A headache generated by the neck. It is often misdiagnosed as migraine and treated that way. That is why it does not respond.
What is a cervicogenic headache?
The upper three cervical nerves (the nerves at the top of the neck) share a pathway with the trigeminal nerve, the main nerve of the face and head. So the brain reads neck signals as head pain.
It is often a result of whiplash and injury to the upper cervical facets (the small joints at the back of the neck).
What does a cervicogenic headache feel like?
- Pain starting at the base of the skull and spreading forward, usually to one side.
- Almost always the same side. Migraine often switches sides.
- Set off or made worse by neck movement or holding one posture.
- Less ability to turn the neck toward the painful side.
- Usually without the nausea, aura and light sensitivity typical of migraine.
How are cervicogenic headaches treated?
- Occipital nerve block, which is both diagnostic and therapeutic.
- Medial branch blocks of the upper cervical facets, and radiofrequency ablation where confirmed.
- Physical therapy for the upper cervical segments.
To be assessed, call us or request an appointment. If this began with a crash or a fall, see accident and injury care.
What usually gets missed
It is labeled migraine far more often than it is diagnosed correctly. The two treatments have almost nothing in common. Triptans and migraine prophylaxis (daily migraine-prevention drugs) do close to nothing for a headache coming from the C2 and C3 facet joints.
Here is what sets it apart. It stays on one side. Neck movement or a held posture sets it off. Turning toward the painful side is limited. There is no aura, photophobia (light sensitivity) or nausea. A diagnostic block of the third occipital nerve or the upper cervical medial branches settles it for good.
Do cervicogenic headaches ever go away?
Once it sets in, it rarely clears on its own, because the joint or ligament problem underneath is still there. It does respond well to treatment aimed at the neck.
Where blocks confirm the upper cervical facets, radiofrequency ablation of the third occipital nerve gives many months of relief. Patients with years of failed migraine treatment often improve within weeks once the target is right.
When this becomes urgent
A headache that hits full strength within seconds, the worst headache of your life, or headache with fever, neck stiffness, rash, vision loss or new neurological signs is not cervicogenic. It needs emergency assessment.
What causes cervicogenic headaches?
Cervicogenic headache starts in the upper cervical spine. Most often the source is the joints between the skull and the first three neck segments. The pain is sent into the head because neck and trigeminal sensory pathways meet in the brainstem. That meeting point is why a neck problem is truly felt as a headache, not just alongside one.
What it gets confused with
The pain usually stays locked to one side. Neck movement or a held posture sets it off. The neck does not move as far as it should. And it lacks the nausea and light sensitivity typical of migraine. It responds to treating the neck. Diagnostic blocks of the joints or nerves involved both confirm the source and give relief.
How we approach it here
The first task is naming the structure at fault, not the symptom. That means an exam built around bringing on your pain and then relieving it. We review any imaging for what it does and does not show. Where the picture points somewhere specific, a targeted block confirms it. Treatment follows the answer instead of coming before it.
Frequently asked questions
How do I know it is my neck and not migraine?
Pain locked to one side, set off by neck movement or posture, with limited neck motion and little nausea or light sensitivity, points to the neck. A diagnostic block confirms it.
The detail is in Occipital Nerve Block.
Will migraine medication help?
Usually not, if the source is the neck. That lack of response is a clue in itself. It is often what leads to a second look.
What is a red flag for a cervicogenic headache?
A headache that peaks within seconds, the worst headache of your life, or a headache with fever, neck stiffness, a rash, loss of vision or new neurological signs is not cervicogenic. Those signs need emergency assessment, not a clinic visit. A true cervicogenic headache starts at the base of the skull, stays on one side and tracks with neck movement or posture.
What can be mistaken for a cervicogenic headache?
Migraine is the usual mix-up. A neck-generated headache is labeled migraine far more often than it is diagnosed correctly. The clues that separate the two: the pain stays on the same side, neck movement or a held posture sets it off, turning the head is limited on the painful side, and there is no aura, light sensitivity or nausea.
What is the outlook for a cervicogenic headache?
Once it is established, it rarely clears on its own, because the joint or ligament problem underneath is still there. It does respond well to treatment aimed at the neck. Where blocks confirm the upper cervical facets, radiofrequency ablation of the third occipital nerve gives many months of relief. People with years of failed migraine treatment often improve within weeks.
Sources
- Piovesan EJ et al. Cervicogenic headache – How to recognize and treat. Best practice & research. Clinical rheumatology, 2024. PubMed 38388233
- Lefel N et al. 11. Cervicogenic headache and occipital neuralgia. Pain practice : the official journal of World Institute of Pain, 2025. PubMed 39219023
- Jull G. Cervicogenic headache. Musculoskeletal science & practice, 2023. PubMed 37301672
- Verma S et al. Cervicogenic Headache: Current Perspectives. Neurology India, 2021. PubMed 34003165
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.