Cervicogenic Headache

How neck problems cause head pain

Nerves from the top three cervical spinal segments (C1 to C3) share a relay center in the brainstem, the trigeminocervical nucleus, with the trigeminal nerve that supplies the forehead and around the eye. Pain signals from the upper neck can therefore be felt in the head. The C2 to C3 facet joint and the C1 to C2 joints are common sources.

Symptoms

• pain on one side of the head, without switching sides
• starts in the neck or back of the head, spreading to the temple, forehead or around the eye
• dull, non-throbbing, moderate pain
• worse with neck movement, awkward positions, or pressing on the upper neck
• reduced range of neck movement
• pain in the shoulder or arm on the same side in some
• mild nausea, light sensitivity or blurred vision, usually less marked than in migraine

Headaches may last hours to days and can become constant.

Causes and risk factors

• Arthritis and degeneration of the upper neck joints (cervical spondylosis)
• Whiplash and other neck injuries
• Disc problems in the upper neck
• Sustained postures: desk work, forward head posture, looking down at phones, sleeping awkwardly
• Occupations with prolonged neck positions, such as hairdressers, drivers and carpenters
• Muscle tightness in the upper neck and shoulders

Cervicogenic headache vs other headaches

Migraine can also cause neck pain, which leads to misdiagnosis.

Diagnosis

Diagnosis is clinical, based on the International Headache Society criteria: evidence of a neck disorder, headache that developed with it, reduced neck movement, worsening with provocative neck maneuvers, and improvement when the neck problem improves or is numbed. A doctor or physical therapist examines neck movement, the upper neck joints, and muscle tenderness. The flexion-rotation test (rotating the head with the neck fully bent) often shows reduced rotation on the painful side.

Imaging (X-ray or MRI) can show arthritis or disc changes but these are common in people without headaches, so they do not prove the cause. MRI is used if there are red flags. Diagnostic nerve blocks that temporarily relieve the headache can confirm the source.

Treatment

Physical therapy

The best-supported treatment. A program combining:

• manual therapy and mobilization of the upper neck joints
• deep neck flexor strengthening (chin tuck exercises)
• shoulder blade and posture exercises
• stretching of tight neck and shoulder muscles

Improvement is often seen within 4 to 6 weeks.

Self-care

• set up your workstation so the screen is at eye level
• take breaks every 30 to 45 minutes to move your neck
• use a supportive pillow that keeps the neck neutral
• apply heat to tight neck muscles
• stay active with regular exercise

Medicines

Acetaminophen (paracetamol) or NSAIDs help some people, following the label dose. Overusing painkillers more than 10 to 15 days a month can cause medication overuse headache. Nerve pain medicines or low-dose tricyclics are sometimes used for chronic cases.

Procedures

• Nerve blocks of the greater occipital nerve or medial branch nerves for diagnosis and short-term relief
• Facet joint injections
• Radiofrequency ablation of the nerves supplying the painful joint, which can give relief for months
• Surgery is rarely needed, only for clear structural problems such as nerve compression

Outlook

Most people improve with physical therapy and posture changes. Symptoms can recur with prolonged poor posture or new strain, so a maintenance exercise program helps. Long-standing cases may need a combination of therapy and procedures.

Frequently asked questions

What does a cervicogenic headache feel like?

It is usually a steady, dull ache on one side of the head that starts in the neck or base of the skull and spreads to the temple, forehead or behind the eye. It worsens with neck movement or posture and comes with a stiff neck.

How do you get rid of a cervicogenic headache?

Physical therapy with neck mobilization and strengthening exercises is the most effective treatment, combined with better posture, regular breaks and heat. Over-the-counter painkillers help in the short term. Nerve blocks or radiofrequency ablation can help persistent cases.

Can bad posture cause headaches?

Yes. Forward head posture and long periods looking down at screens strain the upper neck joints and muscles, which can trigger cervicogenic and tension-type headaches. Adjusting your workstation and taking regular movement breaks often helps.

How is cervicogenic headache different from migraine?

Cervicogenic headache stays on one side, is triggered by neck movement, and has little nausea or light sensitivity. Migraine is usually throbbing, comes in attacks with nausea and sensitivity to light and sound, and can switch sides. Some people have both.

When should I worry about a headache with neck pain?

Seek emergency care for a sudden severe headache, especially after a neck injury or manipulation, or with dizziness, double vision, slurred speech, weakness, fever or a stiff neck. These can signal an artery tear, bleeding or meningitis.