Cervicogenic headache: when your headache starts in your neck

It starts as a dull ache at the base of your skull, creeps over one side of your head, and settles behind your eye by mid-afternoon. Turning to check your blind spot feels stiff. If that sounds familiar, your headache may be coming from your neck.

This type of headache, called a cervicogenic headache, is common and very treatable. In this article we explain what it is, how it differs from other headaches, which warning signs need a doctor, and how our Byron Bay team can help you get on top of it.

There’s more than one kind of headache

Headaches are one of the most common health complaints worldwide. The International Headache Society classifies many types, including [1]:

• Migraine, with or without aura
• Tension-type headache
• Cluster headache
• Medication-overuse headache
• Cervicogenic headache, which is caused by a problem in the neck

Each type is managed differently, so getting the right diagnosis matters.

What is a cervicogenic headache?

A cervicogenic headache is pain felt in the head that is referred from structures in the upper neck, usually the joints, discs or muscles around the top three vertebrae [1][2]. The nerves from these levels share pathways with nerves that supply the head, so the brain can interpret neck pain as head pain.

Common contributors include:

• a previous neck injury, such as whiplash
• long periods in one position, such as desk work, driving or looking down at a phone
• awkward sleeping positions or an unsupportive pillow
• jaw tension or clenching

Common signs

Cervicogenic headaches often have a recognisable pattern [1][2]:

• usually one-sided, starting at the back of the head and spreading forward
• pain triggered or made worse by neck movements or sustained postures
• reduced neck movement, particularly turning
• tenderness at the base of the skull
• sometimes shoulder or arm discomfort on the same side

Migraines and tension-type headaches can overlap with these symptoms, and some people have more than one type of headache. That’s another reason a careful assessment is worthwhile.

When to see a doctor first

Most headaches aren’t dangerous, but some need prompt medical care. See your GP, or go to the emergency department if severe, if you have [5]:

• a sudden, severe headache ("worst ever" or "thunderclap")
• a headache after a head injury or with signs of concussion
• fever, a stiff neck or a rash with your headache
• vomiting, confusion, blurred or double vision, weakness, numbness or trouble speaking or swallowing
• headaches that are new and steadily getting worse, especially if you’re over 50

What does the evidence say about treatment?

The good news is that cervicogenic headache responds well to physical care. A landmark Australian randomised trial found that manual therapy and specific exercises for the deep neck and shoulder-blade muscles each reduced headache frequency and intensity, and the benefits were maintained at 12 months [3]. Combining the two was at least as effective as either alone.

Reviews of the evidence support this hands-on plus exercise approach, while noting that diagnosis needs care and more research is still needed [2][4].

How we can help at Retrain Health

Our osteopaths see neck-related headaches every week. Your appointment may include:

• A detailed history and examination to work out whether your headache is likely coming from your neck, and to screen for anything that needs medical referral.
• Assessment of your neck, upper back, shoulders and jaw, as well as your work set-up, sleep position and daily habits.
• Gentle hands-on treatment such as soft tissue techniques, joint mobilisation and, where appropriate and with your consent, manipulation. Some people also find remedial massage a helpful addition.
• Targeted exercises to strengthen the deep neck flexors and postural muscles, which can be built on through exercise rehabilitation.

If your jaw is part of the picture, our jaw pain and TMJ page has more information.

Things you can try at home

• Break up long positions. Set a reminder every 30–45 minutes to stand, roll your shoulders and look around. Our desk work and health guide has more ideas.
• Try heat. A warm pack on the neck and shoulders can ease muscle tension.
• Look at your pillow. Aim for one that keeps your neck roughly level with the rest of your spine in your usual sleeping position.
• Gentle chin nods. Sitting tall, slowly nod your chin down as if saying "yes", then return. Keep it comfortable and do 10 repetitions, two or three times a day.
• Self-release. Use your fingertips to apply gentle, comfortable pressure (around 5/10) to tender spots at the base of your skull for 20–30 seconds.
• Medication: if you’re using pain relief, talk to your GP or pharmacist, as frequent use of some pain medicines can itself lead to headaches [1].

If any exercise increases your headache, stop and get it checked.

Less headache, more living

If headaches keep interrupting your work, sleep or weekend plans, let’s find out what’s driving them. Book an appointment with our Byron Bay osteopaths, or call us on (02) 6680 7447 if you’d like to talk it through first.

This article is general information only and isn’t a substitute for individual advice. Recovery times vary from person to person.