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The Diagnosis and Treatment of Neck Pain and Headaches

An old study performed by Fejer (2006) showed that approximately 50% of people in the U.S. will experience neck pain in their life, but according to Greene (2023), this number has been shown to be increasing. The cause of neck pain can be put into one of four classifications, with the most common (80% of cases) being a ‘derangement.’ This classification is defined as having a clinical presentation where the person will report a reduction of symptoms when moving their neck in a particular direction ("directional preference") and with a particular amount of force ("loading strategy"). Symptoms can be constant or can come and go; they can be in a very specific location or travel into the head, arm, or shoulder blade; and they often have a common feature called centralization, where the symptoms go away in the head, arm, or shoulder blade and begin to only be in the neck area. (McKenzie, 2020)

Just as pain that travels from the neck into the arm or shoulder blade originate as a neck problem, McKenzie (2020) suggests that headaches (and dizziness) can be as well. In fact, centralization, the phenomenon of pain progressively moving from the arm or shoulder blade toward the spine with directional preference treatment, has been shown to occur with headaches. The most “distal” type of headache would be described in the front of the head, followed by the side or top, and then followed by the back of the head.

Upon centralization, the headache would become absent and the patient would be left with either localized neck pain or no neck pain at all. Headaches that respond to "directional preference" testing are classified as “benign headaches,” which can then be categorized into primary headaches (headaches which then cause cervical pain) or secondary headaches (headaches that come on secondary to neck pain). (McKenzie, 2020)

While the percentage of true benign headaches is low when compared to migraine and tension-type headaches, they do exist. At John Lathrop Physical Therapy PLLC, we use mechanical diagnosis and directional preference testing where progressive force procedures and the frequent reassessment of patient symptoms are always performed to assure safety and effectiveness of treatment. (Cote, 2019)


Fejer R, Kyrik KO, & Harvtingsen J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 15:834-848.

Greene, D. (2023, Feb). The Cervical and Thoracic Spine [in-person seminar]. McKenzie Institute. Harrison, NY.

McKenzie, R. (2020). Part B, The Cervical and Thoracic Spine. McKenzie Institute USA. MGHL.

Cote, P, Yu, H, & Shearer, H. (2019). Non-pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 23;(6):1051-1070.

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