The headache starts at the back of your neck and finishes behind your eye.

CERVICOGENIC HEADACHE

Cervicogenic headache is a headache that starts in the neck and is felt in the head. It is not migraine, and it responds to different things. The most common reason it goes untreated for years is simple. Nobody examined the neck of somebody complaining of headache.

What does a cervicogenic headache feel like?

• Side-locked. Almost always the same side every time, without switching.
• Starts at the back. It begins at the back of the head or just below it (occipital or suboccipital onset). It spreads forward to the temple, the forehead and behind the eye.
• Provoked by neck movement or posture, and by held positions, rather than by the classic migraine triggers.
• Restricted neck movement on exam, usually turning (rotation), on the side with symptoms.
• Reduced or absent nausea, light sensitivity (photophobia) and sound sensitivity (phonophobia) compared with migraine. Mild versions do occur. Having them does not rule it out.
• Relieved by anesthetizing a cervical structure (numbing a part of the neck), which is the confirming step.

Why does a neck problem cause a headache?

The trigeminocervical nucleus is the anatomical explanation. It is worth understanding, because it makes the whole thing make sense. Sensory input (nerve signals) from the upper three cervical nerve roots meets input from the trigeminal nerve (the main nerve of the face and forehead). They meet in the same region of the brainstem.

Once those signals meet, the nervous system cannot fully tell where they came from. So a problem at C2-3 is felt in the area the trigeminal nerve supplies: the forehead, the eye, the temple. The pain is truly felt in the head and truly generated in the neck.

What causes cervicogenic headaches?

The C2-3 facet joint is the most common source. Its referral pattern (where it sends pain) reaches the back and top of the head. The C1-2 lateral atlantoaxial joint is next. It is a distinct target that needs a distinct technique — see atlanto-axial injection. The upper cervical discs and the greater occipital nerve contribute in some people.

The C2 dorsal root ganglion (a cluster of nerve cells at that level) has been described as a central hub for this problem. That is a useful way to see why several different structures at that level all cause a similar headache.

Why it gets treated as migraine for years

Because it is treated by whoever the patient reaches, and a headache complaint goes to headache services. Preventives get tried. They partly work, because most things partly work. And the neck is never examined.

The tell is a headache that fits a pattern. It has not responded well to two or three adequate preventive trials. It is reliably one-sided. And it is worse after a long drive or a day at a desk. That combination deserves a neck exam before a fourth medication.

How do you get rid of a cervicogenic headache?

Confirmation comes from numbing the suspected structure. Depending on the pattern, that is a medial branch block at C2-3, an atlantoaxial injection, or a greater occipital nerve block. A headache that goes away when a specific structure is numbed has been located.

Where blocks confirm a facet source, radiofrequency neurotomy is the durable option. Where the occipital nerve carries it, the blocks and the segment upstream are addressed. Physical therapy aimed at the upper cervical segments has a real role. It is not an afterthought.

Botulinum toxin belongs elsewhere. It is a chronic migraine indication, not a cervicogenic one.

What the first appointment looks for

Range of movement measured properly. We pay attention to rotation in flexion (turning the head while it is tipped forward). That position isolates C1-2. Palpation (pressing) of the upper cervical segments to see if it brings on the headache. The sternocleidomastoid and the suboccipital muscles, because both refer pain (send it to another area) into the head. And the greater occipital nerve where it crosses the skull base.

None of that needs equipment. For this diagnosis, all of it tells us more than imaging. If your headache workup has never included someone examining your neck, the workup is incomplete, however thorough it was otherwise.

Why it responds so poorly to what has been tried

Migraine preventives target a mechanism that is not the one making this pain. Analgesia (painkillers) works briefly and encourages overuse. Massage helps the secondary muscle component, but not the joint underneath it.

Look at the pattern: partial, short-lived responses to several reasonable treatments. That pattern is itself a clue to the diagnosis. It usually means the actual generator has not been addressed. It does not usually mean the headache is refractory (does not respond to treatment).

How is cervicogenic headache different from migraine?

It is side-locked and stays on the same side. It starts in the neck or the back of the head and moves forward, not the other way around. It is provoked by neck position and by pressure over the upper cervical segments. And it usually does not come with the full migraine package — the nausea, the light and sound sensitivity, the aura.

Where those features are present alongside it, both diagnoses can be true at once. Treating only the one recognized first is why some people improve halfway and stop.

Why the neck gets skipped

Headache pathways are built around primary headache disorders. Most of them leave out the neck exam. A patient can complete a full headache workup — imaging, bloods, preventive trials — without anybody having put a hand on the upper cervical spine.

What the treatment sequence looks like

Address the muscle layer first, because it is quick, low-risk and often a large share of the problem. Then test the joint layer. If the upper cervical segments bring on the headache, a diagnostic block answers whether they are generating it.

A positive block opens the door to radiofrequency ablation. It gives months rather than weeks and can be repeated. Where the picture points higher, at C1-2, an atlantoaxial injection is the test that reaches a level nothing else does.

What to bring to the first appointment

Bring a headache diary covering a month. Bring the list of preventives already tried, with the doses. Bring any imaging you have. The diary matters more than the imaging. Side-locking, the link to neck position, and the pattern across a week drive the diagnosis.

If you have had partial relief from something, say so and say how much. Partial responses are diagnostic information, not failures. They usually show that one of two contributing problems has been treated.

When a headache is coming from the neck, our physiotherapy program for neck pain works on the tight, guarding muscles at the top of the neck alongside any injection.

What people ask about headache coming from the neck

Can I be seen for neck-driven headaches without a referral?

Yes. No referral is needed to book. Some insurance plans ask for one on file before paying for specialist care, so check yours. If you keep a headache diary, bring it. Why the side the pain starts on matters.

Can neck arthritis cause headaches?

Yes, specifically at the upper segments. C2-3 is the most common generator. Its referral pattern reaches the back and top of the head and behind the eye. Botox for neck and headache.

How do I know it is not migraine?

Side-locked, starts at the back, provoked by neck position, with restricted rotation on exam. And it responds to anesthetizing (numbing) a cervical structure, which migraine does not. What the facet joints actually do.

Can I have both?

Often, and that is why the history is taken carefully. Treating the cervicogenic part often reduces the overall headache burden. That holds even where a primary headache disorder is also present. The occipital nerve block.

Will an MRI show it?

No. Upper cervical degenerative change (the spine breaking down) is common and does not establish the source. This is diagnosed by exam and confirmed by block. The atlantoaxial joint.

Can cervicogenic headache be mistaken for migraine?

Often. A headache goes to headache services, migraine preventives get tried, they partly work, and nobody examines the neck. Those medicines target a different mechanism from the one making this pain. The clue is a headache that fits a pattern. It has not responded to two or three proper preventive trials. It stays on one side. And it is worse after a long drive or a day at a desk.

Does radiofrequency ablation work for cervicogenic headache?

When diagnostic blocks confirm that a facet joint is the source, radiofrequency ablation is the long-lasting option. It gives relief measured in months rather than weeks, and it can be repeated. The block comes first because it proves which joint is making the headache. Without that proof, there is no target to treat.

Does physical therapy help cervicogenic headache?

Yes. Physical therapy aimed at the upper neck joints has a real role and is not an afterthought. The muscle layer is usually treated first, because it is quick, low-risk, and often a large share of the problem. Massage alone helps the muscle part but not the joint underneath. That is why relief from it tends to fade.

What are the red flags for a cervicogenic headache?

Four patterns mean the neck is the wrong explanation and the headache needs same-day care. A new headache after fifty with scalp tenderness, jaw ache while chewing or any change in vision points to giant cell arteritis. A sudden, worst-ever headache belongs in an emergency department. Headache and a stiff neck with fever is treated as an infection until excluded. New one-sided neck pain with a drooping eyelid, a pulsing noise in one ear or any new neurological symptom raises an artery tear. How sudden neck pain is sorted into the harmless and the urgent.

Do cervicogenic headaches ever go away?

They do once the structure producing them is found and treated, which is the step most people never reach. Without it, the usual story is years of partial relief from medicines aimed at migraine. When a block confirms the joint, radiofrequency treatment quiets it for months at a time and can be repeated, and upper-neck exercise plus fewer unbroken hours in one position keeps the load off it between treatments. How the working week feeds a headache from the neck.

Related reading

• Cervical facet syndrome
• Atlanto-axial injection
• Occipital nerve block
• Cervical medial branch block
• Temporal arteritis
• Sternocleidomastoid spasm

Headache that begins in the neck is usually a sustained ache. Pain that arrives and passes in seconds is a different mechanism.