Headaches: Types, Triggers, Red Flags, and How Physiotherapy Can Help

Headaches are one of the most common reasons people lose focus at work, cancel plans, or stop exercising. The annoying part is how vague the word “headache” is. A migraine is not the same as a tension-type headache. A headache driven by your neck is not the same as one driven by medication overuse. And when you treat every headache the same way, you get inconsistent results.

This article gives you a clean framework:

• The main headache types and how they typically feel
• Common triggers that quietly push you into a flare
• Red flags that need urgent medical care
• Where physiotherapy fits, and what a credible plan looks like

Important note: This is general education, not a diagnosis. In BC, physiotherapy information and promotion must be truthful, accurate, and not misleading. That means no exaggerated promises, no “guaranteed cures,” and no claims that can’t be supported. (chcpbc.org)

First: headaches aren’t one condition

Clinicians often split headaches into two buckets:

Primary headaches

The headache itself is the disorder. Examples include:

• Tension-type headache
• Migraine (with or without aura)
• Cluster headache

Secondary headaches

The headache is a symptom of something else. Examples include:

• Head injury/concussion
• Infection or systemic illness
• Medication-related headaches (including medication-overuse headache)
• Other medical causes

A key reason guidelines exist is to help clinicians recognize which headache pattern fits best, avoid unnecessary tests, and choose targeted management. (NICE)

The common headache types (and what they usually feel like)

1) Tension-type headache

This is the classic “tight band” headache.

Typical pattern

• Pressure or tightness (more than throbbing)
• Mild to moderate intensity
• Often both sides of the head
• Often paired with neck/shoulder tension
• Usually not accompanied by strong nausea

Common contributors

• Stress and sustained concentration
• Poor sleep
• Skipped meals
• Long screen time
• Long periods in one posture
• Jaw clenching

Tension-type headache is one of the core headache disorders covered in NICE CG150. (NICE)

2) Migraine

Migraine is not “just a bad headache.” It’s a neurological condition that often includes symptoms beyond pain.

Typical pattern

• Moderate to severe headache, often throbbing
• Light sensitivity and sound sensitivity
• Nausea (sometimes vomiting)
• Worse with physical activity
• Some people get aura (visual or sensory changes)

Migraine care often includes medical strategies. Physiotherapy can support certain contributing factors (neck pain, tension, activity pacing), but it shouldn’t be positioned as a replacement for migraine-specific medical treatment.

Migraine is also directly addressed in NICE CG150, including migraine with aura and menstrual-related migraine. (NICE)

3) Cluster headache

Less common, but very distinctive.

Typical pattern

• Severe pain, often around one eye or temple
• Attacks can come in “clusters” over weeks
• Often paired with watering eye, nasal congestion, or restlessness

This pattern needs medical assessment and specific treatment. It’s included in NICE CG150 for a reason. (NICE)

4) Medication-overuse headache

This one catches people off guard. If you rely on headache medication frequently, it can sometimes contribute to more frequent headaches over time.

Clues

• Headaches slowly become more frequent
• Medication helps briefly, then headaches return
• You find yourself taking meds more often than you want to

Medication-overuse headache is specifically included in NICE CG150 because it changes the management plan. (NICE)

If this sounds like you, don’t try to brute-force it alone. Adjusting medication patterns can be uncomfortable and should be guided by a pharmacist or physician.

5) Cervicogenic (neck-related) headache

This is head pain referred from the neck (cervical spine structures like joints, muscles, and nerves).

Typical pattern

• Often starts at the base of the skull or upper neck
• May spread into one side of the head
• Triggered by sustained posture (desk work, driving)
• Worse with certain neck movements
• Often paired with neck stiffness or reduced range of motion

This is one of the clearest lanes for physiotherapy, because the neck’s movement, endurance, and load tolerance are modifiable.

Common triggers that push you into headaches

Triggers vary, but most people have a few repeat offenders. The trick is that triggers stack. One poor night of sleep might be fine. Add dehydration, a skipped lunch, two hours of laptop posture, and stress, and now you’re in trouble.

Common triggers include:

• Inconsistent sleep (too little, too much, or irregular timing)
• Dehydration
• Skipped meals
• Caffeine changes (more than usual or sudden withdrawal)
• Alcohol for some people
• Long static postures and heavy screen days
• Jaw clenching or teeth grinding
• Sudden spikes in training load or workload

A simple headache diary for 2–3 weeks helps you see patterns fast. Track:

• Time of onset
• Location and quality (pressure vs throbbing, one side vs both)
• Sleep, hydration, meals
• Stress level
• Medications taken and effect
• Neck pain or stiffness on that day

Red flags: when to seek urgent medical care

Most headaches are not dangerous. Some are. You’re not trying to self-diagnose emergencies. You’re trying not to miss obvious warning signs.

Seek urgent assessment if you have:

• A sudden, explosive “worst headache of my life”
• New neurological symptoms: weakness, numbness, facial droop, slurred speech, confusion, fainting, seizure
• Headache with fever and stiff neck
• Headache after significant head injury
• A new headache pattern that is rapidly worsening
• Visual loss or severe eye pain
• New headaches during pregnancy/postpartum (get assessed promptly)

NICE’s guideline exists partly to improve recognition and management of headache disorders and support appropriate investigation decisions. (NICE)

Do you need a CT or MRI?

A lot of people assume imaging is step one. Often, it’s not. Many primary headache disorders are diagnosed based on history and clinical assessment. Imaging is generally considered when red flags exist, the pattern is atypical, or a clinician needs to rule out a secondary cause.

If you want to be useful in your own care, show up with a clear summary:

• How long this has been happening
• Headache days per month
• What it feels like
• Associated symptoms (nausea, light sensitivity, neck pain)
• Clear triggers you’ve noticed
• Medication use and frequency

How physiotherapy can help (realistically)

Physiotherapy is most relevant when headaches are influenced by the neck, posture load, and muscle endurance. It’s not about “finding the one magic spot.” It’s about reducing the physical drivers that keep irritating your system.

When physiotherapy is most likely to be useful

Physio may help when:

• Headaches start after desk work, driving, or sustained posture
• You have neck pain or stiffness with headaches
• The headache starts at the base of the skull and spreads upward
• You notice limited neck movement or pain with certain positions
• You want a non-drug strategy to reduce frequency and severity

What the evidence supports for cervicogenic headache

For cervicogenic headache, research supports a role for manual therapy and exercise therapy in improving headache outcomes for many people, though results vary and depend on the individual and the program. (Springer Link)

That’s the key phrase: for cervicogenic headache. Not for every headache on earth.

What a good physiotherapy assessment looks like

A credible headache assessment should include:

1) Pattern recognition + safety screening

• Headache type features (tension vs migraine vs cervicogenic patterns)
• Red flag screening and referral when needed
• Medication use patterns (to flag medication-overuse risk)

2) Physical exam that actually matters

• Cervical spine range of motion and symptom response
• Joint and soft tissue sensitivity (when relevant)
• Strength and, more importantly, endurance of neck and upper back muscles
• Postural tolerance (how quickly symptoms build in sustained positions)

3) Clear plan with measurable targets

You should walk out knowing:

• What the working theory is (and what it isn’t)
• What your first 2–3 priorities are
• What you should do if symptoms flare
• How progress will be tracked (frequency, intensity, duration, function)

Common physio strategies for headache management

A physiotherapy plan should be built around self-management and capacity, not endless passive treatment.

Targeted exercise (the long-term lever)

This often includes:

• Deep neck flexor endurance training
• Upper back and shoulder girdle endurance work
• Gradual exposure to the postures that trigger you (done intelligently)

If your headache is driven by posture load, your goal isn’t perfect posture. Your goal is the ability to tolerate real life without your neck fatiguing and “sending pain upstairs.”

Manual therapy (useful for some people, not the whole plan)

Manual techniques may be used to reduce pain sensitivity and improve movement in the short term, especially in cervicogenic patterns. But it should support the exercise plan, not replace it. (Springer Link)

Education that reduces flare-ups

This includes:

• Micro-break structure (short and frequent beats long and rare)
• Sleep and hydration habits that matter
• Trigger stacking (why small issues combine into one big headache day)
• Safe pacing so you don’t swing between “push hard” and “crash”

Ergonomics that are practical

You don’t need a perfect workstation. You need fewer aggravators:

• Screen roughly at eye level
• Chair and desk setup that reduces shrugging and forward head drift
• Keyboard/mouse positioned so you aren’t reaching
• Frequent posture changes

Simple steps you can try now

If you have no red flags and your headaches follow a tension/neck-load pattern:

• Hydrate early, not after symptoms start.
• Eat regularly, especially on busy workdays.
• Micro-break every 30–45 minutes (30–60 seconds is enough).
• Move your neck gently through comfortable range a few times per day.
• Use heat on neck/shoulders if tension is a big feature.
• If you’re using pain medication frequently, talk to a pharmacist or physician about safer strategies and whether medication-overuse may be relevant. (NICE)

FAQs (5)

1) Can physiotherapy treat migraines?

Physio doesn’t replace migraine-specific medical treatment. It may help with contributing factors like neck pain, posture load, and physical tension, and it may support pacing and function. Claims should stay realistic and evidence-informed. (chcpbc.org)

2) How do I know if my headache is coming from my neck?

Clues include headaches starting at the base of the skull, being triggered by neck posture/movement, and being paired with neck stiffness. A proper assessment matters because headache types can overlap.

3) What is a cervicogenic headache?

It’s head pain referred from structures in the neck. Manual therapy and exercise therapy have evidence supporting benefit for many people with this pattern, though outcomes vary. (Springer Link)

4) Can taking painkillers too often cause more headaches?

In some people, frequent use can contribute to medication-overuse headache. This is covered in NICE headache guidance because it changes the treatment approach. (NICE)

5) When should I go to urgent care for a headache?

If it’s sudden and severe, includes neurological symptoms, comes with fever/stiff neck, follows significant trauma, or is a rapidly worsening new pattern, seek urgent assessment. (NICE)
References (3) + Links
CHCPBC — Physical Therapists: Marketing and Advertising Standard (effective March 4, 2024)
https://chcpbc.org/wp-content/uploads/2024/08/RPT_MarketingAndAdvertising-2024-03-04.pdf

NICE — CG150: Headaches in over 12s: diagnosis and management
https://www.nice.org.uk/Guidance/CG150

Systematic Review & Meta-Analysis (2022): Manual and Exercise Therapy for Cervicogenic Headache
https://link.springer.com/content/pdf/10.1186/s12998-022-00459-9.pdf