Conditions · Carrollwood · Tampa Bay
Headaches in Tampa
Headache is one word for several different problems. The type you have decides what care makes sense, and the type is something an examination can work out.
Most headaches are not dangerous. They are still worth taking seriously. The common types behave differently and respond to different things, and they are easy to mislabel from the inside. This page walks through each type and what it tends to feel like. Then it covers where chiropractic care fits.
Headache Overview
The common types of headaches
Tension headache
A tension headache usually feels like pressure or a tight band on both sides of the head. It builds gradually and stays steady rather than throbbing, and it often arrives late in a long day. Screens and stress feed it. The muscles of the neck, scalp, and shoulders are frequently involved. Trigger points in those muscles can refer pain into the head in patterns that feel like the headache itself, which is why the examination includes the neck. It is the most common headache type, and among the ones we see most here.
Cervicogenic headache
A cervicogenic headache starts in the neck and is felt in the head. It is usually one-sided, and it often begins at the base of the skull and wraps forward. Turning the neck often makes it worse. So does holding one position, which is why people who work at a screen all day know this one well. Because the source is the neck, the examination is a neck examination. Our neck pain page covers that ground in detail.
Migraine
Migraine behaves differently. It tends to throb, often on one side, and it brings company: sensitivity to light or sound, nausea, sometimes a visual aura before the pain starts. Migraine is a medical diagnosis, and if that pattern sounds like yours and no one has evaluated it, your physician should do that first. What we can address is the neck involvement that often travels with migraine. Many people with migraine also have neck pain and trigger points, and the exam sorts out which part of the picture is which.
Headache after a car accident
Headaches that begin after a crash are common, and they do not always start the same day, with some taking a week to appear. A headache that shows up three days or a week after a rear-end collision often traces to the neck: the joints and muscles that got loaded when your head snapped forward and back. If your accident was recent, Florida's PIP law requires that initial care begin within 14 days of the crash for your no-fault (PIP) medical benefits to apply, so the timing matters for reasons beyond the headache itself. Our car accident page explains what a first visit involves.
Occipital neuralgia
Occipital neuralgia is a sharp, shooting, electric kind of pain in the back of the head, along the path of the occipital nerves, and it can be startling. It is frequently confused with other headache types, and the examination findings that point toward it are distinctive. It is less common than the types above, and worth naming because people who have it often spend a long time not knowing what it is called.
What the location tells you, and what it doesn't
People describe headaches by where they sit. A headache at the base of the skull, a headache in the back of the head, a headache behind the eyes. Location is a useful clue, but it is not a diagnosis. Pain at the base of the skull often points toward the neck or the suboccipital muscles, the small muscles just under the skull. Pain behind the eyes is less specific. Tension patterns produce it, and so do migraine and sinus problems. The same spot can belong to different types.
So we examine, because where it hurts is only one piece of evidence. What brings it on and how it behaves are two more. The neck examination fills in the rest.
Where chiropractic care fits
The headache types with a neck and muscle component are the ones chiropractic care can address: tension-type headaches, cervicogenic headaches, headaches after a crash, and the trigger-point referral patterns that imitate all of them. The examination looks at how the joints of your neck move and which muscles are tender in ways that reproduce your headache. Your daily positions count too.
Care is matched to what the exam finds. That can include adjustment of neck joints that are not moving well, hands-on work of the involved muscles, and dry needling to treat trigger points or myofascial pain (pain coming from tight bands in muscle) when the exam points there. We have a separate page on dry needling for headaches that goes deeper on that option.
If your headaches started after a car accident: that is its own visit, the Auto Accident Injury Visit, billed to your auto insurance under Florida PIP. Florida’s PIP law requires that your care begin within 14 days of the crash, and headaches after a collision often start days later, so do not wait for them to settle before booking.
Care addresses what the examination finds. What we can tell you before you book is what the visit involves and what it costs, on our pricing page.
What the Research Shows
Headache care here rests on published research, cited in full so you can check it yourself.
On chiropractic care. Headaches that start in the neck are called cervicogenic headaches. A 2020 meta-analysis of seven clinical trials found that spinal manipulation, the treatment at the core of chiropractic care, reduced headache pain, frequency, and related disability in the weeks after care.1 Long-term benefit has not yet been shown, and the researchers called for larger studies. We tell you that up front rather than let a headline version of the finding oversell it.
On acupuncture. A Cochrane review of 22 studies with nearly 5,000 people found that acupuncture reduced how often migraines occurred, with fewer side effects than preventive medication.2 Acupuncture did better than placebo needling in that review. The reviewers called the added benefit small, and concluded it is a reasonable option for people who want to try it. Migraine itself is a medical diagnosis, and its management belongs with your physician; acupuncture is a prevention option alongside that care rather than a replacement for it. For frequent tension-type headaches, a second Cochrane review concluded acupuncture is effective: about five in ten people cut their headache frequency in half, compared with about four in ten after placebo needling.2 Dr. Koser is certified in acupuncture by the Florida Board of Chiropractic Medicine.
On dry needling. A 2021 meta-analysis in the journal Physical Therapy found that dry needling improved headache-related disability in tension-type and neck-related headaches, with pain relief similar to the other treatments studied.3 The same analysis found no significant effect for migraine, so we do not offer needling as a migraine treatment. Our dry needling for headaches page goes deeper.
1. Fernandez M, Moore C, Tan J, et al. Spinal manipulation for the management of cervicogenic headache: a systematic review and meta-analysis. Eur J Pain. 2020;24(9):1687–1702. PubMed
2. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016;2016(6):CD001218. PubMed
3. Pourahmadi M, Dommerholt J, Fernández-de-las-Peñas C, et al. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis. Phys Ther. 2021;101(5):pzab068. PubMed
How we sort the headaches we treat from the ones a physician should see
Some headache patterns need emergency care rather than an appointment: a sudden severe headache unlike any you have had, a headache that begins or keeps getting worse after a blow to the head, a headache with fever and a stiff neck, or new changes in vision, speech, strength, or balance. Call 911 or go to the nearest emergency department.
A pattern you have never had evaluated belongs with your physician first. If you have migraine features or cluster headache, your physician should be the one managing that diagnosis. Most headaches are not in that category, and the list above is short on purpose. It is the same thing we would tell a family member: get the right problem in front of the right person first, and if the exam here finds something that needs a different workup, we refer you out and explain why.
If you are not sure whether what you are having is an emergency, treat it as one. Otherwise, book the exam and we’ll sort it in the room.
Common questions about headaches
Can a chiropractor help with headaches?
It depends on the type, and the answer starts with an examination. Headaches with a neck or muscle component, including tension-type and cervicogenic headaches, are conditions a chiropractic physician examines and treats: joint movement in the neck, plus the trigger points that refer pain into the head and the positions that keep provoking them. Migraine and cluster headache are medical diagnoses that belong with your physician, and we say so when the exam points that way.
How do I know what type of headache I have?
The type is worked out from the pattern and the examination, not from the pain alone. Where the headache sits, how it behaves, what triggers it, and what the neck examination reproduces each narrow the answer. Two headaches in the same spot can have different sources. An examination that includes the neck is how a tension headache gets told apart from a cervicogenic headache or a trigger-point referral pattern, because each is treated differently.
Why do I get headaches at the base of my skull?
Pain at the base of the skull often involves the upper joints of the neck and the small suboccipital muscles that sit just under the skull. Long hours looking at a screen load that exact area. Trigger points there can refer pain up over the head and behind the eyes. An examination can test whether those structures reproduce your headache, which is the useful clue about whether the neck is the source.
Can a car accident cause headaches weeks later?
They can start later than people expect. Headaches after a crash often begin days after the collision rather than at the scene, once the initial soreness settles. Onset weeks out is less common, and an examination is how to sort out whether the neck is the source. The joints and muscles loaded during a rear-end collision are common sources. If your accident was within the last two weeks, Florida's PIP law requires that initial care begin within 14 days of the crash to preserve your no-fault benefits, so it is worth being examined even if the headache seems like a small thing.
When should I worry about a headache?
See a physician promptly for a sudden severe headache unlike any before, a headache that begins or keeps getting worse after a blow to the head, a headache with fever and a stiff neck, or new changes in vision, speech, strength, or balance. Those patterns need medical evaluation first. Most headaches are not in that category. For the common types, an examination is how you find out what is producing yours, and if what we find belongs with a physician, we tell you and refer you.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether a finding explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs described on this page.
Find out what kind of headache you have.
A complete examination and your findings explained the same day. Then a plan built on what we find.