and jaw clenching are frequent triggers.
What's at the base of your skull?
The base of the skull, the occiput, is where your head sits on top of the neck. Just below it are:
- The top three neck vertebrae (C1 to C3). The atlas (C1) and axis (C2) are specially shaped to let your head nod and turn.
- The suboccipital muscles. A group of small, deep muscles connecting the skull to the top two vertebrae. They make fine adjustments to head position all day.
- Larger muscles such as the upper trapezius and semispinalis, running from the skull down into the shoulders and upper back.
- The occipital nerves. These come from the upper neck and supply sensation to the back of the head.
Here's the key piece of anatomy. Nerves from the upper three levels of the neck feed into the same processing area in the brainstem as the trigeminal nerve, which carries sensation from the face and forehead. Because they share that relay station, the brain can't always tell where the pain is really coming from. Irritation in the upper neck can be felt at the base of the skull, over the top of the head, at the temple or even behind the eye.
Those small suboccipital muscles are sensors as well as movers. Like the other deep muscles of the spine, they're packed with muscle spindles that report head and neck position to your brain, part of what makes the spine a sensory organ. When an upper neck segment isn't moving or being controlled well, which chiropractors call a vertebral subluxation, the brain receives less accurate information from that area.1 That's one reason we check how each upper neck level moves. This research is about how the brain senses and controls the neck; it isn't evidence about headaches. More in chiropractic and your nervous system.
Cervicogenic headache: when the neck is the source
"Cervicogenic" means "coming from the neck". In a cervicogenic headache, the pain starts in structures of the upper neck, usually the joints, and is referred into the head. Common features:
- usually one-sided, and often the same side each time
- starts at the base of the skull or the neck, and can spread forward over the head
- brought on or made worse by neck movement or sustained neck positions
- reduced neck movement, often stiff turning towards the sore side
- pressing on the upper neck may reproduce the headache
Tension-type headache: the most common kind
Tension-type headache is the most common type of headache. It typically feels like a band, pressure or tightness, often on both sides of the head, and many people feel it strongly at the base of the skull and across the shoulders. Tender, tight neck and shoulder muscles are a common feature. Stress, long hours in one position, poor sleep and skipped meals are frequent triggers.
Cervicogenic and tension-type headaches can overlap, and some people have both.
Comparing common headache types
| Cervicogenic | Tension-type | Migraine | |
|---|---|---|---|
| Where | One side, from the base of the skull forward | Both sides; band-like; often base of skull and forehead | Often one side; may switch sides |
| Feel | Dull, deep ache | Pressure or tightness | Throbbing, often moderate to severe |
| Neck involvement | Central: neck movement brings it on | Tight, tender neck and shoulder muscles common | Neck pain can occur, but isn't the source |
| Other features | Reduced neck movement | Usually no nausea | Often nausea, sensitivity to light and sound; some people have aura |
Migraine is a different condition with its own causes. Some people with migraine also have neck pain and tension, which can be part of how it presents. We don't claim chiropractic care treats migraine. Part of a good assessment is working out which type of headache you're likely dealing with.
Common triggers for headaches at the base of the skull
- Head-forward posture. Looking down at phones and laptops makes the suboccipital muscles and upper neck joints work hard for hours. See tech neck.
- Sustained positions. Long drives, reading in bed, desk work without breaks.
- Stress. Shoulders creep up and neck muscles tighten.
- Jaw clenching and teeth grinding. The jaw muscles and the upper neck work closely together.
- Poor sleep and awkward sleep positions.
- Past neck injury such as whiplash.
- Dehydration and skipped meals, which commonly feature in tension-type headaches.
How we approach this at MPCC
Not every headache comes from the neck, so we start by finding out what kind of headache you have. Your new patient appointment takes 30 to 40 minutes. We take a careful history of your headaches, take posture pictures, and do a thorough chiropractic, orthopaedic and neurological check of your spine, joints and nerves, including how each level of the upper neck moves and whether pressing on it reproduces your headache.
At your report of findings appointment we explain what we found in plain English and what we'd do. If your neck looks to be involved, care may include specific chiropractic adjustments to the neck and upper back, home exercises, and changes to your desk, phone and sleep setup. See our headaches page and neck pain page.
Tip: keep a headache diary before your first visit. Note when each headache starts, where it is, what you were doing and what helped.
If you're worried about it, call us and we'll talk it through.
References (1)
- Haavik H, et al. (2021). Contemporary model of vertebral column joint dysfunction. Eur J Appl Physiol. doi:10.1007/s00421-021-04727-z