Understanding Headaches: Causes We Commonly Treat

Headaches can come from many places — the neck, posture, training load, or a recent knock to the head. Here are four types our sports and exercise physicians commonly see and treat.

A Closer Look

Cervicogenic headaches are often misdiagnosed as migraines or tension headaches, which can lead to treatment that doesn't address the real source. Because the pain is referred from the neck, it typically responds well to treatment aimed at the cervical spine itself — manual therapy, targeted exercise, and posture correction — rather than standard headache medication alone. Neck injury, whiplash, cervical arthritis, and prolonged forward-head posture from desk work or screen use are common underlying triggers. A useful clue is that the pain often changes with neck position or pressure on the upper neck, something migraines and tension headaches don't typically do.

Tension-type headaches are usually manageable with simple measures: stretching and strengthening through the neck and upper back, addressing training load spikes, improving workstation setup, and managing stress and sleep. Jaw clenching and grinding can also contribute, so it's worth mentioning to your practitioner if you notice jaw tightness alongside the headache. They're rarely dangerous, but frequent or persistent episodes are worth assessing properly, since they can overlap with, or mask, other headache types, and chronic tension headaches sometimes point to an underlying postural or biomechanical issue that's worth correcting rather than just medicating around.

Exercise headaches are usually harmless (called primary exercise headaches), and are thought to occur when strenuous activity causes blood vessels inside the skull to expand, increasing pressure. They're more common with activities that place a lot of strain on the body, such as heavy weightlifting, running, and rowing, and some people find they're more likely in hot weather, at high altitude, or when dehydrated. Because a small proportion of exercise-triggered headaches can signal something more serious happening inside the skull, particularly if the headache begins abruptly or is your first episode of this type, any new, severe, or unusual exercise headache should be checked promptly. Simple prevention strategies include a proper warm-up, staying well hydrated, and avoiding exercising in extreme heat or unfamiliar altitude. If they persist or recur regularly, some athletes are prescribed a preventive medication to take before training.

Post-concussion headaches are managed as part of a broader concussion recovery plan, which may include a graded, symptom-guided return to activity, evaluation of the neck and vestibular (balance) system (since both can independently contribute to headache after a head injury), and management of associated symptoms like sleep disturbance, irritability, and difficulty concentrating. For most people, symptoms resolve within days to a few weeks; for some, they persist beyond three months, at which point they're considered part of persistent post-concussive symptoms and often benefit from a more structured, multi-disciplinary approach. Repeatedly using over-the-counter pain relief can, ironically, worsen headache frequency over time through a phenomenon called medication overuse headache — a sports and exercise physician can help plan medication use appropriately as part of recovery. SMI has a dedicated concussion team who can guide this whole process, from initial assessment through to a safe, staged return to sport, school or work.

For everything short of these red flags, a sports and exercise physician can properly assess whether your headache is coming from the neck, from training, from a past head injury, or from something else — and build a treatment plan around the actual cause, rather than just the symptom.