People often tell me, “It can’t be coming from my neck – sometimes it’s on the left, and other times it’s on the right.”
That’s a widespread belief. Most people have been told that cervicogenic (neck-related) headache (CGH), headaches that come from the neck, always stay on the same side. If a headache swaps sides, it’s usually called migraine instead.
But here’s the thing: that belief isn’t correct.
I’ve Seen This Pattern Before – In the Lower Back
If you’ve ever had lower back trouble, you might know what I mean. When someone experiences one-sided lower back pain, they often lean off to the other side. A few days later, they might lean the other way, experiencing pain on the opposite side. This is called an alternating lumbar list.
It’s still the same problem, just showing up on different sides. No one says, “Oh, it can’t be your back now because it’s on the other side.”
So why can’t the same thing happen at the very top of your neck, around the joint — the area we know is often involved in neck-related headache?
Not Both Sides – Just One Side at a Time
This is what I often hear:
“My headache starts at the base of my skull and goes behind my eye; it’s always on one side. But sometimes it’s the left, and sometimes it’s the right.”
That’s not “both sides”, and it’s not “vague pain.” It’s still clearly one-sided, just not locked consistently to the same side forever.
And that pattern tells you that your neck is involved.
Why This Matters
Here’s why I think this matters so much:
If we only look for headaches that stay on the same side, people whose pain alternates can be told it’s “not from the neck.” Their neck might never be properly checked, and that means the real cause of their pain could be missed.
But if we recognise that side-changing headaches can still come from the neck, it opens the door to care that might actually help: careful assessment and treatment of the upper neck itself.
A Better Question to Ask
Instead of asking, “Does your headache always stay on the same side?”, I find it much more helpful to ask:
“Does it stay on one side at a time, even if that side sometimes changes?”
or,
“When your headache occurs on the other side, is it exclusively, only, on that side?”
That small change in thinking can make a big difference. It can reveal a pattern that confirms your neck as the real driver of the headache.
Moving Forward
Assumptions are powerful – but they’re not always right. Just like the lower back can play up on different sides at different times, the top of the neck can do the same.
If that’s happening to you, it doesn’t mean your pain is “mysterious” or “all in your head.” It simply tells you the source is in your neck, and that it’s worth being checked skilfully.
