Cervicogenic Headache
Cervicogenic headache is a headache that originates from structures in the neck — joints, muscles, nerves or discs — rather than within the brain itself. It’s estimated to account for 15–20% of all chronic headaches, yet is frequently misdiagnosed as tension headache or migraine and treated with medication rather than the real cause.
The right physiotherapy makes a dramatic difference.
How the Neck Causes Headaches
The upper cervical spine (C1–C3) shares nerve pathways with the trigeminal nerve (the main sensory nerve for the head and face). When structures at these levels are irritated — particularly the upper cervical joints — pain signals converge and are interpreted as headache.
Diagnosing It
Key features that suggest your headache is coming from the neck:
- Pain that starts or is reproduced by neck movements or sustained neck postures
- One-sided head pain that doesn’t switch sides
- Pain that starts at the base of the skull and spreads forward
- Stiffness and reduced neck movement during headache episodes
- Tenderness in the upper neck on palpation
- Headache triggered by pressing on specific joints in the upper cervical spine
Symptoms
- Dull, aching head pain, usually one-sided
- Originates at the base of the skull or upper neck, spreading to the forehead, eye or temple
- Often worsened by sustained desk postures, looking down at a phone, or certain sleeping positions
- May include neck stiffness and shoulder pain
- Not typically associated with nausea, visual aura or photosensitivity (which suggest migraine)
Treatment
Upper Cervical Manual Therapy
Joint mobilisation and manipulation targeting the C1–C3 joints is the most evidence-based treatment for cervicogenic headache. Many patients notice significant relief within 2–3 sessions.
Deep Neck Flexor Strengthening
The small stabilising muscles at the front of the neck (deep neck flexors) are consistently weak in people with cervicogenic headache. A targeted retraining program is essential for lasting results.
Postural Rehabilitation
- Screen and workstation ergonomics
- Head and neck position retraining
- Shoulder and thoracic mobility work
Dry Needling
Trigger point dry needling to the suboccipital, upper trapezius and cervical muscles can reduce pain and muscle guarding.
What About Medication?
Analgesics and triptans often have limited effect on cervicogenic headache because they don’t address the mechanical cause. Physiotherapy targets the source.
