Reviewed by Thian Zu Juin, Registered TCM Practitioner · November 2026
由注册中医师 邓祖君医师审阅

頭痛從後腦勺開始，下午最嚴重？緊張型頭痛與偏頭痛

简单回答：如果你的头痛常从后脑勺、脖子根部开始，像一条带子紧紧箍着头，下午或盯荧幕久了更严重，很可能和颈、上背与肩膀的张力有关，这是最常见的紧张型头痛。偏头痛则常是一侧抽痛，怕光怕吵，有时会想吐。两种都很常见，也常常混在一起。醫道閣会先分辨类型，再用针灸、SRM 结构疗法或内科调理处理。

Short answer: if your headache often starts at the back of the head or the base of the neck, feels like a tight band, and gets worse in the afternoon or after long screen time, neck, upper-back and shoulder tension is a likely part of it. This is the common tension-type headache. Migraine is more often a throbbing pain on one side, with sensitivity to light or noise and sometimes nausea. The two often overlap. At Virtue TCM we first tell them apart, then use acupuncture, SRM structural therapy or herbal medicine.

你是哪一種？

紧张型头痛：两侧或后脑勺闷痛、紧绷，脖子转动卡卡的，按肩膀会很酸，休息或热敷后稍微好一点。
偏头痛：常在一侧、一跳一跳地痛，光线、声音、气味让它更严重，可能会想吐；有些人发作前会看到闪光，也常和月经、睡眠不足、饿过头有关。
颈因性头痛：头痛跟着某个颈部动作出现，例如低头、转向某一边。

Tension-type: a dull, tight ache on both sides or at the back of the head, a stiff neck and sore shoulders, a little better with rest or heat. Migraine: often one-sided and throbbing, worse with light, noise or smells, sometimes with nausea or a visual aura beforehand; often linked to periods, poor sleep or skipped meals. Neck-related headache: pain that follows certain neck movements, such as looking down or turning one way.

為什麼脖子會讓頭痛？

后脑勺下方的肌肉，连着颈椎、上背和肩胛。长时间低头看手机、肩膀往前缩、呼吸浅，这些肌肉一直处在出力状态。更常见的是，问题不在脖子本身：惯用手长年使用让胸廓和上背扭过去，颈胸交界卡住，脖子只好代偿，张力一路传到头。所以只按脖子，常常隔天又回来。

The muscles under the back of the skull connect to the neck, upper back and shoulder blades. Long hours looking down, rounded shoulders and shallow breathing keep them working all day. Often the neck is not where it starts: years of using one hand more turn the rib cage and upper back, the junction between neck and upper back locks, and the neck compensates, passing tension up into the head. That is why massaging only the neck often helps for a day.

醫道閣怎麼處理

醫：把脉看舌，问睡眠、压力、月经和饮食。中医会区分肝阳上亢、气血不足、痰湿等不同体质，偏头痛常需要内科一起调。
形：SRM 先找是哪一条张力在拉住脖子，通常先松上背、胸廓和肩胛，再处理颈部，不用力扳脖子。做完会检查转头、低头、仰头是否两边一样顺。
養：针灸帮助放松、睡眠，再加上一两个简单的日常习惯，例如荧幕高度和每 45 分钟起身一次。

Assess: pulse and tongue, plus sleep, stress, periods and diet. TCM looks at different patterns, and migraines often need herbal medicine too. Structure: SRM looks for the line of tension holding the neck, usually freeing the upper back, ribs and shoulder blades before the neck itself, with no forceful neck cracking. We check turning, looking down and looking up before you leave. Recover: acupuncture for relaxation and sleep, plus one or two simple habits such as screen height and getting up every 45 minutes.

第一次來會做什麼？

问诊约 15 分钟：头痛多久了、在哪个位置、什么时候发作、有没有吃止痛药、睡眠与压力，也会把脉看舌。之后医师会说明建议的调理方式。初诊问诊 RM60（带 X 光、血液或其他报告 RM100），复诊 RM30；疗程费用另计，开始前会先说明。

A consultation of about 15 minutes covers how long you have had headaches, where and when they come, any painkillers you take, and your sleep and stress, plus pulse and tongue. Your practitioner then explains what they suggest. First consultation RM60 (RM100 if we review X-rays, blood tests or other reports), follow-up RM30; treatment is priced separately and explained before anything starts.

這些頭痛請立刻看西醫

突然、剧烈、这辈子最痛的头痛；头痛伴随发烧、脖子僵硬、皮疹；说话不清、一侧手脚无力、脸歪、视力突然改变；头部撞击后的头痛；50 岁以后才开始的新头痛，或头痛模式明显改变，请立刻到医院或急诊。

Go to A&E straight away for a sudden, severe “worst ever” headache; headache with fever, a stiff neck or rash; slurred speech, weakness on one side, a drooping face or sudden vision change; headache after a head injury; or a new headache pattern after age 50.

延伸閱讀

颈肩痛调理 Neck & Shoulder Pain

肩膀按完松了，隔天又硬回来

针灸 Acupuncture

SRM 系统还原手法‧结构疗法

个人情况因人而异，疗程建议需经问诊与医师评估后决定。本文不能取代医疗诊断。
Individual conditions vary. Recommendations follow consultation and practitioner assessment. This article does not replace a medical diagnosis.

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