Home / Conditions / Cervicogenic headache
A headache that starts in the neck. The pain is felt in the head, which is why it is so often mistaken for migraine — but the source is the cervical spine, and that changes what treatment works.
Cervicogenic headache is pain referred from a structure in the neck up into the head. It is usually a steady ache rather than a throb, and it is typically side-locked — it stays on the same side of the neck, head or face rather than swapping.
It is a secondary headache, meaning it is caused by something else that came first. That might be an injury — a fracture, a dislocation, a whiplash injury — or an underlying condition such as arthritis. Often it is simply the cumulative effect of posture: a neck held in one position for hours a day.
Because the pain is felt in the head and not always in the neck, it is difficult to diagnose, and it is regularly treated as something it is not.
The nerves from the top of the neck — around the C2–C3 facet joint and the suboccipital muscles — do not run to the brain on their own private line. They converge with the trigeminal nerve, which carries sensation from the face and scalp, at a junction called the trigeminocervical complex.
Because those signals arrive together, the brain cannot always tell which of them started where. A problem in the upper neck is therefore experienced as pain in the head — typically behind the eye, at the temple, or across the side of the skull, on the same side as the neck problem.
This is why painkillers aimed at a headache tend to disappoint, and why treating the neck often resolves something that had been managed as migraine for years.
The three overlap enough to be confused, and they respond to different treatment. These are tendencies rather than rules — but they are what an examination looks for.
| Cervicogenic | Migraine | Tension | |
|---|---|---|---|
| Side | One side, always the same side | Usually one side, can swap | Both sides |
| Character | Steady ache, sometimes intense | Throbbing or pulsing | Tight band, pressing |
| Starts | Back of the head and neck, moves forward | Temple or behind an eye | Across the forehead or scalp |
| Triggered by | Neck movement or sustained posture | Sleep, food, hormones, light | Stress, fatigue |
| Neck | Stiff, reduced range of movement | May ache, but moves normally | Often tight |
They can also coexist. Someone with migraine can develop cervicogenic headache as well, which is one reason a headache that has changed its pattern is worth reassessing rather than treating the same way.
Most people describe a headache alongside neck pain and stiffness, brought on or worsened by particular neck movements. Alongside that:
Left untreated it tends to worsen, and can become chronic and resistant to the painkillers that worked at first.
There is no single test. Diagnosis rests on the history and the examination — what you were doing when it started, where exactly it hurts, and what reproduces it.
Assessment of neck movement, the joints and muscles of the upper cervical spine, and a neurological examination covering sensation, reflexes and nerve function.
Not always needed. Where the pain is unusual, has changed, or the examination raises a question, imaging is used to establish the source and to exclude other causes:
Where the diagnosis is uncertain, anaesthetising the suspected nerve can confirm it: if the headache stops, the neck was the source. This is both a test and, often, the beginning of treatment.
Most people improve without surgery. Treatment usually works through the following, in roughly this order:
Which of these applies depends on what the examination finds, which is why the diagnosis matters more than the label.
A sudden, severe headache unlike any you have had before, a headache with fever and a stiff neck, or one with new weakness, numbness or confusion, needs same-day assessment at an emergency department rather than a clinic appointment.
Yes. Nerves from the upper neck converge with the trigeminal nerve at the trigeminocervical complex, so signals from the two arrive together and the brain can misread which started where. The pain is genuinely felt in the head even though it originates in the neck — see the diagram above.
The strongest clues are that it stays on one side, that neck movement provokes it, and that the neck itself is stiff. But the two can coexist, and an examination settles it more reliably than a symptom list.
Almost certainly not. Surgery is reserved for cases where a nerve is compressed and non-surgical treatment has not worked. Most people are managed with physiotherapy, medication and where needed a nerve block.
No. You can book directly. Bring any scans and reports you already have.
It is common, and it is a reason to have the headache reassessed rather than to increase the dose. Medication that stops working can also start causing headaches of its own.
Headaches (all types) · Migraine · Tension headache · Cluster headache · Neck pain · Whiplash injury · Cervical spondylosis · Cervical radiculopathy
Bring any scans you have. You will leave knowing whether the neck is the source and what the options are.
