Headaches

If your headache always starts at the base of the skull, after screens, or with jaw clenching, the neck is a suspect. Pure Wellness treats those mechanical headaches with cervical work, muscle care, and acupuncture when stress physiology is part of it.

Dr. Johnson’s Wilmington patients often mention headache relief in reviews. That is not a promise. It is a pattern we know how to exam.

Sudden worst-of-your-life headache, neurological deficit, or headache after trauma needs urgent medical care first.

The anatomical basis for neck-driven headache is well established and worth explaining, because it makes the treatment make sense. Sensory nerves from the top three cervical segments converge with the trigeminal nerve — which supplies sensation to the face and head — in a shared region of the brainstem called the trigeminocervical nucleus. Because those inputs share a relay, the brain cannot always tell whether a signal originated in the upper neck or in the head, and pain from an irritated upper cervical joint or from the suboccipital muscles is genuinely perceived as head pain.

That explains the geography patients describe so consistently: pain starting under the base of the skull, wrapping over one side toward the temple, and settling behind the eye. It explains why it is provoked by long periods of sustained neck posture — a laptop, a commute down I-95, a phone held low — and why it eases when the neck moves freely. It also explains the referral pattern from the jaw muscles, which is why the TMJ page and this one overlap so much.

Tension-type headache has a different quality. It is usually both-sided, described as a band or pressure rather than a throb, mild to moderate rather than disabling, and it does not worsen with routine activity. The associated finding on examination is tenderness in the pericranial muscles — the temporalis, the masseter, the suboccipitals, and the upper trapezius. In practice, tension-type and cervicogenic headaches frequently coexist in the same person and respond to overlapping treatment.

The examination is specific rather than general. Cervical range of motion with particular attention to rotation in flexion, which isolates the C1-C2 segment where a large share of cervicogenic headache originates. Palpation of the upper cervical joints looking for reproduction of the patient's familiar headache — reproduction is the finding that matters, not just tenderness. Assessment of the suboccipital, upper trapezius, levator scapulae, and jaw muscles. Deep neck flexor endurance testing. And a screen for red flags before any of it.

Treatment combines manual therapy to the restricted upper cervical segments, soft-tissue release through the suboccipital and jaw muscles, and thoracic work where a stiff mid-back is forcing the neck to compensate. Acupuncture is a genuine option where stress and autonomic load are part of the picture, and it has reasonable evidence in tension-type headache specifically. Alongside that, deep neck flexor training, because endurance in those muscles is consistently reduced in headache patients and improving it changes recurrence rates.

A headache diary is the least glamorous and most useful thing we ask for. Frequency, duration, side, what preceded it, sleep the night before, caffeine, and medication taken. Four weeks of that usually reveals patterns nobody had noticed, and it is the only reliable way to tell whether treatment is actually reducing attack frequency or whether a good fortnight was coincidence.