Headaches: who to see and what helps

Headaches · Kitchener, Waterloo & Cambridge

Tension-type headache, a pressing ache on both sides of the head, is very common and is not a sign of an underlying condition. Other headaches start in the neck, and some are kept going by pain medicine. When headaches with neck pain have lasted over three months, an Ontario guideline says clinicians may consider neck and shoulder exercise, and expects small benefits at best. At CARESPACE the first visit is with a physiotherapist or a chiropractor.

What kind of headache this page covers

Three kinds: tension-type headache; cervicogenic headache, which is caused by a problem in the bones, discs or soft tissue of the neck; and medication-overuse headache. Migraines have their own page.

Symptoms: telling the types apart

• Tension-type headache. A constant ache that does not throb: pressure or tightness on both sides of the head, around the forehead, or at the temples and back of the head. It is mild or moderate and is not made worse by everyday activity. It is called chronic when it comes on 15 or more days a month for more than three months.
• Cervicogenic headache. Usually comes with neck pain. The clues are pain that stays on one side, spreads from the back of the head toward the front, and is brought on by moving the head or pressing on the neck muscles, with a neck that does not turn as far as it should.
• Medication-overuse headache. Headache on 15 or more days a month in someone who takes triptans, opioids or combination pain relievers on 10 or more days a month, or acetaminophen or anti-inflammatories on 15 or more.
• Something else. Severe pain around one eye that makes you restless may be cluster headache, which needs a physician. For headache with jaw symptoms, see TMJ & Jaw Pain.

What causes and triggers headaches

• Stress, low mood and poor sleep.
• Hunger and thirst: skipped meals and not drinking enough.
• Muscle strain: neck strain from posture, tight shoulders and upper back, jaw clenching or teeth grinding.
• Eye strain from long spells at a screen. A full day at a monitor, routine in the region’s tech and office jobs, can stack several of these triggers at once.
• Caffeine, alcohol, and pain medicine taken too often.

How headaches are diagnosed

By your answers to questions and a physical examination. A headache diary helps: when each headache came, how long it lasted and what you took. People with a diagnosed tension-type or medication-overuse headache should not be sent for brain imaging solely for reassurance, and neck findings are common on the scans of people who have no headaches.

When a headache is an emergency

Call 911 for a sudden, severe headache that is different from any you have had before, especially one that reaches full strength within minutes; or for a headache with sudden numbness, weakness or loss of movement in your face, an arm or a leg, sudden trouble speaking, understanding or remembering things, sudden confusion or drowsiness, sudden loss of vision or blurred or double vision, sudden trouble walking or keeping your balance, or a seizure. Go to an emergency department for a headache with a fever and a stiff neck, a rash that does not fade when a glass is rolled over it, a red eye, or a head injury in the past three months. Do not drive yourself, and do not wait for an appointment with us: nobody at CARESPACE can rule these out.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

See a physician or nurse practitioner the same day, or go to an urgent care clinic, for a headache with any other eye or vision problem; with jaw pain when you eat or a sore, tender scalp; brought on or made worse by coughing, sneezing, bending down or exercise; with new vomiting; or with any other symptom that worries you. For a child, add a headache that is getting worse or wakes them at night. These are the urgent lists of the UK’s NHS and HealthLink BC, put into Ontario terms. Book an ordinary appointment if your headaches are getting worse or more frequent, wake you at night, began after age 50, or have you taking pain medicine on more than two days a week.

What the evidence says about treating headaches

• Where this comes from. Mainly a 2019 Ontario guideline for adults whose tension-type or cervicogenic headaches come with neck pain and have lasted more than three months. The exercise, hands-on and massage points are its positions, and its authors say everything they recommend gives “small benefits at best”. UK and US guidelines fill in the rest. “May consider” and “suggest” are weaker than “offer” and “recommend”: the words show how sure each panel was, not just how good the studies were.
• Neck and shoulder exercise. For tension-type and cervicogenic headache alike, clinicians may consider low-load endurance exercises for the deep neck and shoulder-blade muscles. For chronic tension-type headache they may also consider supervised stretching, strengthening and aerobic exercise. Physical therapy for both types has a weak US recommendation as well.
• Hands-on treatment depends on the type. For cervicogenic headache, manipulation of the neck and upper back, with or without mobilization, may be considered for up to 10 sessions over six weeks. For tension-type headache the guideline’s summary says not to offer neck manipulation as the only treatment, whether the headache is episodic or chronic. Its full recommendation for the episodic kind goes further: clinicians should not offer it, in view of evidence that it does not work. For the chronic kind, up to nine sessions combining mobilization, neck exercise and postural correction may be considered.
• Massage. For chronic tension-type headache, eight sessions of clinical massage over four weeks may be considered, on the evidence of one trial of traditional Thai massage.
• Acupuncture: the advice differs. In the UK, a course of up to 10 sessions over five to eight weeks is something to consider for preventing chronic tension-type headache. The Ontario panel neither recommends nor refutes it, and the US panel found insufficient evidence for or against acupuncture or dry needling.
• Medicines belong to physicians, nurse practitioners and pharmacists. UK advice for a tension-type headache is to consider aspirin, acetaminophen or an anti-inflammatory, and not to offer opioids; amitriptyline is suggested in the US for preventing the chronic kind. Medication-overuse headache is treated by stopping the overused medicine for at least a month; headaches are likely to get worse first, so do it with their help.

How each CARESPACE service treats headaches

Physiotherapy

A physiotherapist can test whether neck movement or pressure brings on your usual headache, then teach the endurance exercises for the deep neck and shoulder-blade muscles. For a cervicogenic headache they can add mobilization of the neck and upper back. Some CARESPACE physiotherapists offer dry needling.

See our physiotherapy team →

Chiropractic

For a cervicogenic headache, a chiropractor can manipulate or mobilize the neck and upper back. For tension-type headache, where neck manipulation is advised against, a chiropractor can work with exercise, mobilization and posture, so working out which type you have comes first. The guideline behind these points gives no figures on side effects; ask about the risks before agreeing to neck manipulation.

See our chiropractic team →

Massage Therapy

A Registered Massage Therapist can treat the neck and shoulder muscles. A course of clinical massage may be considered for chronic tension-type headache, and massage is one of the relaxing activities suggested for a tension headache. For the other two types there is no evidence to report.

See our massage therapy team →

Acupuncture

Acupuncture practitioners can provide a course of treatment for chronic tension-type headache, the type on which the guidelines disagree. For cervicogenic headache there is no recommendation either way.

See our acupuncture practitioners →

Counselling

Registered Psychotherapists and Registered Social Workers can provide counselling that uses cognitive behavioural or problem-solving therapy, which HealthLink BC says can help with tension headaches. A US guideline panel judged the evidence on cognitive behavioural therapy, mindfulness and biofeedback insufficient either way, so treat counselling as an option when stress is what sets your headaches off.

See our counselling team →

Other services people ask about

Naturopathic medicine and supplements. The supplement research is about migraine. For the three headache types on this page we have no evidence to report.

Where most people start

Book with a physiotherapist or a chiropractor. Both assess and treat at the first visit, and the first job is sorting out which kind of headache this is. For migraine or medication overuse, a physician or nurse practitioner is the right next step.

How your team works together

Exercise from your physiotherapist or chiropractor is the base. Massage therapy or acupuncture can be added for chronic tension-type headache, and counselling when stress sets your headaches off.

Browse by service: physiotherapists, chiropractors, registered massage therapists, acupuncture practitioners and counsellors.

What to expect at your first visit

1. Your headache pattern: where it sits, how often it comes, how long it lasts, and what you take for it on how many days a month.
2. Safety questions about sudden onset, fever, your eyes and vision, weakness and recent head injury, because some of these belong in a hospital.
3. An examination of the neck and shoulders, including whether moving or pressing on the neck brings on your usual headache.
4. A working answer on the type of headache, treatment that day, and a plan built around neck and shoulder exercise.

What you can do at home

• Eat regular meals, drink plenty of water and keep a regular sleep schedule.
• At a screen, look away often and keep the monitor about an arm’s length away.
• Try a heating pad set on low on tight neck and shoulder muscles.
• Count the days you take pain medicine. If it is more than two days a week, talk to your physician or pharmacist.

Outlook

A single tension-type headache lasts from 30 minutes to several days. How long the chronic kind or cervicogenic headache goes on is not something our sources put a number on. The treatment courses above run for four to twelve weeks at most, and end sooner if you report significant recovery.

Headache treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractor in Kitchener, Massage Therapy in Kitchener, Acupuncture in Kitchener and Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractor in Waterloo, Massage Therapy in Waterloo, Acupuncture in Waterloo and Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge, Acupuncture in Cambridge and Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How do I know if my headache is coming from my neck?

Not from symptoms alone. One-sided pain that spreads forward from the back of the head and comes on with neck movement points that way, but those clues are not unique to it. It takes an examination of the neck.

Should I have my neck adjusted for a tension headache?

Not as the only treatment, and for the episodic kind the Ontario guideline’s full recommendation is not to offer it at all. Manipulation may be considered for cervicogenic headache.

Is it a tension headache or a migraine?

A tension-type headache presses on both sides, is mild or moderate and lets you carry on. Migraine is moderate or severe, gets worse with routine activity and brings nausea or sensitivity to light and sound. See Migraines.

Do I need a scan for my headaches?

Not as a routine: brain scans and neck X-rays are not recommended for the routine assessment of headache.

Can I get headache treatment in Cambridge?

Yes. Physiotherapy, Acupuncture and Counselling are offered in Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Côté P, Yu H, Shearer HM, et al. Non-pharmacological management of persistent headaches associated with neck pain: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain, 2019;23(6):1051–1070.
• National Institute for Health and Care Excellence (UK). Headaches in over 12s: diagnosis and management (CG150). 2012, with later updates.
• Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Canadian Family Physician, 2015;61(8):670–679.
• US Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Headache: provider summary. Version 2.0, 2023.
• International Headache Society. International Classification of Headache Disorders, 3rd edition: 11.2.1 Cervicogenic headache. 2018.
• Canadian Headache Society and Choosing Wisely Canada. Headache: tests and treatments to question. Updated July 2020.
• Emergency signs and home care: HealthLink BC (Healthwise), Tension Headaches, current as of August 2022; NHS (UK), Headaches, reviewed April 2024, and Tension headaches, reviewed August 2025.

Related conditions

Migraines · Neck Pain · TMJ & Jaw Pain · Whiplash · Stress

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Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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