If your headache is reliably brought on by neck position or long desk posture, stays on the same side, and lacks nausea and throbbing, the generator may be in your neck rather than your head.
This matters because treating the head does not fix a neck problem. People cycle through migraine medications for years without touching the actual source.
How cervicogenic headache presents
- Pain that starts in the neck or at the base of the skull and spreads forward — over the back of the head, behind the ear, sometimes to the forehead or around the eye
- Usually one-sided, and it stays on that side — it does not alternate the way migraine can
- Provoked by neck movement or position, or by pressure over the upper neck joints
- Reduced range of neck motion on the affected side
- A deep ache rather than electric jolts, and without the marked scalp tenderness of occipital neuralgia
ICHD-3 (the international classification of headache disorders) requires evidence that the headache comes from a disorder of the cervical spine or the soft tissues of the neck. It lists two ways of showing it. Either the headache develops in time with the neck disorder, or the headache is abolished (fully stopped) by a diagnostic blockade of a cervical structure or its nerve supply.1
That second criterion is the important one. It is the whole reason diagnostic blocks exist for this condition.
Which structures refer pain into the head
The atlanto-axial joint (C1–C2)
The joint that lets you shake your head “no” carries more rotation than any other in the neck. It refers pain to the back of the head and behind the ear. It is often missed, because it sits above the levels most neck imaging and most injections address. An atlanto-axial injection reaches it, under fluoroscopy (live X-ray) with contrast dye to confirm the spot. The vertebral artery and the C2 nerve root sit right next to it, so this one is never done blind.
The upper cervical facet joints
C2–C3 in particular refers pain into the back of the head. Diagnostic medial branch blocks show whether these joints are the source.
The occipital nerves
Not a joint, but the pathway. An occipital nerve block is often the first step because it is quick, low-risk under ultrasound, and tells us something right away.
Why whiplash shows up years later
Cervicogenic (neck-driven) headache often follows a neck injury. The gap between the injury and the headache can be months. People do not connect the two. Neither does the clinician who was not told about the accident. If you have had whiplash at any point, mention it, even if it seems like ancient history.
What the treatment plan looks like
An image-guided block comes first, to find the source. If the block abolishes the pain, you have a target, and the longer-term options become reasonable. If it does not, the diagnosis moves, and you have not wasted months.
Physical therapy aimed at the upper cervical spine does much of the lasting work. Injections buy the window in which that becomes possible. Treating a neck that hurts too much to move gets you nowhere.
Everything here is placed under ultrasound or fluoroscopic guidance. With a diagnostic block, guidance is not an extra. An unguided block that fails tells you nothing, because it may simply have missed.
Common questions
Can neck arthritis on an X-ray prove my headache is cervicogenic?
No. Degenerative changes are extremely common in people with no headache at all. ICHD-3 requires either a link in timing or abolition by a diagnostic block. Imaging findings alone are not enough. See cervicogenic headache treatment.
I get neck pain with my migraines. Does that make them cervicogenic?
Usually not. Neck symptoms are very common during migraine attacks and are part of the migraine itself. The key question is whether neck movement provokes the headache, rather than just coming along with it. See migraine treatment.
What if the block only helps a little?
A partial response is truly unclear, and we treat it that way. It may mean more than one structure is contributing. Or it may mean the targeted structure is not the main generator. See image guidance for why a guided block makes a negative result trustworthy.
Is this the same as occipital neuralgia?
No. Occipital neuralgia is electric, shooting pain with a very tender scalp. Cervicogenic headache is a deeper ache that spreads from the neck and is set off by neck position. They overlap, and a block often separates them — see occipital neuralgia treatment.
Headache that starts in the neck gets treated at the neck, not with another migraine pill. Our cervicogenic headache treatment confirms the source with an image-guided block, usually the same day, at our headache clinic in St. Louis.
Sources
- Headache Classification Committee of the International Headache Society. ICHD-3, 11.2.1 Cervicogenic headache. ichd-3.org