Could Your Headache Be Coming From Your Neck, Jaw or Shoulders?
Headaches are incredibly common, but not every headache starts in the head.
As physiotherapists, we regularly see people with headache symptoms alongside jaw pain, neck stiffness, prolonged sitting, stress or tension around the neck and shoulders. Sometimes there is a musculoskeletal component that we can identify during an assessment.
The important word there is sometimes.
There are many different types and causes of headaches, and our first job isn’t to assume yours is coming from a tight muscle. It’s to understand the pattern, assess what might be contributing and make sure there isn’t anything that needs further medical investigation.
There are three musculoskeletal patterns I commonly see in clinic.
1. The Jaw
If someone presents with headaches, I’ll often ask about their jaw.
Do you clench or grind your teeth? Do you wake up with a sore or tired jaw? Does it click? Has your dentist previously suggested a splint or night guard? Is the side of your jaw tender to touch? Can you comfortably open your mouth?
The masseter and temporalis are two of the major muscles involved in closing the jaw. If you regularly clench or grind your teeth, these muscles can spend a lot of time working. Jaw-related disorders can be associated with pain around the jaw, ear and temple, headaches around the temples, clicking and difficulty opening the mouth fully.
If your headache consistently appears alongside those symptoms, your jaw may be one piece of the puzzle.
Things we might look at include:
☐ Jaw opening and movement
☐ Tenderness and sensitivity around the jaw and temple
☐ Clenching, grinding and other habits that may be contributing
2. The Neck
Another common pattern is headache accompanied by neck pain or stiffness.
Someone might describe symptoms beginning around the back of the neck or base of the skull before travelling towards the head. They may also notice that their neck feels restricted or that particular neck movements reproduce or aggravate their familiar headache.
This is where prolonged positions can become relevant.
Think about sitting at a computer. We often imagine poor posture as simply slumping forwards and looking down. But if your head moves forwards while your eyes continue looking towards the screen, your neck may actually remain relatively extended to keep your gaze level.
Hold that position for long enough and the muscles around the back of the neck have to keep working to support your head.
That doesn’t mean there is one “bad posture” you must avoid. The bigger issue is often spending a lot of time in one position without enough movement, strength or capacity for what your day requires.
With a suspected neck contribution, we might look at:
☐ Whether neck movement changes or reproduces your headache
☐ Neck and upper-back movement and capacity
☐ How long you spend in sustained positions and how frequently you move throughout the day
3. The Shoulders and Upper Traps
Then there’s the person who seems to carry everything in their shoulders. If you know, you know!
Stress hits and the shoulders rise. They’re concentrating at the computer and the shoulders rise. They clench their jaw and the shoulders rise. Sometimes people don’t realise how often they do it until I start pointing it out during their appointment.
The upper trapezius helps elevate the shoulder blade, and constantly spending time in that elevated position can contribute to tension and sensitivity around the neck and shoulder region.
The first step here is often surprisingly simple: awareness.
Can you recognise when you’re shrugging? Can you relax out of that position? Do you have enough strength and control around the rest of the shoulder blade and upper back? Are stress, jaw clenching, your work setup or prolonged positions contributing to the pattern?
Treatment might then involve a combination of movement, strengthening, changing aggravating positions or habits, and gradually building the capacity of the neck and shoulder region rather than simply trying to “release” the upper traps forever.
We might look at:
☐ How often you unconsciously elevate or tense your shoulders (get someone to notice for you!)
☐ Strength and control around the shoulder blade and upper back
☐ Stress, jaw tension and sustained positions that repeatedly bring the tension back
The Pattern Matters
None of these findings automatically means we’ve found “the cause” of your headache.
You might have features of more than one. Jaw clenching can happen during periods of stress. Stress might also increase shoulder tension. Long days at a computer can change how much your neck and upper back are moving. Sleep, training, workload and other factors can sit over the top of all of it.
That’s why an assessment should be about putting the pattern together, not simply finding one tight muscle and blaming everything on it.
If we can reproduce or meaningfully change your familiar symptoms by assessing your jaw, neck or shoulder region, that gives us useful information to work with. From there, treatment might involve symptom relief alongside movement, strengthening, awareness and changing some of the repeated loads or behaviours that appear to be contributing.
When a Headache Needs Medical Assessment
Headaches aren’t something we should automatically assume are musculoskeletal.
A sudden and severe headache, or a headache associated with symptoms such as confusion, seizure, fever with neck stiffness, significant visual changes, loss of balance, unexplained vomiting or new neurological symptoms needs urgent medical care - Call 000 or go to your nearest emergency department.
Headaches should also be medically reviewed when they are new or changing significantly, progressively worsening, occurring after a head injury, waking you from sleep or simply don’t fit the pattern we would expect from a musculoskeletal presentation.
Sometimes the appropriate outcome of a physiotherapy assessment is treatment.
Sometimes it’s referral.
Knowing the difference matters.
If you experience recurring headaches alongside jaw pain, neck stiffness or shoulder tension, an assessment may help determine whether your musculoskeletal system is contributing to the bigger picture.
Book an appointment with the By Design Physiotherapy team to have your neck, jaw and movement assessed.
This is general information only and is not intended to diagnose the cause of a headache. New, severe, changing or concerning headaches should be appropriately medically assessed. If you’re managing pain or an injury, speak with your physio about what’s right for you.
