Headache: Exercise for Tension-Type and Neck-Related (Cervicogenic) Headache

40%Share of people worldwide living with a headache disorder (3.1 billion people, 2021)

50%How much more common tension-type headache is in women than in men

200Patients in the study showing the effect of exercise and manual therapy on neck-related headache

15 daysHeadache on this many days a month or more is considered chronic

What type of headache do you have?

Tension-typeA tight, pressing or squeezing pain on both sides of the head, like a band around it. It is usually mild to moderate and does not get worse with everyday activity. Stress, lack of sleep and staying in the same position for a long time can set it off.
Neck-relatedUsually on one side; it starts in the neck and spreads to the back of the head, and sometimes to the forehead and around the eye. Neck movements or staying in the same position for a long time can bring it on, and moving your neck may be restricted.
MigraineUsually one-sided, throbbing, moderate to severe pain; it may come with nausea and sensitivity to light and sound, and it gets worse with physical activity. Diagnosis and treatment are planned by a doctor.
Medication overuseTaking painkillers very often over a long period can make headaches persistent. In this case, the medicines need to be cut down with a doctor's guidance.

What can exercise and physiotherapy do?

In an Australian study of 200 people with neck-related headache, both manual therapy and specific exercises for the neck and shoulder blade muscles, given over 6 weeks, significantly reduced how often headaches came on and how severe they were; the effect was still there 12 months later.

In the treatment of headache, the World Health Organization stresses the importance of patient education and of lifestyle changes such as regular sleep, drinking enough fluids, avoiding alcohol and exercising regularly.

If you spend long hours at a screen, have a look at our desk work guide; if stress sets off your headaches, see the stress guide; and if your sleep is irregular, read the sleep guide.

Exercises at home

Six exercises for your neck and posture

These exercises help strengthen and relax the neck and shoulder muscles, especially in tension-type and neck-related headache. Move slowly and stay within a pain-free range; stop if you feel dizzy or get numbness spreading into your arms.

Chin tuck

Sit up straight and look straight ahead. Without tipping your head down, draw your chin straight back in a level line; feel the back of your neck lengthen. Hold for 5 seconds, then release. Repeat often throughout the day.

10 reps, 2–3 times a day

Isometric strengthening

Isometric neck strengthening

Place your palm on your forehead. Without moving your head, push gently into your hand while your hand pushes back. Repeat for the back and both sides of your head. Half your strength is enough.

5 seconds in each direction, 5 reps

Shoulder blade squeeze

Sit or stand up straight. Without lifting your shoulders, draw your shoulder blades back and down towards each other, hold for 5 seconds, then release. It makes a good break if you spend long hours at a desk.

10–15 reps, twice a day

Upper back (thoracic) extension

Sit on a chair with a low back and clasp your hands behind your neck. Lift your chest towards the ceiling and gently arch your upper back backwards. The movement should come from your upper back, not your neck.

5–10 reps

Side stretch

Neck side stretch

Hold the edge of the chair you are sitting on with one hand. Slowly bring your ear towards the opposite shoulder; you should feel a gentle stretch along the side of your neck. Do not lift your shoulder.

20–30 seconds, 2–3 times on each side

Neck rotation

Keep your shoulders still. Slowly turn your head to the right and hold for 2–3 seconds at the furthest comfortable point, then turn to the left in the same way.

10 reps in each direction

Video

Videos for neck-related headache

From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.

The one neck exercise everyone should do

How to do the most basic neck pain exercise correctly.

Six exercises for a stiff neck

A short programme to get a stiff neck moving again.

Videos belong to the Bob & Brad channel.

Frequently asked questions

Do I need an MRI or CT scan for my headache?

For typical tension-type or neck-related headache, it is usually not needed. Your doctor may ask for imaging if you have one of the warning signs below or if the character of your pain has changed.

How often can I take painkillers?

Taking them now and then is fine. However, taking painkillers on more than 10–15 days a month can lead to medication-overuse headache. If you need them this often, see your doctor.

Do neck exercises help with migraine?

The main treatment for migraine is planned by a doctor. Regular aerobic exercise, a regular sleep routine and managing stress can help reduce attacks; if your migraine also comes with neck pain, neck exercises may bring extra benefit.

Do my pillow and sleeping position matter?

A pillow that keeps your neck in line with your body can bring relief if your neck-related pain starts in the morning. Sleeping on your front can make the pain worse, because it keeps your neck turned for a long time.

When to seek help right away

In the following situations, a headache may be a sign of a serious problem. Go to an emergency department without delay or call 112:

A headache that comes on suddenly and is the worst you have ever had
Headache with fever, a stiff neck or a rash
Difficulty speaking, weakness, numbness, loss of vision or a change in consciousness
A headache that starts after a blow to the head or keeps getting worse
A headache that starts for the first time after the age of 50 or keeps getting worse; a history of cancer or treatment that suppresses the immune system
A headache that gets clearly worse when you cough, strain or bend over, or that wakes you in the morning with vomiting

Sources

World Health Organization. Migraine and other headache disorders. Fact sheet.
Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835-1843.
Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.