One of the patterns I hear pretty regularly in the office is, “I feel fine when I wake up, but by three or four in the afternoon I can feel the headache starting.”
That timing interests me.
If you’re waking up without a headache and consistently developing one as the day goes on, something is changing between morning and afternoon. Maybe you’ve spent six hours looking at a computer. Maybe your neck has gradually tightened up. Maybe you haven’t eaten enough, haven’t had much water, are under a lot of stress, or have been staring at a screen without giving your eyes much of a break.
There are a lot of possibilities, which is exactly why I don’t like immediately blaming headaches on one thing.
But when someone tells me the headache consistently builds along with neck and shoulder tension throughout the workday, the neck is something I want to evaluate.
Why Do Headaches Get Worse as the Day Goes On?
I usually start by looking for patterns.
When does the headache begin? Where does it start? What does it feel like? How long does it last? What was the person doing beforehand? Does neck movement change it? Does it improve after leaving work? Does it happen during the weekend?
Those questions often tell me more than simply knowing that someone “gets headaches.”
Several factors can contribute to headaches later in the day, including:
- Neck and shoulder tension
- Prolonged computer work
- Visual strain
- Migraine
- Stress
- Poor sleep
- Skipping meals
- Dehydration
- Caffeine use or withdrawal
- Jaw clenching
- Certain medications
- Changes in blood pressure
- Other medical conditions
Sometimes several of these are happening at the same time.
That’s why identifying the type and pattern of headache matters before deciding what to do about it.
Can Neck Problems Cause Headaches?
Yes. Some headaches originate from structures in the cervical spine. These are called cervicogenic headaches.
A cervicogenic headache is pain perceived in the head even though the source is believed to be in the neck. The upper cervical spine has neurological connections that help explain how pain originating from cervical structures can be referred into different areas of the head.
Someone with a cervicogenic headache may notice pain beginning around the neck or base of the skull and traveling upward. Neck stiffness or restricted movement may occur with it, and certain neck positions or movements may aggravate the headache.
That doesn’t mean every headache accompanied by neck pain is cervicogenic.
Migraine can cause neck pain too. In fact, a 2022 systematic review and meta-analysis found that neck pain is substantially more common in people with migraine than in people without headache disorders.¹ Tension-type headaches may involve tenderness around the neck and shoulders as well. Someone can also have more than one headache type.
The examination matters because the symptoms can overlap.
Why Do My Neck and Shoulders Get Tight Before a Headache?
Think about what happens during a typical workday.
You sit down at your computer in the morning feeling pretty good. A few hours later, you’ve barely moved. Your head has gradually drifted closer to the screen. Your shoulders are slightly elevated. You’re concentrating, maybe you’re stressed, and you haven’t taken much of a break.
By late afternoon, you start rubbing the area where your neck meets your shoulders.
Then the headache starts.
I see this pattern often enough that patients sometimes assume the tight muscle itself is the entire problem. They’ll massage it, stretch it, or dig into it with a massage gun. It feels better temporarily, but the same problem returns the next day.
The question I ask is: Why does that area keep getting tight?
Muscles respond to the demands placed on them. If certain muscles are being asked to maintain your head and shoulders in roughly the same position for hours, fatigue and discomfort aren’t particularly surprising.
There may also be restricted movement elsewhere in the cervical or thoracic spine, workstation factors, stress, or physical conditioning contributing to the problem.
Is Forward Head Posture Causing My Headaches?
It may contribute, but I wouldn’t tell a patient that a picture of their posture proves the cause of their headaches.
That’s too simplistic.
Posture changes the mechanical demands placed on the neck. Research has found an association between forward head posture and neck pain in adults, but an association doesn’t prove that posture is the cause of someone’s pain or headaches.⁴
For someone who already has neck pain, restricted cervical movement, or recurring headaches associated with prolonged desk work, posture becomes clinically relevant.
But posture is only one piece.
I’ve seen people with obvious forward head posture who don’t have headaches. I’ve also treated people whose posture looks pretty good, but who still experience significant headache problems.
I use posture as information, not as a diagnosis.
What About “Tech Neck”?
I don’t particularly love the term, but the behavior it describes is real.
Many of us spend a huge percentage of the day looking at something in front of us or below eye level.
You work at a computer for eight hours. Then you leave work and look down at your phone. You sit on the couch and look at a tablet. Even your “break” from the computer may be another screen.
The issue isn’t that looking down at your phone for five minutes is damaging your spine. It’s the total amount of time you’re spending in a relatively small number of positions. Your neck needs movement just like the rest of your body does.
Can Eye Strain Cause Afternoon Headaches?
Absolutely, and this is something I don’t want to overlook just because I’m a chiropractor.
If your headache consistently develops during computer work, vision needs to be part of the conversation.
Digital eye strain can include headaches, tired or irritated eyes, blurred vision, and difficulty focusing. Research examining digital eye strain has also identified screen exposure and ergonomic factors as relevant considerations, although the quality and consistency of the evidence varies.⁵
Someone may also unconsciously move their head closer to the screen if they’re struggling to see clearly, which can add another mechanical demand on the neck.
If you haven’t had your vision checked in years and your headaches consistently occur while working on a computer, that’s worth considering.
Not every headache needs a spinal explanation.
Can Stress Cause Headaches and Neck Tension?
Stress can absolutely play a role.
Think about how your body responds during a stressful day. You may clench your jaw, elevate your shoulders, change your breathing, sleep poorly, exercise less, or sit at your computer for hours without realizing how much tension you’re holding.
None of this means a headache is “just stress.”
I don’t find that phrase particularly useful.
Stress produces real physiological responses, and it can interact with sleep, muscle tension, pain sensitivity, migraine susceptibility, and behavior.
When someone tells me their headaches are dramatically worse during stressful weeks, that’s useful clinical information.
Could My Headaches Actually Be Migraines?
Possibly.
Migraine is a neurological disorder, and it shouldn’t be reduced to simply having a bad headache.
Migraine attacks can involve throbbing or pulsating pain, nausea, sensitivity to light or sound, visual disturbances, and other neurological symptoms. Some people experience an aura, while many do not.
Neck pain is also common in people with migraine.
That’s important because someone can have neck pain during a migraine without the neck necessarily being the original cause of the migraine.
This is one of the reasons I’m careful with statements like “your neck is causing your headaches.”
Sometimes it is contributing. Sometimes we’re dealing with a primary headache disorder. Sometimes both issues are present.
My job is to figure out which explanation best fits the person sitting in front of me.
Why Do I Get a Headache Behind My Eyes?
Pain location can provide clues, but it doesn’t diagnose the headache by itself.
Pain behind or around the eyes can occur with migraine, tension-type headaches, certain headaches originating from the neck, visual strain, sinus conditions, and other problems.
If someone tells me the pain starts at the base of the skull and travels forward toward the eye, that gets my attention from a cervical standpoint.
But I still need more information.
Does neck movement reproduce it? Is the neck tender or restricted? Is there nausea? Light sensitivity? Visual change? Is it always on one side? How long does it last?
One symptom rarely gives us the whole answer.
What Can I Do If My Headaches Start During the Workday?
Before making this complicated, start with some basic things.
Pay attention to what happens during the two or three hours before the headache begins.
Did you eat lunch? Have you had water? How much caffeine have you consumed? Have you moved from your desk? How long have you been staring at a screen? Are you squinting? Is your jaw clenched? Is your neck getting progressively tighter?
Then change some of those variables.
For desk workers, I commonly suggest:
- Change positions throughout the day.
- Get up and walk periodically.
- Make sure your primary monitor is positioned directly in front of you.
- Bring the screen closer instead of bringing your head toward it.
- Give your eyes regular breaks from close screen work.
- Move your neck and shoulders through comfortable ranges of motion.
- Don’t spend every work break looking down at your phone.
- Stay consistent with meals and hydration.
- Pay attention to caffeine patterns.
- Exercise regularly outside of work.
None of these is a miracle headache treatment.
They’re simply low-risk variables worth addressing when the pattern points toward the workday.
When Should Headaches Be Evaluated?
If headaches are becoming more frequent, changing in character, or interfering with your normal life, I think they deserve a proper evaluation.
There are also situations where a headache requires urgent medical attention rather than waiting for a routine chiropractic appointment. Established headache red-flag frameworks include sudden onset, new neurological deficits, significant changes in a previous headache pattern, systemic symptoms, and headaches associated with trauma.⁶
A sudden, severe headache unlike anything you’ve experienced before should be evaluated urgently. The same applies when a new headache occurs with neurological symptoms such as weakness, difficulty speaking, confusion, loss of consciousness, significant vision changes, or severe problems with balance.
Headache after significant head trauma also deserves appropriate attention.
And if something simply feels very different from your usual headache pattern, don’t ignore that.
How I Evaluate Headaches at Crown City Chiropractic & Wellness
When a patient comes into our Charlotte office because of headaches, I don’t begin by assuming their neck is responsible.
I start with the history.
What does the headache feel like? Where does it begin? How frequently does it happen? How long does it last? What seems to trigger it? Is there nausea? Light sensitivity? Neck pain? Visual symptoms? Numbness? What medications are being used?
Then I look for objective findings.
Depending on the patient, that may include:
- Cervical range of motion
- Neurological testing
- Orthopaedic examination
- Postural assessment
- Upper cervical and thoracic movement
- Shoulder function
- Muscle tension and tenderness
- Digital X-rays when clinically indicated
If the history doesn’t sound like a mechanical headache or I find something that concerns me, the next step may be referral.
I’m comfortable saying, “This doesn’t look like something I should be treating.”
That’s part of doing a good examination.
Can Chiropractic Care Help Headaches?
It depends on the headache.
For cervicogenic headaches, treatment directed toward cervical musculoskeletal dysfunction may be appropriate. Systematic reviews have found that manual therapy and exercise can improve headache intensity and frequency in some patients with cervicogenic headache, although the quality of evidence and results vary between studies.² ³
That’s why I don’t think the right question is simply, “Does chiropractic help headaches?”
I want to know what type of headache we’re dealing with and whether the examination shows a cervical component that makes sense to treat.
If I find restricted cervical movement, reproducible neck-related symptoms, muscular dysfunction, and a headache pattern consistent with a cervical component, chiropractic care may make sense as part of the treatment plan.
If the clinical picture points somewhere else, the plan needs to change.
I don’t think every headache needs an adjustment. I think every recurring headache deserves an explanation that makes sense.
Keep a Headache Log for Two Weeks
This is one of the simplest things you can do before an appointment, and it can be incredibly useful.
For two weeks, write down:
- What time the headache started
- Where you felt it
- How long it lasted
- What you were doing beforehand
- Whether your neck hurt
- How you slept the previous night
- Meals and hydration
- Caffeine intake
- Stress level
- Any visual symptoms, nausea, numbness, or other symptoms
- What made the headache better
Patterns become much easier to recognize when they’re written down.
You may discover that every headache occurs after six hours at your computer. Or after skipping lunch. Or following a bad night’s sleep. Or on the days you drink significantly more or less caffeine.
That’s useful information for you and for whoever is evaluating you.
The Bottom Line
If you keep getting headaches toward the end of the day, don’t automatically assume you just need more ibuprofen or another cup of coffee.
Look at the pattern.
Your neck may be contributing, particularly if the headache builds alongside neck stiffness, shoulder tension, restricted movement, or prolonged computer work. But vision, migraine, stress, sleep, hydration, nutrition, caffeine, medication use, and other medical conditions may also be involved.
I don’t want to force every headache into a chiropractic explanation.
I want to figure out what makes sense for that particular patient.
If you’re waking up feeling fine and consistently ending the day with a headache, something is changing during those hours in between. Finding that pattern is usually a much better place to start than simply covering up the symptom and waiting for it to happen again.
Frequently Asked Questions About Afternoon Headaches
Why do I get a headache every afternoon?
Afternoon headaches can have several causes, including prolonged computer work, neck tension, migraine, eye strain, stress, dehydration, skipped meals, caffeine changes, poor sleep, medications, and other medical conditions. The timing and accompanying symptoms can help narrow down possible causes.
Can neck problems cause headaches?
Yes. Cervicogenic headaches originate from structures in the cervical spine and can refer pain into the head. Neck pain can also occur with other headache disorders, including migraine, so neck pain alone doesn’t prove the headache is coming from the cervical spine.
Why do I get headaches after working on a computer?
Computer work can combine several potential headache triggers, including prolonged static positioning, neck and shoulder tension, visual strain, stress, and reduced movement. Looking at your workstation and your overall workday habits can help identify contributing factors.
Can poor posture cause headaches?
Posture can contribute to mechanical stress on the neck, but it should not automatically be considered the cause of a headache. The relationship between posture and pain is influenced by movement, workload, physical conditioning, headache type, stress, and other factors.
Why does my headache start at the base of my skull?
Several headache types can involve pain around the base of the skull. Cervical joints, muscles, and other tissues can refer pain into the head, but migraine and other headache disorders can also involve neck and occipital pain.
Can dehydration cause headaches?
Yes. Inadequate fluid intake may contribute to headaches in some people. If headaches routinely occur later in the day, hydration is one of several simple variables worth reviewing.
Can eye strain cause headaches?
Digital eye strain can be associated with headaches, blurred vision, eye discomfort, and difficulty focusing. People who spend many hours using computers should consider vision and screen habits as part of the overall picture.
Can a chiropractor help with headaches?
Chiropractic care may be appropriate for certain headache presentations, particularly when cervical musculoskeletal dysfunction is contributing. The type of headache should be considered before deciding whether chiropractic treatment is appropriate.
How do I know if my headache is coming from my neck?
A headache associated with neck pain, restricted cervical movement, symptoms reproduced by neck movement or sustained positioning, and pain that appears to originate around the neck or base of the skull may have a cervical component. An examination is needed to distinguish this from other headache types.
When is a headache an emergency?
Seek urgent medical evaluation for a sudden severe headache, especially one unlike previous headaches, or a headache accompanied by new weakness, difficulty speaking, confusion, loss of consciousness, significant visual changes, severe balance problems, or other acute neurological symptoms.
References
- Al-Khazali HM, Younis S, Al-Sayegh Z, et al. Prevalence of neck pain in migraine: a systematic review and meta-analysis. Cephalalgia. 2022;42(7):663-673. doi:10.1177/03331024211068073.
- Bini P, Hohenschurz-Schmidt D, Masullo V, Pitt D, Draper-Rodi J. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis. Chiropractic & Manual Therapies. 2022;30(1):49. doi:10.1186/s12998-022-00459-9.
- Núñez-Cabaleiro P, Leirós-Rodríguez R. Effectiveness of manual therapy in the treatment of cervicogenic headache: a systematic review. Headache. 2022;62(3):271-283. doi:10.1111/head.14278.
- Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Current Reviews in Musculoskeletal Medicine. 2019;12(4):562-577. doi:10.1007/s12178-019-09594-y.
- Mataftsi A, et al. Digital eye strain in young screen users: a systematic review. Preventive Medicine. 2023;170:107493. doi:10.1016/j.ypmed.2023.107493.
- Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134-144. doi:10.1212/WNL.0000000000006697.
About Dr. Pat Buchar
Dr. Pat Buchar, D.C. is the founder of Crown City Chiropractic & Wellness in Midtown Charlotte, North Carolina. With more than a decade of clinical experience and over 100,000 chiropractic adjustments performed, Dr. Buchar’s approach combines detailed examination, chiropractic care, movement and postural assessment, rehabilitation, and patient education. His goal is to understand why a patient is experiencing a problem before deciding how it should be treated.
Crown City Chiropractic & Wellness
The Metropolitan | Midtown Charlotte, NC
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