A headache whose generator is in the neck. Treat the head and it comes back; treat the neck and it often does not.
How it presents
Pain that begins in the neck or the base of the skull and is referred forward — over the back of the head, behind the ear, sometimes to the forehead or around the eye. It is usually one-sided and stays on that side. It is provoked by neck position or movement, by sustained desk posture, or by pressure over the upper cervical joints, and range of neck motion is often reduced on the affected side.
It frequently follows a neck injury, including whiplash, sometimes months later.
Telling it apart
Against migraine: cervicogenic headache lacks the throbbing quality, the nausea and the light sensitivity, and it is reproduced by neck manoeuvres rather than by movement in general. Against occipital neuralgia: the pain is a deep ache rather than electric jolts, and the marked scalp tenderness is absent.
Overlap is common, and a nerve block is often what separates them.
What we do
An occipital nerve block is usually the first step, both to relieve the pain and to establish where it is coming from. Where the source is the cervical facet joints rather than the occipital nerve, the diagnostic and treatment pathway moves to those joints instead. Physical therapy directed at the upper cervical spine does much of the durable work; injections buy the window in which it becomes possible.