Headaches
& Migraines
San Diego
Evidence-based chiropractic care for tension headaches, cervicogenic headaches, migraines, occipital neuralgia, and TMJ-related head pain — drug-free, root-cause treatment at UTC San Diego.
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Take the Headache Quiz
22%Achieved >90% migraine reduction with chiropractic (Tuchin et al.)
68%Avg. decrease in migraine intensity (Jahangiri et al.)
98.9%SUCRA — spinal manipulation ranked #1 for cervicogenic headache (Xu & Ling, 2025)
Your headache
may be coming
from your neck
If you’ve tried everything for your headaches — medications, rest, avoiding triggers — but never had your neck evaluated, you may be missing the root cause.
Headaches are one of the most common conditions treated at this practice. Most patients arrive having managed symptoms for years without understanding why they keep coming back. A thorough cervical spine evaluation often reveals the answer.
Identify your headache type below
1 in 5
headaches originate from cervical spine dysfunction — joints, discs, and muscles in the upper neck referring pain into the skull. These are among the most treatable headache types and respond exceptionally well to spinal manipulation.
Headache Types Treated
Tension Headache
Cervicogenic
Migraine
Occipital Neuralgia
TMJ-Related
Red Flag Screening
Identify your
headache type
Each headache type has a distinct pattern, cause, and treatment approach. Select the description that most closely matches your experience.
Patients describe it as…
A tight band squeezing around my head
Dull ache on both sides — forehead, temples, back of head
Gets worse after hours at a desk or screen
My head feels like it’s in a vice, especially end of day
No nausea or light sensitivity — just constant pressure
Tension Headache
Most common headache type · Desk workers, athletes, stress
Common Causes
Forward head postureScreen timeSuboccipital trigger pointsUpper trap tightnessStress / jaw clenchingPoor ergonomics
How Chiropractic Helps
Cervical and upper thoracic adjustments restore joint mobility and reduce muscle guarding. Suboccipital soft tissue release deactivates trigger points that refer pain across the skull. Postural correction addresses forward head carriage — every inch of anterior translation adds ~10 lbs of cervical load.
2026 Clinical Guideline (Trager et al.): Spinal manipulation combined with soft tissue techniques and exercise is recommended for tension-type headache management.
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Patients describe it as…
It always starts in the back of my neck or base of skull
Pain is only on one side — it never switches
Turning my head or looking up makes it worse
Started after a car accident or whiplash
My neck feels locked, especially in the morning
Cervicogenic Headache
Neck-origin headache · Most responsive to chiropractic
Common Causes
C1/C2/C3 joint dysfunctionWhiplash / MVADisc degenerationForward head postureWeak deep neck flexors
How Chiropractic Helps
Upper cervical and thoracic manipulation is the most effective manual therapy for this condition. The Flexion-Rotation Test (90–91% sensitivity) confirms C1/C2 dysfunction. Treatment includes cervical traction, deep neck flexor strengthening, and scapular stabilization.
Xu & Ling (Front. Neurology, 2025): Spinal manipulation ranked highest for pain reduction (SUCRA 98.9%) and disability improvement (SUCRA 82.2%), outperforming all other manual therapies.
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Patients describe it as…
Throbbing or pulsing, usually on one side
Nausea, sometimes vomiting during attacks
Bright lights and loud sounds are unbearable
Sometimes I see zigzag lines or blind spots before it starts
Each episode lasts 4 hours to 3 days
Migraine
Neurological condition · Frequency & intensity reduction
Common Triggers & Causes
Upper cervical dysfunctionHormonal shiftsSleep disruptionDietary triggersBarometric pressureCentral sensitization
How Chiropractic Helps
C1/C2 adjustments reduce irritation at the trigeminocervical nucleus — the brainstem relay where cervical and trigeminal nerve pathways converge. The goal is fewer, less intense migraines. For complex cases, co-management with a neurologist is offered. Chiropractic is not an abortive treatment for acute attacks.
Tuchin et al. (JMPT, 2000): 22% of patients achieved >90% reduction in migraine frequency. A 2012 study showed an average 68% decrease in intensity.
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Patients describe it as…
Sharp, electric-shock or stabbing pain from the base of my skull
Pain shoots upward toward the top of my head or behind my eye
My scalp is so tender that combing my hair hurts
Certain neck positions set it off
Occipital Neuralgia
Greater occipital nerve compression · C1–C2 level
Common Causes
C1–C2 misalignmentSuboccipital muscle entrapmentWhiplash scarringCervical arthrosisForward head posture
How Chiropractic Helps
Upper cervical adjustments at C1–C2 decompress the greater occipital nerve at its exit point. Suboccipital release reduces muscular entrapment, and cervical traction increases available nerve space. If conservative care is insufficient after a reasonable trial, referral for occipital nerve block evaluation is provided.
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Patients describe it as…
My temples hurt, especially when I chew or yawn
My jaw clicks, pops, or feels like it catches
I wake up with a tight, sore jaw and a headache
Ear pain or fullness, but ears check out fine
Pain spreads from my jaw to my temples and the back of my head
TMJ-Related Headache
Jaw-cervical complex · Co-managed with dentist when needed
Common Causes
Bruxism / grindingTMJ dysfunctionForward head postureC1–C3 dysfunctionDental malocclusion
How Chiropractic Helps
The TMJ and cervical spine share neurological pathways through the trigeminal nerve. Treatment addresses both the jaw joint and upper cervical spine as an integrated complex — including TMJ-specific adjustments, soft tissue work on masseter and pterygoid muscles, and upper cervical adjustments. Co-management with a dentist for night guard fabrication when bruxism is confirmed.
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How chiropractic
addresses
headaches
The upper nerves in your neck share a relay station in your brainstem with the nerves responsible for headache pain. When cervical joints are restricted or misaligned, this relay station becomes overactivated — triggering or amplifying headaches.
Upper Cervical AdjustmentRestores C1/C2 alignment, reducing trigeminocervical irritation
Suboccipital Release (ART)Deactivates trigger points that refer pain across the skull
Cervical TractionDecompresses upper cervical segments and disc nerve pressure
Postural RehabCorrects forward head carriage — each inch adds ~10 lbs of load
Deep Neck Flexor StrengtheningRestores segmental stabilization for lasting improvement
Ergonomic CounselingWorkstation setup, monitor height, sleep positioning
01
Comprehensive Evaluation
Flexion-rotation test, neurological screening, postural assessment, and headache pattern history to identify the root cause.
02
Targeted Spinal Care
Precise upper cervical and thoracic adjustments combined with soft tissue work — not random cracking, but joint-specific treatment guided by your exam findings.
03
Corrective Exercise
Deep neck flexor training, scapular stabilization, and mobility work to reinforce spinal changes and prevent recurrence.
04
Progress Reassessment
Regular clinical reassessment with clear benchmarks. No open-ended treatment plans — measurable outcomes drive all care decisions.
2025 Meta-Analysis Confirms
Spinal manipulation outperformed mobilization, exercise, and massage for cervicogenic headache pain reduction — ranking highest in the network meta-analysis by Xu & Ling (Frontiers in Neurology).
Not sure which
type you have?
Take the quiz.
Answer 8 questions and we’ll help you identify your likely headache type — and whether chiropractic care is a good fit.
60-Second Assessment
Headache & Spine
Assessment Tool
Developed from clinical symptom patterns across five headache types. This is not a diagnosis — it helps identify patterns that guide your evaluation. All results include a clinical recommendation.
Question 1 of 8
01
Your first visit
explained
A thorough initial evaluation — no guessing, no assembly-line care. Here’s exactly what happens at your first appointment.
01
Detailed Headache History
Pattern, frequency, triggers, prior treatments, and medication history — everything needed to understand the full picture before any hands are laid on.
02
Neurological Screening
Red flag screening at every intake. If any finding suggests chiropractic care is not appropriate or safe, you’ll receive a referral — not an adjustment.
03
Cervical Spine Examination
Flexion-rotation test (90%+ accuracy for upper cervical dysfunction), range of motion assessment, joint palpation, and postural analysis.
04
Diagnosis & Plan Discussion
Clear explanation of findings, likely headache type, treatment approach, and realistic timeline — before treatment begins.
05
First Treatment (if appropriate)
Spinal adjustment, soft tissue work, or both — depending on exam findings. You’ll leave knowing exactly what’s driving your headaches.
06
Home Care Instructions
Exercises, ergonomic adjustments, and sleep position guidance prescribed on day one — because what you do between visits matters as much as what happens in the office.
45–60 minInitial evaluation duration
Bring if availablePrior imaging, medication list, headache diary
In-network insuranceAetna, Blue Shield, Anthem, UHC, VA CCN
Your questions
answered
Evidence-based answers to the questions patients actually search before booking.
About Chiropractic for Headaches
Yes. Research shows chiropractic spinal manipulation can reduce migraine frequency and intensity. A clinical trial published in the Journal of Manipulative and Physiological Therapeutics found 22% of migraine patients experienced greater than 90% reduction in frequency, and a 2012 study showed an average 68% decrease in intensity. Chiropractic works particularly well when there is a cervical component contributing to migraine episodes.
Tension headaches are commonly driven by muscle tightness, joint restriction, and poor posture in the neck and upper back. Chiropractic addresses these root causes through cervical adjustments, soft tissue release, and postural correction. The 2026 Trager et al. clinical practice guideline supports spinal manipulation combined with soft tissue techniques and exercise for tension-type headache management. Most patients notice improvement within the first few weeks of care.
Multiple clinical trials and systematic reviews demonstrate lasting improvement, not just momentary relief. For cervicogenic headaches, spinal manipulation reduces both pain and disability with effects maintained beyond the active treatment period. For migraines, studies document reduced frequency that persists after the initial care plan concludes. The key is addressing underlying spinal dysfunction — not simply masking symptoms — and reinforcing results with corrective exercises and ergonomic changes.
Understanding Your Headache Type
Several signs suggest a neck origin: your headache consistently starts at the base of your skull or in your neck; it is worse on one side; turning your head or holding certain positions triggers or worsens it; you have a history of neck injury or stiffness. During a chiropractic evaluation, the cervical flexion-rotation test — which has over 90% accuracy for detecting upper cervical dysfunction — is used to determine whether your neck is the source.
A cervicogenic headache originates from dysfunction in the joints, discs, or muscles of your upper neck (C1–C3 vertebrae). The pain typically stays on one side, starts in the neck or base of the skull, and worsens with neck movement — without nausea or light sensitivity. A migraine is a neurological condition producing throbbing one-sided pain with nausea, light/sound sensitivity, and sometimes visual aura. Cervicogenic headaches are among the most responsive to chiropractic spinal manipulation, as confirmed by the 2025 Xu & Ling meta-analysis.
Absolutely. The temporomandibular joint shares nerve pathways with the upper cervical spine through the trigeminal nerve. TMJ dysfunction — from grinding, clenching, or joint misalignment — can produce headaches in the temples, behind the eyes, and at the back of the head. Both the jaw and cervical spine are evaluated together because they function as an integrated complex. Co-management with a dentist for night guard fabrication is provided when bruxism is confirmed.
Occipital neuralgia causes sharp, electric-shock-like pain shooting from the base of the skull upward toward the scalp or behind the eye. It occurs when the greater occipital nerve is compressed or irritated — often by misalignment at C1–C2 or tight suboccipital muscles. Upper cervical adjustments and targeted soft tissue release can decompress this nerve and reduce symptoms. If conservative care does not provide adequate relief, referral for occipital nerve block evaluation is provided.
Treatment, Safety & Process
Most patients begin noticing improvement within 2–4 weeks, typically starting with 2–3 visits per week. Total visits depend on headache type, severity, chronicity, and individual response. Acute cervicogenic headaches may resolve within a few sessions. Chronic or complex patterns may require 6–12 weeks of active care. Progress is reassessed at regular intervals — there are no open-ended treatment contracts.
A 2024 systematic review and meta-analysis (Pankrath et al., Pain Physician) examining 14 randomized controlled trials found no statistically significant difference in adverse events between cervical manipulation and control groups. All reported adverse events were mild — temporary soreness or brief pain aggravation — and resolved quickly. No moderate or serious adverse events occurred. Some patients experience mild muscle soreness after a first adjustment, similar to starting a new exercise routine. This typically resolves within 24 hours.
Cervical spinal manipulation performed by a licensed chiropractor has a strong safety profile. The 2024 Pankrath et al. meta-analysis of randomized controlled trials concluded that high-velocity, low-amplitude cervical manipulation does not increase the risk of adverse events compared to control interventions. A thorough screening is performed before any cervical adjustment, including neurological and vascular assessments. If any finding suggests cervical manipulation is not appropriate, alternative techniques or specialist referral is provided.
It’s not too late. Many patients have lived with headaches for decades before seeking chiropractic care and still achieve meaningful improvement. Chronic headaches often develop from years of accumulated spinal dysfunction, poor posture, and compensatory muscle patterns. While long-standing issues may take longer to resolve than acute ones, the underlying joint restrictions and muscle imbalances are still treatable. The first step is a thorough evaluation to identify what’s driving your headaches and determine a realistic care plan.
Yes, and this is one of the primary goals of chiropractic migraine management. Clinical research shows patients receiving chiropractic care experience fewer migraine days per month. The mechanism involves reducing upper cervical dysfunction that irritates the trigeminocervical nucleus — the brainstem region where cervical and trigeminal nerve signals converge. Restoring proper cervical alignment lowers the threshold for migraine activation. Lifestyle counseling on sleep, diet, and stress management is incorporated into care as well.
A thorough headache evaluation includes: detailed headache history (patterns, triggers, prior treatments), neurological screening to rule out red flags, orthopedic and functional cervical spine testing including the flexion-rotation test, palpation of neck joints and musculature to identify restriction and tenderness, and a postural assessment. Based on these findings, the headache type is determined and a decision is made whether chiropractic care is appropriate — or whether referral to another provider is indicated. Evaluation runs approximately 45–60 minutes.
Go to the emergency room immediately if you experience: the sudden “worst headache of your life” reaching maximum intensity within seconds, headache with fever and stiff neck, headache after head trauma, headache with vision loss or double vision, new onset of severe headache after age 50, headache with arm or leg weakness, or headache with confusion or difficulty speaking. These symptoms can indicate serious conditions — brain hemorrhage, meningitis, or stroke — that require emergency medical evaluation. A responsible chiropractic evaluation screens for these red flags at every visit.
When to seek
emergency care
A responsible chiropractor screens for red flags at every intake. Knowing when NOT to adjust is as important as knowing how to adjust. If you experience any of the following, seek emergency medical care immediately.
The sudden “worst headache of your life” — reaching maximum intensity within seconds (thunderclap onset)
Headache with fever and stiff neck — possible meningitis or encephalitis
Headache following head or neck trauma
Headache with vision loss, double vision, or persistent visual changes
New onset of severe headache after age 50
Headache with weakness, numbness, or speech difficulty
Progressive headache that worsens over days or weeks
Headache that wakes you from sleep at the same time each night
⚠ Emergency Resources — San Diego
Emergency: Call 911 · Scripps La Jolla ER: (858) 626-4123
UC San Diego Health ER: (858) 657-7000
SNNOOP10 Screening Framework
| Letter | Flag | Concern |
|---|---|---|
| S | Systemic symptoms | Infection, malignancy, arteritis |
| N | Neurologic symptoms | Stroke, tumor, CNS infection |
| O | Onset sudden | Subarachnoid hemorrhage |
| O | Older age (new after 50) | Giant cell arteritis, tumor |
| P | Pattern change | Mass lesion, progressive pathology |
| P | Positional headache | Intracranial pressure change |
| P | Precipitated by Valsalva | Posterior fossa malformation |
| P | Papilledema | Intracranial mass, hypertension |
| P | Progressive, atypical | Tumor, vascular disorder |
This screening framework is applied at every initial evaluation. Your safety is the first priority — knowing when to refer is as important as knowing how to treat.
Stop managing.
Start fixing.
Most patients begin to feel improvement within the first few weeks of care. The first step is understanding what’s actually driving your headaches.
Book Your Evaluation
Call (858) 558-3111
Dr. Jordan Loewenstein, D.C., M.S. Nutrition, ART Certified
8881 Complex Dr, Suite 100, San Diego, CA 92123
sdspinecare.com