Headaches: Types, Assessment and Warning Signs

This page does not tell you what chiropractic care will do for your headaches. That varies from person to person, and no outcome is promised. What it does set out is which types of headache are recognised, what an assessment involves, and what the options are once that assessment is done. One of those options is always that someone else is the right person to see.

How headaches are grouped

Headache is a symptom, not a single condition. Clinicians sort headaches into two groups.

A primary headache is the condition in its own right. Nothing else is causing it. Tension-type headache, migraine and cluster headache sit in this group.

A secondary headache is caused by something else: an infection, dehydration, a head or neck injury, raised blood pressure, a sinus problem, or a disorder of the neck. The headache is a signal from that cause, so the cause is what a clinician looks for.

The common types

Tension-type headache is the most common. It is usually described as a dull, pressing band across the forehead or around the head, on both sides, of mild to moderate intensity, and it is not usually made worse by routine activity such as walking upstairs.

Migraine is a neurological condition. Episodes are often one-sided and throbbing, can last hours to days, and commonly come with nausea or with sensitivity to light and sound. Some people get warning symptoms beforehand, known as aura, such as flickering lights or blind spots. Migraine is diagnosed by a doctor, and your GP is the right first point of contact for it.

Cluster headache is uncommon. It causes severe pain around or behind one eye in bouts, often with a watering eye, a blocked nostril or a drooping eyelid on the same side. It needs medical assessment.

Cervicogenic headache is the term used when a headache is attributed to a disorder in the neck. It is classified as a secondary headache, is typically one-sided, often starts at the base of the skull, and is associated with restricted neck movement.

Naming these types is general information. It is not a diagnosis of your headache, and it is not a statement that a chiropractor can change any of them.

Not every headache is musculoskeletal

Musculoskeletal means the muscles, joints, ligaments and discs, and how they are loaded and moved. Some headaches have a musculoskeletal element and many do not. Migraine and cluster headache are neurological. Headaches from infection, blood pressure or sinus problems are medical. A headache after a blow to the head needs medical assessment on its own account.

If a headache is not coming from the musculoskeletal system, we will say so and tell you who to see.

Warning signs that need urgent medical care

Go to an emergency department, or call 000, if you have any of the following.

A headache that comes on suddenly and severely, reaching its worst within seconds or a few minutes.
A headache after a blow to the head, a fall or an accident.
A headache with a fever, a stiff neck or a rash.
A headache with new neurological changes, such as weakness or numbness anywhere in the body, a change to your vision, difficulty speaking, or confusion.
A headache with a seizure or any loss of consciousness.

See your GP promptly, rather than waiting, if: the headache is a new kind of headache for you; the pattern or the intensity has changed; it wakes you from sleep; it is worse when you cough, strain or lie down; it started after the age of 50; you are pregnant or recently gave birth; you have a weakened immune system or a history of cancer; or the headaches keep coming back and you have never had them looked at.

If you are unsure, let that be the reason you ring your GP, or Healthdirect on 1800 022 222, and ask.

What an assessment involves

A first appointment is an assessment, and most of it is conversation. The chiropractor asks where in your head you feel it, whether it is one-sided, what it feels like, how long an episode lasts and how often episodes happen. You are asked about past head or neck injury, your sleep, your working day, how much of it is at a screen, and any other symptoms. You are asked directly about the warning signs above, because those change what should happen next before anything else does.

If the history does not point to a medical cause, the examination looks at the neck and upper back:

How far your neck moves in each direction, and where movement is restricted or uncomfortable.
The tone and tenderness of the muscles at the base of the skull, along the neck, across the shoulders and around the jaw.
How the joints of the upper neck and upper back move when examined individually.
How you hold your head, neck and shoulders standing, and again sitting as you would at a desk.
Where it is relevant, strength, sensation and reflexes in the arms.

These findings describe how your neck moves and loads on the day you are examined. They are not a diagnosis of your headache, and a normal neck examination does not rule a medical cause in or out.

What happens after the assessment

You are told what was found, in plain language, and what the options are. Those options may include musculoskeletal care, lower-force techniques, advice about movement and your desk set-up, doing nothing for now and watching how things go, or referral to your GP or another practitioner. Doing nothing for now is a real option and it gets offered.

You can decline any technique, at any time, and you can ask for a lower-force approach instead. You should be told what a technique involves before it is used, and you can stop and ask questions at any point. Nothing happens without your consent.

More detail on what a visit is like is on our first appointment page, and on the techniques our team uses on our chiropractic care page.

Neck load, desks and screens

The neck carries the weight of the head all day, and holding one position for hours keeps the same muscles working without a break. Long stretches at a desk, or looking down at a phone, are the common versions of this on the Lower North Shore, where a lot of work is office work.

General workstation advice is the same for everybody: put the top of the screen at about eye level, keep the keyboard close enough that your elbows stay by your sides, use a chair that lets your feet reach the floor, and change position every 30 to 45 minutes. This is general information about how the neck is loaded. It is not a statement about what is causing your headaches.

Our pages on posture, neck pain and chiropractic and office work cover this in more detail.

Where to find us

ReFigure Chiropractic Health Centre is at 18A Spit Road, Mosman NSW 2088, entrance via Brady Street. Call (02) 8937 2740 or email info@refigurechiro.com. You can find our clinic on Google for location, hours and contact details, and our team page tells you who you would be seeing.

Want a musculoskeletal assessment?

Tell us what you are experiencing and we will take a history and examine how your neck and upper back move. You will be told what was found and what the options are, including referral if that is the right next step.

Book your appointment Call (02) 8937 2740

Frequently asked questions

What are the common types of headache?

Headaches are grouped into primary and secondary. A primary headache is the condition itself, and the common ones are tension-type headache, migraine and cluster headache. A secondary headache is caused by something else, such as an infection, a head or neck injury, or a disorder of the neck, which is called cervicogenic headache. Naming a type is general information, not a diagnosis. Only a clinician who has assessed you can say which type you have. Naming a type is not a statement that a chiropractor can change it.

When is a headache an emergency?

Go to an emergency department or call 000 if a headache comes on suddenly and severely, if it follows a blow to the head, if it comes with a fever or a stiff neck, or if it comes with new weakness, numbness, confusion, or a change to your vision or speech. See your GP promptly if a headache is new for you, if the pattern has changed, if it wakes you at night, or if it keeps coming back.

Do I need a referral to see a chiropractor?

No. You can book an appointment directly at our Mosman clinic. We are happy to work alongside your GP. If your history or your examination points to a medical cause, we will tell you and we will ask you to see a doctor.

What happens at a first appointment if I get headaches?

The first appointment is an assessment. The chiropractor takes a history, including where in your head you feel it, how often it happens, how long it lasts, any past head or neck injury, and what your working day and your sleep look like. The examination then looks at how the neck moves, at the muscles around the base of the skull, neck and shoulders, and at how you hold your head. What is found decides the next step, which may be musculoskeletal care, movement and desk advice, doing nothing for now, or referral to your GP or another practitioner. You can decline any technique. None of these options is a statement that care will change your headaches.

Related pages & areas we serve

We welcome patients from across the Lower North Shore, including Mosman, Neutral Bay, Cremorne, Cammeray and Spit Junction. Have a question first? Get in touch.

Please note: this page is general information, not a diagnosis and not personal health advice. It does not describe what chiropractic care will do for any condition. If you are worried about a headache, contact your GP, and in an emergency call 000.

Headaches: what they are and what assessment involves