What If Your Headache Isn’t Coming From Your Head?
If you’ve been living with persistent headache or migraine that doesn’t respond well to medication, it might be time to consider a possibility that’s often overlooked: your neck could be the source of your head pain.
When the neck is the cause of a headache, it is called Cervicogenic Headache, ‘cervico’ meaning neck, and ‘genic’ meaning origin. It simply refers to headache that comes from the neck. And more specifically, research shows that it originates from the top three spinal segments: C1 (between the base of the skull and C1), C1-2 (between C1 and C2), and C2-3.
How Can the Neck Cause Headache?
The head and upper neck share a nerve system that meets in the lower brainstem. This area acts like a ‘mixing station’ where signals from the head (like the sinuses, scalp, and face) blend with signals from the neck. When something goes wrong in the upper neck, such as joint stiffness, muscle dysfunction, or nerve irritation, the brain can’t distinguish between them. It feels like the pain is coming from the head, even though it’s not.
Think of it like blending apples and blueberries into a juice. If the apples (your neck) are bitter, the whole juice tastes off, but your brain only blames the blueberries (your head). This is why neck-related headache is often mistaken for migraine, tension-type, or even cluster headache.
Could This Be You? Key Patterns of Cervicogenic Headache
Cervicogenic Headache can resemble many other types of headaches. But some telltale signs point to the neck as the true source:
• Your headache is one-sided but can switch sides between attacks, sometimes within the same episode.
• You feel your headache on both sides, but one side is always more intense than the other, and that dominant side can switch.
• Your headache starts on one side and spreads to the other without ever leaving the original side.
• You’ve had a neck injury (like whiplash, concussion, or a fall) in the months before your headaches began.
• Your headache starts in the upper neck.
• Your headache started or worsened after switching to a more sedentary or screen-heavy lifestyle.
• Your headache is brought on by postures, like looking down, slouching, or a poking chin position.
• You feel tightness, discomfort, or ache in your neck and/or radiating to your shoulder or shoulder blade, or used to, even if it’s no longer obvious.
These patterns suggest that the upper neck is not only involved but potentially driving the very reason for your head pain.
It is essential to emphasise that the absence of neck symptoms does not mean your neck is not involved. Consider those who have referred arm or leg pain, without neck and lower back symptoms, respectively, but an issue in the neck or lower back is responsible, i.e., the source of referred pain is not always obvious.
Why Hasn’t Anyone Told Me This Before?
Unfortunately, Cervicogenic Headache is often underdiagnosed. The current medical model sees migraine and other primary headaches as purely neurological, even though their cause is still considered “unknown.” Ironically, this mindset often leads to rejecting the neck as a possible source simply because it doesn’t fit the current paradigm.
But here’s the reality: the nerves in your neck and head do interact. And when neck dysfunction is present, it can cause head pain even if it’s called “migraine.”
You Are Not Imagining This
Many people living with headache instinctively know their neck is involved. But they’re told it’s not because their neck scan is clear, their medication isn’t working, or their diagnosis says otherwise, i.e., if your symptoms resemble migraine, the diagnosis will be “migraine” and therefore it cannot be your neck (even though the cause of migraine is unknown).
As neurologist Dr. Peter Nathan once said to a colleague, “Trust your patient, they are telling the truth. It is up to you to find out why. If your patient tells you (and I paraphrase) that it is their neck, it is, even if you cannot understand it.”[1](p.1912) However, to consider the potential role of neck disorders requires a significant paradigm shift, and moreover, a skilled and experienced examination of the upper neck; respectfully, this is recognised as beyond the scope of Neurologists.[2]
What Can You Do About It?
A thorough examination of the upper cervical spine can help determine whether your headache is originating from the neck. This isn’t a general neck massage, aggressive oscillatory movements or cracking of your joints. Instead, it should be a specific, informed, and hands-on assessment performed by someone trained and experienced in assessing the function of the top three spinal segments.
If this examination can reproduce your headache and, more importantly, resolves by gently sustaining the examination technique/s, this confirms your headache is cervicogenic.
And here’s the good news: Cervicogenic Headache is one of the most treatable types of headache.
Don’t Settle for a Lifetime of Medication
Not every headache is a migraine. And not every migraine is just a migraine. Your neck could be the missing piece, and a skilled assessment or the upper cervical spine could make all the difference.
References:
1. Woolf, C.J., What to call the amplification of nociceptive signals in the central nervous system that contribute to widespread pain? Pain, 2014. 155(10): p. 1911-1912.
2. Becker, W.J., Cervicogenic headache: evidence that the neck is a pain generator. Headache, 2010. 50(4): p. 699-705.
