Here’s something you might find surprising: the official rules for diagnosing a cervicogenic headache — that’s a headache coming from the neck — weren’t written by people who actually treat neck problems every day. Neurologists wrote them.
Now, neurologists are brilliant in their own field. They’re experts in the brain, nerves, and complex neurological conditions. But neck-related headaches are a musculoskeletal problem — meaning they involve joints, muscles, and movement. That’s the everyday work of physiotherapists, chiropractors, osteopaths, and manual therapists.
It’s a bit like asking a heart specialist to write the rulebook for knee injuries. Both are excellent doctors, but only one specialises in knee care.
Why does this matter for you?
Because the way the “rulebook” is written shapes how headaches get diagnosed, and whether people receive the proper treatment.
The Neurologist-written criteria focus on what can be ruled out with scans and neurological tests. But they don’t pay much attention to the neck itself, things like subtle stiffness, joint restrictions, or when your headache is triggered (or eased) by moving the neck.
That means some people with a genuine neck-driven headache are told they don’t “fit the definition.” And if it doesn’t fit the definition, they often miss out on care that could actually help.
The bigger picture
To make things trickier, migraine and neck headaches often overlap. Neurologists even acknowledge this. But without a skilled hands-on assessment of the neck, that overlap is seen as a “mystery”, instead of what it really is: the brain and the neck sharing the same pain pathways.
A way forward
The solution is simple, common sense: the people best trained to examine the neck – musculoskeletal clinicians – need to be part of writing the rules. Neurologists and experienced, skilled musculoskeletal clinicians should work together.
