Cervicogenic Headache: Symptoms, Causes, and Treatment

If you experience headaches that seem to come from your neck, you may be suffering from a cervicogenic headache, which is a condition that still leaves many headache specialists scratching their heads.

Let’s learn more about this unusual headache and how it’s diagnosed and treated.

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Symptoms

A cervicogenic headache is located on one side of the head, and it is usually triggered by certain head and neck movements or by awkward positions of the head.

Other features of a cervicogenic headache include:

  • Constant, non-throbbing pain that radiates from the back of the head to the front
  • Duration of pain is variable
  • Intensity of pain fluctuates but is generally moderate to severe

In addition to head pain, a person may also experience the following associated symptoms:

  • Neck stiffness
  • Shoulder, neck, or arm pain on the same side of the headache
  • Occasional migraine symptoms like nausea, vomiting, blurred vision in the eye on the same side as the headache, dizziness, and a sensitivity to light and sound

Causes

Scientists and healthcare providers are still puzzled by the precise cause of cervicogenic headaches. That being said, the pain of a cervicogenic headache is felt to be referred from the first three spinal nerves—known as C1–C3 of the upper or cervical spine where your neck lies.

More specifically, certain occupations or head and neck injuries may trigger the development of cervicogenic headaches. Some of these scenarios include:

  • Experiencing whiplash or concussion injuries
  • Engaging in work that requires sustained neck positions like hair-dressing, carpentry, and truck or tractor driving
  • Engaging in hobbies like weight-lifting

Diagnosis

The diagnosis of this condition is challenging, as its symptoms overlap with other types of headaches.

In addition, there is no consensus on exactly how this disorder is diagnosed. In fact, there are two sets of criteria described by different groups: the International Headache Society (IHS) and the Cervicogenic Headache International Study Group (CHISG).

According to the IHS, the diagnostic criteria for cervicogenic headache include two or more of the following:

  • Headache has developed in temporal relation to the onset of the cervical disorder or appearance of a lesion.
  • Headache has significantly improved or resolved in parallel with the improvement in or the resolution of the cervical disorder or lesion.
  • The cervical range of motion is reduced, and the headache is made significantly worse by provocative maneuvers.
  • Headache is abolished following diagnostic blockade of a cervical structure or its nerve supply.

A diagnostic blockade is when an experienced practitioner injects a numbing agent into the area of the neck that is causing the pain. If the headache resolves with numbing of the nerve thought to be responsible, a diagnosis of cervicogenic headache is supported.

Imaging studies, such as X-ray or magnetic resonance imaging (MRI), may or may not show abnormalities. In some people with cervicogenic headaches, lesions or other disorders in the cervical spine or soft tissue are evident in areas of the neck known to cause headaches. It is not required for a diagnosis.

There may also be clinical evidence, for example, pain occurs when a healthcare provider presses on specific points on the neck. However, this, too, is not required for a diagnosis.

In addition, the symptoms should not be better accounted for by another ICHD-3 diagnosis.

Diagnostic Criteria

According to the CHISG, a person with cervicogenic headache must note that their headache is triggered by one of the following:

  • Certain neck movements
  • Sustained, awkward head positions
  • Pressing on the back of the head or the neck

The criteria for cervicogenic headache, according to the CHISG, may also be fulfilled if a person notes limited neck range of motion and same-sided neck, shoulder, or arm pain associated with their headaches.

What Else Could Your Headache Be?

If you suspect your head pain is being referred from your neck, a team of healthcare providers can help differentiate cervicogenic headache from other headache disorders.

Remember, migraines and tension-type headaches (two of the most common types of headaches) cause similar symptoms of neck pain and muscle tenderness in the back of the head or upper neck.

Less common medical conditions, including occipital neuralgia and hemicrania continua, may also mimic cervicogenic headache.

Other more serious, potentially life-threatening medical conditions that may cause neck pain and headache include:

Treatments

For at-home relief, try applying a warm compress or moist heating pad to your neck. Over-the-counter pain relievers, like Tylenol (acetaminophen), Advil (ibuprofen), or Aleve (naproxen), may help take the edge off.

Physical therapy in the form of delicate and graded muscle stretching and manual cervical traction is the initial treatment for cervicogenic headache. If this does not do the trick, a healthcare provider may recommend a steroid or anesthetic injection into the neck.

Radiofrequency neurotomy is a form of therapy in which radio waves are transmitted to the affected nerves through needles that create heat. The heat deactivates the nerve, so it cannot send pain signals to the brain.

Biofeedback, relaxation, and cognitive-behavioral therapy have also been examined as therapeutic options. Surgery is the last option for a patient when other treatment modalities fail.

High-velocity cervical manipulation techniques are not recommended for the treatment of cervicogenic headache, due to the risk of dissection of an artery in the neck and vertebrobasilar stroke.

A Word From Verywell

Due to the controversy, as well as complexity surrounding the diagnosis of this disorder, a team of practitioners is usually needed to make the diagnosis of cervicogenic headache. Regardless, if you believe your neck is the source of your headache, speak with your healthcare provider so you can undergo a proper evaluation.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. International Headache Society. IHS Classification ICHD-3. 11.2.1 Cervicogenic headache.

  2. Sjaastad O, Fredriksen TA, Pfaffenrath V; Cervicogenic Headache International Study Group. Cervicogenic headache: diagnostic criteria. Headache. 1998;38(6):442-445. doi:10.1046/j.1526-4610.1998.3806442.x

  3. Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 6(3):254–266.

  4. Manchikanti L, Knezevic NN, Knezevic E, et al. A systematic review and meta-analysis of the effectiveness of radiofrequency neurotomy in managing chronic neck pain. Pain Ther. 2023;12(1):19-66. doi:10.1007/s40122-022-00455-0

  5. Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev. 2017;6(1):64. doi:10.1186/s13643-017-0458-y


By Colleen Doherty, MD

 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.

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