Head neck pain

Head and neck pain needs a classification system to determine just how bad it is.

It still astonishes me how often I have a new patient with a cervical spine problem of several decades duration who has never consulted a chiropractor. Fifty years ago I can understand; there weren't too many DCs around in those days.

But to have been suffering all those years, gulping down prodigious quantities of pills that are known to poison the kidneys, or just suffering in misery, makes absolutely no sense when science proves so conclusively what causes migraine, for example.

Here is a quote from the Kidney Foundation website.

"Generally when used as directed, over the counter analgesics are reasonably safe. On the other hand, long term or heavy use of drugs, especially those that contain a mixture of different painkilling medications in one capsule, have been associated with chronic kidney disease. Read the labels and beware should you see aspirin, acetaminophen and caffeine, for example, all in one pill."

Almost everyone will have head neck pain periodically.

Why? For many reasons, but not least that there are few of us who have not had a car accident, fallen down the stairs or taken a tumble from a horse or bicycle. Getting out of bed in the morning is dangerous but there's only one thing more dangerous; not arising from your slumbers.

Most people die in their beds.

This page was last updated by Dr Barrie Lewis on 9th May, 2021.

Head Neck pain

But seriously, just when is the right time to go to your doctor or chiropractor, (sorry, got that wrong: your chiropractor, or your doctor) with head neck pain? Yes, we really do know what causes headache.
HEADACHE CHIROPRACTIC is the subject of this page.

Preferably before your brain requires this sort of examination! Recognise the Dutch artist? Rembrandt van Rijn who lived about 400 years ago. This is what it might look like when a surgeon has to peel the meninges off the brain. But you won't let the headaches get that bad, will you? Look for a good chiro in your neck of the woods.

The worst pain in your life, the thunderclap headache, is not for your chiropractor, or for your doctor either, for that matter; go straight to the emergency rooms.

Neck pain treatment

"How bad is my head neck pain?" is a question you may have been asking yourself. "Am I being a baby with a low pain threshold, or do I actually have a problem?"And, "do I need neck pain treatment?"

A few thoughts. Just because you have a pain in the neck, or elsewhere, does not mean you must rush off to the chiropractor or your doctor. But then when should you go?

These are my golden tips. If you have

  • Really severe pain,
  • Neck pain which radiates down the arm
  • Stiff neck and headache
  • Neck pain and a fever
  • Headache and a fever
  • Pain which you know is not getting better

Now it's time to get help. After, mm, how many days? That's difficult to say; it's best to use your own intuition. But recognise that if you arrive at the chiropractor with a pain you have had for three months or more, the definition of chronic, then you will certainly need more than a few treatments.

What's more, research shows that if you've had neck pain for over six months then, no matter what treatment you have, it's with you for life. It can be managed, helped, reduced, relieved, but it won't ever go away completely.

For an acute problem that has only begun in the last few days or weeks, as a rule, after a short course of chiropractic neck pain treatment, one may expect the problem to go away completely. Better still, if you go through a few extra consultations of rehabilitation, there's a good chance that it won't return for a long time.

But if you have had head neck pain for months or years, it is more difficult for your chiropractor to give you an assurance that your symptoms will recede completely. Don't wait too long. But do not go too soon either unless it is really severe, or you have a pinched nerve that radiates down your arm.

Then you really shouldn't wait; arm pain probably will not go away on its own.

If you're handy you can make a home traction unit that is very effective against head neck pain particularly if it radiates to the arm; make it yourself for a fraction of the cost of a commercial unit.

One of the great things about the chiropractic adjustment is that it's rarely painful. Artfully done, even with severe neck pain, and you're terrifiied that he or she is going to hurt you, or make it worse, it's rare that the cervical adjustment is painful.

Just this week, a lady with very severe neck pain; just one adjustment, no pain from the treatment, and she's eighty percent better; it's not always like that, especially if there's also arm pain.

Make sure you tell as accurately as possible any old injuries and illnesses that you may have had. I certainly, and I presume others have too, missed that a patient has had breast cancer, for example. It's not common but every chiropractor will have had patients who have metastases from an old, and presumed quiescent, cancer. That's why a complete lifestyle change is so important after cancer. Never accept the we got it all statement; don't live in terror of cancer but do change what you eat, and don't eat. Changing to a healthy lifestyle is important for us but particularly for the cancer patient. Otherwise it just comes back, often years later.

Or a car accident that happened thirty years ago, and was presumed irrelevant. It's those old injuries that cause the chronically fixated joints that become arthritic.

In the interim, a good massage from your spouse may relieve your head neck pain, particularly for back of head headaches, use some alternating ice and heat, do a few simple exercises, and don't go playing silly twits! This is not the time for a game of rugby, or lifting pianos. Avoid carrying heavy groceries on the affected side.

A strong recommendation ...

Research indicates that if you have neck pain for six months, then YOU WILL PROBABLY HAVE IT FOR THE REST OF YOUR LIFE. Once you know it's not going to get better of its own accord, then do something -- or spend the rest of your life suffering from head neck pain.

Why is that? Frankly, we're not totally certain but what we do know is that the hyaline cartilage in the little bones in your neck is very sensitive to subluxations - it's now proven that the cartilage begins to degenerate within 13 hours (in white mice anyway).

Read more about the importance of hyaline cartilage in spinal function.

A simple classification system for head neck pain

  • Grade I head neck pain:

    No signs or symptoms suggestive of major structural pathology (ie no severe pain, no radiation, no recent trauma) and no interference with activities of daily living. This will likely respond to those simple things suggested above; it does not usually require intensive investigations or ongoing treatment.

  • Grade II cervical neck pain:
  • No severe pain or radiation, but now begins to interference with activities of daily living. You wake in the night with pain. You can't turn your head, and driving the car is thus dangerous. After a week or ten days, you have to acknowledge that it's not really improving. Then we suggest it's time to make an appointment with your chiropractor (or even your doctor first, if that is your first choice). A good examination is in order, and perhaps some early intervention aimed at preventing long-term disability.

  • Grade III cervical neck pain:
  • with the onset of neurological symptoms. Headache, radiation pain or tingling down the arm, or into the midback. Now it's definitely time to get help, particularly if it has lasted for more than a few days.

  • Grade IV cervical neck pain:
  • Still no signs or symptoms of major structural pathology, but presence of neurologic signs such as decreased deep tendon reflexes, weakness, and/or sensory deficits. In my opinion it is now definitely time for x-rays, perhaps even a scan. The pain of a pinched nerve in neck is often severe, the ache in your arm something you cannot escape, no matter how you change your position. It's often worst at night. This head neck pain should no longer be ignored.

  • Grade V neck pain: Signs or symptoms of major structural pathology, such as fracture, myelopathy, neoplasm, or systemic disease; requires prompt investigation and treatment, and probably a consultation with a specialist. Certainly if the condition is not responding within a few weeks to conservative treatment.

Slipped disc in neck

Undoubtedly one of the most difficult conditions at the Chiropractic Coalface is a severe neck pain radiating down the arm, especially if there is wasting of the muscles.

A slipped disc causing arm pain is a challenge for all practitioners.

The classic sign is RELIEF of arm pain when raising the limb above the head. Slipped disc in neck casefile...

Thoracic Outlet Syndrome

The thoracic outlet syndrome is another cause of head neck pain, often with radiation down the upper limb; it can coexist with arthritis in the neck making the definitive diagnosis difficult.

Do you have vague tingling and pain in your arm?

The thoracic outlet showing the passage of the brachial plexus and the great vessels through the interscalene triangle.

Another cause of pain running down the upper extremity is a subluxated first rib deep in the neck; that may result in scalene muscle spasm, pinching the artery and nerves. The classic clinical sign is increased ache and tingling in the arm and hand when raised above your head.

However, if you have a rotator cuff or frozen shoulder injury, obviously this is excepted; raising your arm will naturally increase the pain in your arm.

If it's the rib on the left side, then it may mimic a heart condition, with pain in the neck which radiates down that arm.

What I always remind my patients is that before you get really ill, it all starts with a dripping nose. Neglect it and you will get bronchitis, then pleurisy and finally a good dose of pneumonia; now it's life threatening. An ounce of prevention when you are at the cold and flu stages makes good sense.

It's frightening how quickly a grade one head or neck pain condition can progress when neglected. A sure indication that it is getting worse is increasing tingling, numbness or ache in the arm, and particularly if raising the limb above your head relieves the symptoms; that's called the shoulder abduction relief sign.

Avoid the gym at this time; it might help but the risk of making the condition worse is relatively high. Don't carry heavy parcels in the outstretched arm.

Here's an aside for your interest. You are a patient. Is there anything important that you would like your chiropractor to know?

Patients and their doctors often don't click. It may be that he isn't listening to you. Is he always running late? He or she may technically be the best in town, but if he doesn't explain things, or there are other factors that irritate you, then it's best to speak frankly. Let us hear your opinion about these six golden rules for chiropractors.

Sleeping on your tum

Tum sleepers will suffer from head and neck pain.

Sleeping on your tum is a recipe for chronic head neck pain; get that left shoulder and arm under and in front of you. Worse, tum sleeping deprives the joints in the neck of normal nutrition; it's one of the causes of arthritis in the spine. If you've also had a neck injury, then you're almost certain to get degenerative joint disease in the spine.

It has a dreadful effect on the atlanto axial joint anatomy.

Adson's test

Adson's test of the pulse in the wrist is the definitive test for a thoracic outlet syndrome.

A Mr S. consulted me about six weeks ago with head neck pain that turned out to be a Thoracic Outlet Syndrome. It started a year earlier whilst on holiday in Italy, perhaps after playing tennis which he hadn't done for some years. In the left arm, possibly from throwing the ball up to serve. This action requires use of the neck muscles, raising the arm, collar bone and first rib.

Severe pain in the chest, neck and left arm began in the middle of the night and, assuming the worst, they rushed off to the nearest hospital. A nightmare - they were on holiday in Florence.

Extensive heart tests, both that night, and after he returned to Holland revealed nothing amiss with his heart. Unfortunately, nobody considered a musculo-skeletal cause of the pain, or whether Adsons Test, the classic orthopaedic test for TOS could be positive.

The pinched nerve in neck pain continued to plague him on and off, particularly with tingling in the arm at night, which would waken him. Twice more his wife rushed him off to the hospital in the middle of the night. A stent was mooted even though nothing specifically wrong with his heart could be found.

Why chest pain? The ribs attach posteriorally to the spine, but in the front they articulate with the breast bone. A dysfunctional rib may also cause pain in the front of the chest. Nevertheless obviously it is important to rule out at heart attack first. Do you know the classic signs of a HEART ATTACK ...

Chiropractic Help

This website, Chiropractic Help, is to give you better understanding of your head neck pain. When is it urgent that you should immediately consult a medical doctor and not a chiropractor?

For more interesting cases from the Chiropractic Coalface, follow the link below. Yesterday, for example, after only five treatments a patient was bemoaning the fact that he had suffered from this condition for over a year, yet chiropractic had fixed it so quickly. In fact, after the first treatment it was already 80% better. Miracles we do at once, the impossible takes a little longer! "Don't tell me. Tell you doctor! And your neighbour too!"

Some understanding of the anatomy of the cervical spine - the atlanto axial joint anatomy, at the top of your neck - may be of interest to you. If not, skip the link:


Astonishingly, TEN YEARS AFTER a whiplash injury, only 12% of the victims have absolutely no symptoms. For the remaining 88% ... research by a group of orthopaedic surgeons states that a majority are suffering from a cervical facet syndrome. That would confirm my experience as a chiropractor ... worse, unless carefully managed, leads inexorably to arthritis of the neck.

Neglected, the lower neck syndromes almost inevitably lead to NECK ARM PAIN ... tingling in the fingers, carpal tunnel syndrome, frozen shoulder, and the like. 

Spurling's test and the upper limb tension test are used to evaluate the patient with radiating nerve pain in the arm; both can be done at home, though the interpretation of the results is not straight forward.


What causes headache?

I'm sure it's becoming increasingly clear that what causes headache is neither simple, nor straight forward. There's a whole spectrum of seriousness from you'll be dead in five minutes, to see your chiropractor sometime in the next day or two. Chiropractic Help is dedicated to helping you make these important decisions.

This causes of headache casefile illustrates the point.

Rebound headache

If you are taking more than half a dozen analgesics per week then it is definitely time to consider chiropractic treatment. Remember that rebound headache is CAUSED by over-dosing with painkillers. It's also listed amongst what causes headache.

The pills you are taking may actually be CAUSING your headaches! Probably 10-20% of my day is taken up with patients suffering from headaches.


Some 80% of headaches are reckoned to be 'tension headache'. This is not from stress / tension, but tension of the meninges surrounding the neck and brain.

  • The most usual cause is the Cervical Facet Syndrome in the upper neck. (link above) You may be interested in some of the anatomy of this area. This is a page that describes it succinctly, and simply. It's interesting, and if you are a headache sufferer, you will be especially intrigued. Read more about the Atlanto Occipital Joint ...

  • Tension in the neck muscles , for example after long periods of studying with the neck flexed is another common cause of headaches and neck pain.
  • Another rare cause is meningitis. High temperature, stiff neck and a headache. Straight to hospital. Fortunately, brain tumours are a very rare cause of headache.

Getting them off the medication, or at least greatly reducing them is usually not a problem. What is particularly destructive is dual anti-inflammatory drugs; take two different painkillers in the same week.

Migraine headache

In the practice one often finds that migraine headache has been misdiagnosed: Any severe headache is often called a migraine. Not so. What makes true migraine headache difficult is that there are a number of causes. Food allergies, a problematic tooth or jaw joint, an eye problem, a neck condition.

Friday fun headache is a true story in lighter vein; you'll enjoy it.

Whiplash chiropractic

Whiplash chiropractic is pooh poohed in many medical and insurance circles, but after nearly thirty years in practice, I have come to the conclusion that not many people escape completely unscathed from a car accident. I am personally one of the lucky ones. I was hit from the side, which is often the worst, because of damage to the uncovertebral joints of Luschka, some twenty years ago, and I have absolutely no problems. Perhaps because I was treated promptly by a colleague, and so didn't develop the dreaded immobilisation arthritis.

I treat many, many people with neck pain and headaches. On questioning, we realise that most can trace the condition back to a whiplash that apparently, mysteriously, caused no injury. But down the road you realise otherwise.

Ligaments are highly innervated, so that the brain will know where the neck is in space whilst the eyes are closed. Any excessive stretching of ligaments, as in whiplash, will cause nociceptors in these structures to fire off, giving pain.

If the ligaments are stretched beyond their elastic limits then important changes in the posture of the neck, and the position of the bones will occur, causing further neck pain.

In the normal neck, the curve is known as a lordosis. After a whiplash, it is reversed, producing a kyphosis.

My take on cervical anatomy is that kyphosis equals pain. I have yet to find a patient with a reversal of the curve who did not have significant problems in the neck.

It remains pure mystery how a whiplash that caused no obvious injury could years later prove to be the source of your stiff neck and headache.

That was until research proved that immobilisation arthritis was the spoke in the wheel. When a joint isn't moving normally, the hyaline cartilage is starved of normal nutrition and oxygen, waste products build up, and slowly, slowly, undetected, arthritis.

It's now been proved beyond all doubt: FIXATIONS CAUSE ARTHRITIS.

It's a vast subject, but here are some other ideas on neck pain and headache.


Chiropractic periodically gets bad press when a patient has a stroke after treatment. A case 3-4 years ago occured 17 days after the treatment! Another that gained wide negative publicity, on investigation, proved that the chiropractor treated only the patient's foot! But the newspaper headline: CHIROPRACTOR STROKES PATIENT had already done its damaged.

People have strokes, and just because they consulted a chiropractor in the last month, that does not mean that was the cause. In fact, research proves that people who had strokes were equally likely to have consulted their medical doctor in the last weeks as their chiropractor. The stroke was developing and had nothing to do with what the medical doctor, or chiropractor, were doing.

The chiropractic adjustment is probably the safest medical procedure in the treatment of head neck pain. There are one in two million manipulations serious mishaps after neck adjustments. We as a profession are not in denial; and we do our best to identify those at higher risk. Statistically you are more likely to be struck by lightning on the golfcourse than have a stroke after a chiropractic adjustment. Read what the latest research on stroke proves.

Popular story teller, chiropractor Bernard Preston, daily confronted with patients suffering from head neck pain, tells of his brush with STROKE ...

Popular story teller, chiropractor Bernard Preston, daily confronted with patients suffering from head neck pain, tells of his brush with stroke.

Bats in my Belfry by Dr Bernard Preston telling how chiropractors manage head and neck pain.


The jaw joint is a major cause of head neck pain and facial pain. It's a very complex joint, so this next very interesting, but perhaps difficult page will certainly give you some insights, if you think you may have this problem. Clicking sounds in the jaw and pain just in front of the ear and the muscles around the jaw are the cardinal signs. For more info about the TMJ, follow the link.

Meantime you might be interested in these little exercises if you suspect your head neck pain is coming from your jaw, or if you are experiencing jaw joint pain. The TMJ is a common cause of head neck pain and especially one sided headache just ABOVE the ear. Where you'll find the Temporalis muscle, a great big jaw muscle. Sorry, but you will have to learn some TMJ anatomy. And much more about what causes headache.

Shoulder pain

HEAD NECK PAIN and the Rotator Cuff are intimately connected, not only because they share muscles and bones, but because the nerves that innervate the shoulder come from the neck. For more about shoulder pain, click here: ROTATOR CUFF ...

We could add tennis elbow exercises, and the carpal tunnel for completion.

Why do we hiccup?

Hiccuping is a complex subject, but at the heart of the problem is a large muscle called the Diaphragm. It separates the chest cavity from the abdomen. The Diaphragm is ennervated by the Phrenic muscle that comes from the neck, C3-4-5 nerve roots. It's a common complaint in infants, the hic often responds readily when treated with Colic Chiropractic. COLIC CHIROPRACTIC ...


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