Headaches & Migraines: Types, Causes, and What Actually Helps

Tension Headaches

Headaches affect almost half of the population. Fifteen to twenty percent of all headaches arise from problems in the neck and are classified as “tension headaches.” The most common catalyst for tension headache is limited movement of the joints in the upper cervical spine. In a correctly functioning neck, each joint moves freely and independently. Restrictions in the upper cervical spine may start a cycle of stiffness, pain, muscle tightness, and joint inflammation, irritating the nerves leading from the neck into the back of the head.

Tension headaches are most commonly one-sided but may be present on both sides. Pain often radiates from the base of the skull toward the top of the head and sometimes over the eyes, occasionally traveling into the arm. Episodes can last hours to days, with a continuous, often “deep” quality, and chronic neck tenderness and stiffness frequently accompany them.

Certain movements and postures can trigger or reproduce symptoms. The condition is more common after recent trauma — especially a motor vehicle accident or concussion — and often affects middle-aged adults, more commonly women. Poor posture is a frequent accompaniment.

As tension headaches result from a mechanical problem, medications are often ineffective. Chiropractic care and acupuncture are both effective treatment options.

Migraine Headaches

A migraine is an intense throbbing headache that may be accompanied by nausea, vomiting, and sensitivity to light or noise. Migraine headaches are caused by a combination of nerve irritation and enlargement of blood vessels in the brain. They often run in families — sufferers frequently inherit a sensitive nervous system from their parents — and patients who are overweight or have other vascular risk factors are more likely to experience them. Migraines are set off by “triggers,” with the headache occurring once the number of triggers reaches a critical threshold.

Known triggers include certain foods, neck tightness, stress, smoking, strong odors, bright or flickering lights, fluorescent lighting, too little or too much sleep, head trauma, weather changes, motion sickness, cold, lack of activity, overexertion, fatigue, eye strain, dehydration, hunger, fasting, and hormonal changes including menstruation and ovulation. Certain medications, including hormones and oral contraceptives, are also known triggers.

About 20–33% of people who get migraines experience warning symptoms known as an “aura” before the headache presents, developing slowly over 5 to 20 minutes and lasting up to an hour, sometimes with numbness or tingling in the arms or face.

Tell your provider right away if you experience confusion or decreased consciousness with a headache. Other signs to watch for: abrupt headaches that develop and peak very quickly, headaches following a head injury, light-headedness, dizziness, difficulty speaking, swallowing, or walking, fever, rash, or any “new” headache that differs significantly from your prior pattern.

What the Research Actually Shows

We think it’s worth being direct about this rather than making a vague claim: the research on spinal manipulation for headaches is real, but it’s also genuinely mixed, and there’s active academic debate about how to interpret it. We’d rather tell you that honestly than oversell it.

The best-designed single trial we’re aware of is a 2017 three-armed, placebo-controlled RCT (Chaibi et al., European Journal of Neurology) involving 104 migraineurs, all diagnosed by a neurologist — a notable strength, since most migraine studies rely on self-reported diagnosis. Participants receiving real chiropractic spinal manipulation, sham manipulation, and continued usual care were compared over 17 months. Both the real treatment and the sham treatment groups showed improvement, which is itself informative — manual contact and attention appear to carry real therapeutic value regardless of the specific technique, though the study also examined whether the “real” treatment provided benefit beyond that baseline effect.

Broader systematic reviews of the whole evidence base have reached less consistent conclusions. An older 2002 review (Astin & Ernst) found modest, inconsistent benefit across a small number of trials. A 2025 review reached notably more critical conclusions about the evidence for headache in general — but that review has itself been publicly disputed by other researchers over its methodology, in a debate that was still unfolding as of late 2025. We’re not going to pretend this is more settled than it is.

What we can say with more confidence: cervicogenic headache — headache specifically originating from the neck, distinct from migraine — tends to respond more predictably to manual therapy directed at the cervical spine, since the mechanism (joint restriction referring pain to the head) is more directly addressed by that treatment. Migraine is a more complex neurological condition, and while many patients do experience meaningful relief with chiropractic and acupuncture care, we evaluate each case individually rather than promising a specific outcome.

FAQ

How do I know if my headache is a tension headache, cervicogenic headache, or migraine? Tension headaches and cervicogenic headaches both relate to the neck and often respond to similar treatment, while migraine involves a distinct neurological mechanism with associated symptoms like nausea, light sensitivity, and sometimes visual aura. A thorough evaluation, including assessment of your neck’s mobility and a detailed symptom history, helps sort out which pattern — or combination — you’re dealing with.

Is chiropractic care effective for migraines? The evidence is genuinely mixed, and we’d rather be honest about that than oversell it. Some well-designed trials show benefit, including from the treatment context itself (manual contact and attention), and cervicogenic headache in particular tends to respond well to cervical treatment. Migraine is more variable. We evaluate your specific presentation rather than promising a guaranteed outcome.

Can acupuncture help with headaches? Yes, acupuncture is a treatment option we offer alongside chiropractic care, particularly for patients who haven’t responded fully to manual therapy alone or who prefer a combined approach.

When should I be concerned about a headache? Seek immediate evaluation for a sudden, severe headache unlike any you’ve had before, a headache following head trauma, confusion or decreased consciousness, difficulty speaking or walking, fever with a stiff neck, or vision changes. These can indicate something beyond a typical tension headache or migraine.

How long does treatment take to show results? This varies significantly by headache type and how long the pattern has been established. Cervicogenic and tension headaches driven by clear joint restriction often improve within several visits. Migraine, given its more complex mechanism, may take longer to assess whether a given approach is helping, and we’ll be honest with you about what we’re seeing as treatment progresses.

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