Everything You Need to Know About Cervicogenic Headaches

When our head hurts, we call it a headache. But there are many different types of headaches, and not all head pain comes from the head. This is important because the cause of a headache often sets the course for the right treatment.

In this article, we discuss the symptoms, diagnosis, and treatment of cervicogenic headaches.

What is a cervicogenic headache?

Cervicogenic headaches are caused by a problem in the neck, not the head itself. “Cervicogenic” means starting from the cervical area of the body, otherwise known as the neck. The cervical area includes the cervical spine (neck bones) and soft tissues (muscles, ligaments, tendons). 

Pain that you feel in one part of the body but actually comes from a different part of the body is called “referred pain.” A cervicogenic headache is referred pain from the neck. 

So how does pain in the neck get “referred” to the head? To understand referred pain, we need to understand a bit about neck anatomy. There are lots of different structures that make up the neck:

• Cervical spine (neck bones)

• Spinal cord and nerves

• Intervertebral discs (cushions between the neck bones)

• Facet joints (between the neck bones)

• Soft tissues (muscles, tendons, ligaments)

The cervical spine protects the spinal cord. Nerves branch off the spinal cord and exit through spaces in between the neck bones to help different parts of the body feel and move. When nerves in the neck become irritated, they can cause pain in different areas of the head.

What causes a cervicogenic headache?

The cause of cervicogenic headaches are problems affecting the cervical spine or spinal nerves. Degenerative disc disease (osteoarthritis) is the most common cause of cervicogenic headache. Aging causes degenerative disc disease. Cervical spondylosis and facet arthropathy also fall under this category.

Other causes include:

• Neck bone fracture or dislocation

• Whiplash

• Infection

• Rheumatoid arthritis

• Tumors (that start in the spine, or spread there)

Experts previously believed (and some still do) that myofascial pain (tight muscles in the upper back or neck) can cause cervicogenic headaches. But according to the International Headache Society, headache due to myofascial pain is a separate diagnosis from cervicogenic headache. 

What are the symptoms of a cervicogenic headache?

Cervicogenic headaches are different for everyone who has them. Typical symptoms include head pain that:

• Starts in the neck and spreads to one side of the head (especially behind the eyes), shoulder, or arm 

• Does not move to the other side of the head or neck

• Worsens when you move your neck or hold your neck in an awkward position

• Is moderate (not severe) and usually not throbbing in nature 

In rare cases cervicogenic headaches may have migraine symptoms, like:

• Nausea and vomiting

• Sensitivity to light (photophobia)

• Sensitivity to sound (phonophobia)

How do you diagnose a cervicogenic headache?

Experts have described two different ways to diagnose cervicogenic headaches. Both ways are valid. Diagnostic criteria from the International Headache Society include both options. 

The two ways to diagnose cervicogenic headache are:

1. Clinical diagnosis: Symptoms (like those listed above) and a thorough physical exam confirm the diagnosis. This diagnosis does not require imaging or other tests.

2. Interventional diagnosis: This involves a nerve block procedure to confirm the diagnosis. Anesthesiologists or pain specialists typically perform nerve blocks in a hospital or surgery center. The provider inserts a small needle into the neck with the help of imaging to guide them. Then they inject a small amount of anesthetic near the structure they believe is causing the problem. This causes temporary numbing. If the headache improves after this procedure, it’s a good sign that cervicogenic headache is the cause. 

Your provider may order imaging tests of the head or neck to find the cause of the headache. Tests may include X-rays, CT, or MRI. But abnormalities in the cervical spine are common, especially as we age. So even people who do not have headaches may have abnormal findings. That means an abnormal imaging finding doesn’t always explain the cause of the headache or require treatment. 

How do you treat cervicogenic headaches?

There are no specific treatment guidelines for cervicogenic headaches. But there are scientific papers that review the available treatment options. These include information about the scientific evidence to support each approach.

To treat a cervicogenic headache, you need to treat the problem in the neck that’s causing the headache. So the best treatment depends on the cause. 

Possible treatments for cervicogenic headache include:

• Physical therapy and/or manual therapy: This is first-choice therapy for many cervicogenic headaches since it has few possible side effects. Physical therapy involves stretching and strengthening exercises. Manual therapy involves hands-on techniques to relieve tension and increase mobility of the neck. A physical therapist does both.

• Transcutaneous electrical nerve stimulation (TENS unit): A provider places pads on the neck, which deliver small amounts of electricity to help with pain.

• Radiofrequency ablation/neurotomy: This procedure uses radio waves to kill a nerve so it stops sending painful signals.

• Steroid injections: A provider injects anti-inflammatory medication (steroid) into the neck to reduce pain.

• Spinal surgery: For some causes of cervicogenic headache, like tumors, this might be the first-choice treatment. For other causes, it’s a last resort. 

When it comes to medications, limited data suggest that pregabalin (a nerve pain medication) may help. Botox injections aren’t effective for cervicogenic headaches. 

What kind of specialist should I see? 

Many different specialists can treat cervicogenic headaches. The first specialist you see might be a: 

• Pain medicine doctor

• Physical medicine and rehabilitation (PM&R) doctor

• Neurologist who specializes in headaches 

For treatment, you might also see a:

• Physical therapist

• Spine surgeon 

• Anesthesiologist

• Interventional radiologist

Why trust our experts?

Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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