Head and Face Pain: Understanding Your Symptoms

Head and facial pain are common. Problems with the jaw, neck, or a concussion can contribute to this pain. Inner ear problems mainly involve dizziness and balance issues, which may accompany your other symptoms. Physical therapy can help with many of these issues, with treatments tailored to your evaluation. This guide helps you describe your symptoms and determine which treatments to seek.

You may experience recurring headaches, dizziness when you turn your head, or pain that starts in your jaw and radiates to your temple. These symptoms can be frustrating and sometimes frightening. It’s normal to feel worried. Understanding their cause is the first step toward relief.

How Do I Know Where My Head Pain Comes From?

Assessing your symptoms, their triggers, and your movements helps your healthcare provider determine the cause of your head pain. This guide presents four possible causes: the jaw, the neck, balance disorders, and concussion. Jaw problems can affect the temporomandibular joint (TMJ), which connects the jaw to the skull, or the surrounding muscles. Vestibular problems affect the system that helps you maintain your balance, particularly in the inner ear.

The circumstances surrounding the pain provide clues, though they are not enough to make a diagnosis on their own. Pain that worsens when you chew suggests a jaw problem. Headaches that start at the base of the skull may warrant an examination of the neck (see our guide on neck pain). Dizziness that occurs when changing positions may be caused by the vestibular system. Learning to recognize these signs will help you better describe your situation to your healthcare provider.

The following sections explain these approaches and the symptoms you should mention during your appointment.

Does My Pain Come From My Jaw (TMJ)?

Pain related to the jaw may occur near the ear or in the temple and worsen when you chew, yawn, or clench your teeth. Pain after meals or upon waking may also guide the evaluation. These signs may suggest a disorder of the TMJ or the masticatory muscles; an examination is still necessary, as facial pain can have other causes.

The TMJ connects your lower jaw to your skull. It moves every time you speak, eat, or yawn. Pain can also be felt in areas other than the one being stimulated; this is known as referred pain. In a study of 230 people with a TMJ disorder, applying pressure for about five seconds to sensitive points on the head or neck caused referred pain in 196 people. The cheek, ear, and forehead were the most common sites of referred pain.¹

The temporal muscle, located in the temples, is responsible for closing the jaw. This muscle occupies part of the side of the skull. It works hard in people who clench their teeth, and the tension felt in this muscle can be part of the picture of a headache. The physical therapist will assess its sensitivity and its role in your symptoms.

• Your jaw cracks or clicks painfully when you open your mouth
• You experience pain when eating hard foods
• You wake up with a tight or painful jaw
• Do you feel the pain spreading to your temple or ear?

If this sounds like you, your pain may be coming from your jaw. A clicking sound that causes no pain or limits movement is common and generally does not require treatment, according to the NIDCR, the U.S. National Institute of Dental and Craniofacial Research². Jaw-related pain can be managed through specialized physical therapy, with a treatment plan tailored to your evaluation. Manual therapy—which involves gently moving the tissues or joint with the hands—and exercises can improve range of motion and reduce pain. To learn more, check out our comprehensive guide to jaw pain and TMJ.

But perhaps your pain seems to come from elsewhere. Let's look at cervicogenic headaches.

Could my headache be caused by my neck?

A headache can originate in the neck; this is known as a cervicogenic headache. Cervicogenic headaches account for a portion of persistent headaches, and estimates vary widely depending on how the diagnosis is made.³ The pain may start at the base of the skull and radiate upward toward the forehead or behind the eye. It may be limited to one side.

Migraines and tension headaches can also be accompanied by neck pain. Tension headaches often cause a sensation of pressure around the head. In the case of a cervicogenic headache, the neck problem contributes to the headache. Sensory signals from the upper neck travel primarily through the first three cervical nerves, known as C1 through C3. These signals reach areas of the nervous system that also receive signals from the head. This overlap helps explain why pain felt in the head may actually originate in the neck.^{4, 5}

• The pain begins after staying in one position for a long time (using a computer, driving)
• Turning or tilting the head triggers or worsens the headache
• You experience neck stiffness along with your headache
• The pain often remains on the same side

The cervical flexion-rotation test helps measure the mobility of the upper neck. The physical therapist tilts your head forward and then rotates it. This test can help identify a headache originating in the neck, but it is not sufficient on its own to make a diagnosis: the result also depends on age, pain, and the measurement method.^{6, 7} The ICHD-3 criteria, the International Classification of Headaches⁸, require several consistent clues pointing to a connection with the neck.

Manual therapy of the neck and targeted exercises can reduce cervicogenic headaches. A review of 20 trials, involving 1,439 people, reports improvements in pain, headache frequency, and difficulties with daily activities. Studies on combination therapies are encouraging, but several have limitations in how they compare treatments. The evidence is of moderate certainty regarding the results of two trials of neck manipulation—rapid movements performed by a professional—which showed modest average benefits.⁹ Your physical therapist will choose the appropriate treatment based on your specific challenges and situation. Our guide on headaches and cephalalgia provides details on these treatments.

What can you do at home when a headache starts in the back of your neck?

A gentle neck massage may provide some relief if you already know what type of headache you have and there are no signs of a medical emergency. The NHS, the UK's public health service¹⁰, recommends massage and relaxation techniques for tension headaches. The studies presented here do not compare which areas to massage: pain at the back of the head alone is not enough to determine a treatment or to conclude that it originates in the neck.

If you try self-massage, use gentle pressure that remains comfortable. You can use your fingers to make small movements on tender muscles, without applying force or trying to crack your neck. Stop if it makes your symptoms worse or causes discomfort.

See if the technique helps you, and discuss it with your healthcare professional. The frequency and duration can be adjusted to suit your comfort level. Frequent headaches—especially those that change or do not improve—warrant a medical consultation; you should not wait until the end of a massage trial.

A trial on tension headaches assigned 62 participants to either a manual therapy program, a sham treatment, or a waiting list; 56 were analyzed. The program combined several techniques applied to the head and neck over a six-week period. The frequency of headaches decreased in both the manual therapy and sham treatment groups, with no statistically significant difference between them. However, participants in the manual therapy program reported greater overall improvement. The finding applies to the program as a whole, not to any specific maneuver or self-massage at home.¹¹

Dry needling involves inserting thin needles into the muscles. A trial involving 44 people with tension headaches compared dry needling to friction massage—which involves rubbing the muscles—with three sessions over the course of a week and an assessment 48 hours after the last session. This small, short-term trial is not sufficient to conclude that the two approaches are equally effective for all types of headaches.¹² Couto’s study, meanwhile, focuses on needle-based techniques in women with persistent muscle pain; it does not compare these techniques to massage.¹³

What if your main problem isn't pain, but rather a sensation of dizziness?

What is the difference between dizziness and vertigo?

Vertigo causes a false sensation of movement, often of rotation, while dizziness can describe a feeling of floating or instability. In a study of people aged 75, 36% reported dizziness or a loss of balance. These data pertain to this specific age group.¹⁴

The vestibular system consists of structures in the inner ear and nerve pathways that provide the brain with information about head movements and position. It helps maintain balance and stabilize vision. A problem with this system can cause a sensation of spinning, rocking, or instability. An evaluation helps determine the appropriate treatment based on the underlying cause.

• Do you experience severe dizziness when lying down or getting up?
• Turning your head quickly causes a spinning sensation
• You feel unstable when walking, especially in the dark
• The dizziness began after an ear infection or an injury

Benign paroxysmal positional vertigo (BPPV) is a common cause of recurring dizziness. Its name describes brief episodes triggered by certain head positions. Tiny crystals move within a canal in the inner ear, where they disrupt signals related to movement.¹⁵ A healthcare professional confirms the condition by observing, among other things, eye movements during positional tests. The term “benign” refers specifically to this diagnosis; it does not mean that all dizziness is harmless.

The Epley maneuver guides the crystals out of the posterior canal, one of the canals of the inner ear. A review of 11 trials concluded that this maneuver is effective for BPPV involving this canal. In five trials that measured the resolution of vertigo, approximately 56% of those treated experienced relief, compared with 21% in the sham treatment or no-treatment groups.¹⁶ The review also reports recurrence rates of around 36%; this does not predict your personal risk. Advice from the American Academy of Otolaryngology¹⁷—the specialty of ears, nose, and throat—specifies that a repeat maneuver or multiple sessions may be necessary. If symptoms persist, have the cause reevaluated. Our guide on vertigo and dizziness outlines other causes and treatments.

To understand this specialized approach, consult our article on vestibular physiotherapy.

If your symptoms began after a blow to the head or body, a concussion should also be considered.

Is it related to a concussion?

A concussion may explain headaches or dizziness that develop after a blow to the head or body. A medical evaluation is necessary when a concussion is suspected. Some people continue to experience symptoms for weeks or months, such as headaches, dizziness, fatigue, or difficulty concentrating.¹⁸

After a concussion, difficulties may arise with balance, vision, or the neck. A review article describes, in particular, problems with balance and gaze stabilization following a sports-related concussion.¹⁹ A study of adolescents aged 13 to 17 who played competitive hockey primarily observed a decline in certain neck functions. Tests of gaze stabilization during head movements and balance while in motion did not show any statistically significant changes at the group level.²⁰ The profile therefore varies depending on the individual and the functions being assessed. Tailored support helps address existing difficulties.

• Your symptoms started after a blow to the head or body
• Do you have headaches, and does mental work tire you out?
• Screens and crowded environments make your symptoms worse
• You experience issues with concentration or memory

Physical therapy specializing in concussions combines several approaches: balance exercises, eye stabilization exercises, neck care, and a gradual return to activities. Our guide on concussions details the stages of recovery.

When to consult a physiotherapist?

You should see a physical therapist if your symptoms persist, interfere with your daily activities, or return after initially subsiding. The physical therapist will assess your difficulties and determine the appropriate treatment. Some symptoms require an urgent medical evaluation first, such as those described below.

The evaluation includes your medical history—that is, your past health issues and injuries—as well as tests of movement, strength, or balance, depending on your symptoms. The results help identify what is contributing to the problem. The physical therapist may also refer you to a doctor or dentist if further evaluation is needed.

• Headaches that impact your daily life
• Dizziness that prevents you from driving or working
• Jaw pain that limits what you can eat
• Symptoms that persist after an accident or a head injury

After a neck injury caused by a sudden head movement, appropriate early movement can help. In a trial involving 61 people who had recently been injured, early exercises and mobilization—guided neck movements—led to greater improvements in pain and mobility at eight weeks than rest with a cervical collar, a support worn around the neck.²¹ This finding supports an active approach following injury assessment; it does not provide a timeline for full recovery.²¹ Your healthcare professional will help you choose the right movements, their frequency, and how to progress.

When to seek urgent care?

A sudden, extremely severe headache requires urgent evaluation. Call 911 if it is accompanied by signs of a stroke—a condition that interrupts blood flow to part of the brain—or if the person loses consciousness. Sudden signs of a stroke require calling 911 even without a headache and even if they go away.

• A sudden, extremely intense headache, or the worst headache of your life
• Weakness or numbness in the body or face, especially on one side
• Difficulty speaking or understanding, or a new difficulty walking or maintaining balance
• Double vision or vision loss
• A headache accompanied by a high fever, a stiff neck, or severe sensitivity to light
• Loss of consciousness, sudden confusion, or seizures—uncontrollable, repeated body movements

These signs may indicate a serious problem. Don’t wait for a physical therapy appointment. After a concussion, a severe headache or one that gets worse also warrants emergency care, as noted in the advice sheet from INESSS, the Quebec agency that evaluates health care²². Jaw pain while chewing combined with a headache, or a headache accompanied by a tender scalp, also requires urgent medical attention. See the NHS’s warning signs for headaches²³ and the signs of a stroke²⁴ to understand these situations.

How can Physioactif help you?

Physioactif offers assessment and treatment for jaw or neck pain, certain types of dizziness, and difficulties following a concussion. The physical therapist selects the tests and treatment plan based on your symptoms, activities, and goals.

• Assessment of Your Symptoms and the Factors Contributing to Your Pain
• TMJ treatment using manual techniques and exercises
• Exercises or maneuvers suitable for certain types of dizziness and balance disorders
• Treatment for cervicogenic headaches
• Program for Resuming Activities After a Concussion

You can see a physical therapist at a private clinic in Quebec without a doctor's prescription. However, your insurance provider may require a prescription for reimbursement, as specified by the Quebec Professional Order of Physical Therapy²⁵. If you’re experiencing head or jaw pain, or persistent dizziness, our team can assess your needs and provide support.

What studies does this page draw on?

This page is based on studies of jaw pain, headaches, dizziness, concussions, and neck injuries. The numbers below correspond to the references in the text. PubMed is a public database of scientific health references. Its entries include the references and, when available, the abstract; access to the full text depends on the publication.

1. Wright EF. Patterns of referred craniofacial pain in patients with temporomandibular disorder. J Am Dent Assoc. 2000;131(9):1307-15. ↩ Back to text
2. National Institute of Dental and Craniofacial Research (NIDCR), United States. TMD (Temporomandibular Disorders). ↩ Back to text
3. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1(1):31-46. ↩ Back to text
4. Bogduk, N. "The Anatomical Basis for Cervicogenic Headache." J Manipulative Physiol Ther. 1992;15(1):67-70. ↩ Back to text
5. Piovesan EJ, Kowacs PA, Oshinsky ML. Convergence of cervical and trigeminal sensory afferents. Curr Pain Headache Rep. 2003;7(5):377-83. ↩ Back to text
6. Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther. 2007;12(3):256-62. ↩ Back to text
7. Paquin JP, Dumas JP, Gérard T, Tousignant-Laflamme Y. A perspective on the use of the cervical flexion-rotation test in the physical therapy management of cervicogenic headaches. Arch Physiother. 2022;12(1):26. ↩ Back to text
8. International Headache Society. ICHD-3: 11.2.1 Cervicogenic headache. ↩ Back to text
9. 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. Chiropr Man Therap. 2022;30(1):49. ↩ Back to text
10. National Health Service (NHS), United Kingdom. Tension headaches. ↩ Back to text
11. Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain. 2015;31(2):159-68. ↩ Back to text
12. Kamali F, Mohamadi M, Fakheri L, Mohammadnejad F. Dry needling versus friction massage for the treatment of tension-type headache: A randomized clinical trial. J Bodyw Mov Ther. 2019;23(1):89-93. ↩ Back to text
13. Couto C, de Souza IC, Torres IL, Fregni F, Caumo W. Paraspinal stimulation combined with trigger point needling and needle rotation for the treatment of myofascial pain: a randomized sham-controlled clinical trial. Clin J Pain. 2014;30(3):214-23. ↩ Back to text
14. Kollén L, Frändin K, Möller M, Fagevik Olsén M, Möller C. Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. Aging Clin Exp Res. 2012;24(4):317-23. ↩ Back to text
15. Fife, TD. Benign paroxysmal positional vertigo. Semin Neurol. 2009;29(5):500-8. ↩ Back to text
16. Hilton MP, Pinder DK. The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;2014(12):CD003162. ↩ Back to text
17. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Frequently Asked Questions: Benign Paroxysmal Positional Vertigo (BPPV). Patient information. ↩ Back to text
18. Permenter CM, Fernández-de Thomas RJ, Sherman AL. Postconcussion Syndrome. StatPearls. 2023. ↩ Back to text
19. Mucha A, Fedor S, DeMarco D. Vestibular dysfunction and concussion. Handb Clin Neurol. 2018;158:135-144. ↩ Back to text
20. Schneider KJ, Meeuwisse WH, Palacios-Derflingher L, Emery CA. Changes in Measures of Cervical Spine Function, Vestibulo-ocular Reflex, Dynamic Balance, and Divided Attention Following Sport-Related Concussion in Elite Youth Ice Hockey Players. J Orthop Sports Phys Ther. 2018;48(12):974-981. ↩ Back to text
21. Mealy K, Brennan H, Fenelon GC. Early mobilization of acute whiplash injuries. Br Med J (Clin Res Ed). 1986;292(6521):656-7. ↩ Back to text: 1st, 2nd citations
22. Mild Traumatic Brain Injury (Concussion). Brochure. National Institute of Excellence in Health and Social Services (INESSS). ↩ Back to text
23. National Health Service (NHS), United Kingdom. Headaches. ↩ Back to text
24. National Health Service (NHS), United Kingdom. Symptoms of a stroke. ↩ Back to text
25. Quebec Professional Order of Physiotherapy. Physical Therapy: How Does It Work? OPPQ. ↩ Back to text

Our physical therapists defined the research strategy, plan, and clinical content of this article. An AI tool assisted with the literature review and text editing to ensure consistency in content and writing style.