Cervicogenic Headache: Symptoms, Causes & Treatment | Sydney

Cervicogenic Headache — Symptoms, Causes and Treatment

A headache that starts in the neck and spreads forward, usually on one side. Explained by a Sydney neurologist, with clear guidance on when neck pain and headache need urgent attention.

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When Headache and Neck Pain Need Urgent Care

Most headaches that come with neck pain are not dangerous. A few patterns need care the same day, so they come first.

Call 000 — or go to an emergency department — if

a headache comes on suddenly and severely, reaching its worst within a minute (the worst headache of your life)
neck pain or headache follows an injury, even a minor one, and comes with dizziness, double vision, slurred speech, trouble swallowing, unsteadiness, a drooping eyelid, or numbness or weakness of the face, an arm or a leg
headache comes with fever, a stiff neck (you cannot bend your chin to your chest), a rash, confusion or unusual drowsiness
there is new weakness or numbness in both arms or both legs, or new trouble controlling your bladder or bowels
headache comes with a seizure, loss of vision or difficulty speaking

Neck pain with those symptoms after an injury can mean a tear in the wall of an artery in the neck (a dissection), which needs urgent treatment to prevent a stroke. Remember FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 000.

See your GP the same day if

you have a new, severe or unusual neck pain or headache after a neck injury, even with no other symptoms
you are over 50 with a new headache, especially with jaw pain when chewing, a tender scalp, or blurred or double vision
the headache is worse lying down, wakes you from sleep, or is brought on by coughing, sneezing or straining
the headache is much worse when you sit or stand up and eases within minutes of lying flat
it comes with weight loss, fevers or night sweats, or you have had cancer or have a weakened immune system
it is steadily getting worse over days or weeks

If you cannot see your GP that day, go to an emergency department.

Where most people sit

These patterns are uncommon. Most people whose headache seems to start in the neck have migraine, tension-type headache or cervicogenic headache: common, treatable conditions that do not damage the brain or the spine. If you are worried about a brain tumour: a headache that has kept the same pattern for months, with no other symptoms and a normal examination, is very unlikely to be caused by one.

What Is Cervicogenic Headache?

If your headache seems to start in your neck, it is natural to assume your neck is causing it. Sometimes it is. But neck pain is also one of the most common symptoms of migraine; in one study of people with migraine, neck pain during attacks was more common than nausea. So how do you tell a headache that comes from the neck from a migraine that happens to involve it?

Cervicogenic headache (from cervical, meaning the neck, and ‑genic, meaning arising from) is a headache caused by a problem in the neck itself, usually one of the small joints, discs or muscles of the upper neck. It is much less common than migraine or tension-type headache, and it is one of the few headaches where treating the neck treats the headache.

Why is a neck problem felt in the head? Because of how the nerves are wired. The nerves from the top three segments of the neck (C1 to C3) feed into the same relay station in the brainstem (the trigeminocervical nucleus) as the trigeminal nerve, which carries sensation from the forehead, the temple and around the eye. It works a little like two phone lines sharing one switchboard: a signal that starts in the upper neck can be felt behind the eye. Doctors call this referred pain. It is the same reason a problem with the heart can be felt in the arm.

Where most people sit

Cervicogenic headache is a mechanical problem: a joint or muscle that is irritated, not damaged beyond repair. It does not mean the spine is unstable, and it does not harm the brain. Many people improve substantially with the right physiotherapy program, and there are further options for those who do not.

Cervicogenic Headache Symptoms — What It Feels Like

Cervicogenic headache has a typical pattern. No single feature proves it, but together they point to the neck.

One side, always the same side. The pain is "side-locked": it does not swap sides from one headache to the next.
It starts at the back. Pain begins in the neck or at the base of the skull and spreads forward over the head to the forehead, the temple or around the eye.
A steady ache, not a throb. Usually moderate, coming in episodes that last hours to days, or rising and falling on a constant background.
The neck sets it off. Particular movements, holding your head in one position (reading, driving, a laptop), or pressing on tender spots at the back of the neck bring on your usual headache.
A stiff neck. Turning or tilting the head is reduced, often on the painful side.
Sometimes a vague ache in the shoulder or arm on the same side.
Migraine-like symptoms are milder. Nausea, or sensitivity to light or noise, can occur but are usually less marked than in migraine.

Neck Headache, Migraine or Tension-Type Headache?

The three can feel alike, and the neck can ache in all of them. These features help tell them apart.

Swipe the table sideways to compare all three →

Feature	Cervicogenic headache	Migraine	Tension-type headache
Side	One side, always the same	Often one side, but can switch sides or affect both	Both sides
Where it starts	Neck or base of the skull, spreading forward	Often the temple or behind the eye; neck pain is common	A band around the head, or the neck
Feels like	A steady, non-throbbing ache	Throbbing or pulsing, moderate to severe	Pressing or tightening, mild to moderate
Brought on by	Neck movement, sustained postures, pressure on the neck	Sleep loss, missed meals, hormonal changes, the let-down after stress, alcohol	Stress, tiredness, poor sleep
Other symptoms	Stiff neck; sometimes a shoulder or arm ache	Nausea, sensitivity to light and noise; sometimes aura	Usually none; no more than mild nausea
Between headaches	Neck movement often stays reduced	Usually completely well	Usually well

Two less common conditions also come up. Occipital neuralgia causes brief, electric, shooting pains in the back of the scalp, along the path of the occipital nerve. Hemicrania continua is a rare, constant headache that stays on one side, like cervicogenic headache, but responds completely to one particular medicine. And headaches can coexist: a person with migraine can also have a neck problem, and then each needs its own treatment. Sorting this out is a large part of what a neurologist does.

Where most people sit

Most people whose headaches involve the neck turn out to have migraine or tension-type headache. That is good news: both are common and treatable, and treating the migraine often settles the neck pain too. The table is a guide, not a diagnosis: the features overlap, and telling them apart is the main job of the consultation.

What Causes Cervicogenic Headache?

The source is almost always in the top three segments of the neck.

Injury. Whiplash from a car accident, a fall or a sports injury. After whiplash, the most common single source of headache is the joint between the second and third neck bones (the C2–3 facet joint).
Wear & tear and arthritis in the small joints of the upper neck, which become more common with age.
Disc problems in the upper neck (less common).
Muscle strain and tender trigger points in the neck and shoulder muscles, which can add to the pain.
Sustained postures. Long hours looking down at a screen or a desk can aggravate it, though posture is rarely the whole explanation.
Rarely: inflammatory arthritis (such as rheumatoid arthritis), infection, a fracture or a tumour in the upper neck, which is one reason the warning signs at the top of this page matter.

A word about scan reports

"Degenerative changes" on a neck X-ray or MRI are very common with age, including in people with no neck pain or headache at all. A report that mentions them does not prove your neck is causing your headaches. And a normal scan does not rule it out either.

How Is Cervicogenic Headache Diagnosed?

There is no blood test or scan that proves cervicogenic headache. The diagnosis rests on three things.

Your story. Where the pain starts, which side, what brings it on, how long it lasts, and whether it began after a neck injury.
The examination. Checking how far the neck moves, and pressing on the joints and muscles of the upper neck to see whether that reproduces your familiar headache, together with a full neurological examination, to make sure nothing else is going on.
Sometimes, a diagnostic block. Guided by X-ray, a small amount of local anaesthetic is placed on the nerve supplying one joint in the upper neck, for example the third occipital nerve, which supplies the C2–3 joint. If your usual headache disappears while the anaesthetic is working, that joint is the source. It is the most reliable test; Dr Granot plans the block and arranges it with a radiologist.

Scans are arranged when there is a warning sign, when the story is unusual, or before a procedure — not routinely. A few weeks of a headache diary (the side, what you were doing, how long it lasted) often makes the pattern clear.

Cervicogenic Headache Treatment

Treatment aims at the source in the neck, and at any migraine or tension-type headache that is part of the picture.

Physiotherapy comes first. The best evidence supports hands-on treatment of the upper neck joints and a specific exercise program that retrains the deep muscles at the front of the neck and the muscles that hold the shoulder blades. In an Australian trial of 200 people with cervicogenic headache, each reduced how often and how badly the headaches came over six weeks of treatment, the two together helped a few more people, and the benefit was still there a year later.
Stay active. Keep the neck moving within comfort, break up long periods in one position, and set your screen at eye level. Heat can ease muscle spasm.
Medicines play a smaller role. Simple pain relief can help for a short time. But taking pain relief on 10 or more days a month for some kinds, or 15 or more for others (your pharmacist can tell you which), can itself cause daily headache (medication overuse headache). If pain persists, your doctor may suggest a preventive medicine of the kind used for other chronic headaches.
Injections, when exercise is not enough. A nerve block (an injection of local anaesthetic) can sometimes ease pain for weeks. Depending on where the pain comes from, Dr Granot plans which to inject — the greater or lesser occipital nerve at the back of the head, the C2 nerve, or the facet joints of the upper neck — and arranges it with a radiologist, so there is no need to see a pain specialist as well. When blocks have shown that the C2–3 joint is the source, radiofrequency neurotomy, which uses heat to switch off the small nerve supplying the joint, can give relief lasting months and can be repeated.
Treat the migraine, if migraine is present. If the "neck headache" turns out to be migraine, neck treatment alone will not settle it, while migraine treatment often will.
Surgery is rarely needed.

Where most people sit

Many people improve substantially with an active physiotherapy program, and many need nothing more. The key is the right diagnosis first: neck treatment for a neck headache, migraine treatment for migraine — and both when both are present.

When to See a Neurologist About Neck Pain and Headache

You are not sure whether it is a neck headache, migraine or something else
Headaches on more days than not, or you are using pain relief several days a week
Headache that began after a neck injury or whiplash
No real improvement after 6–8 weeks of physiotherapy
A headache that always stays on the same side
A new headache after about 50 (after urgent care, if any of the warning signs applied)
You want a clear diagnosis and a plan

A consultation involves a detailed history, a neurological examination and a plan: working out which headache, or headaches, you have, arranging a scan or a diagnostic block when the result will change what happens next, and coordinating treatment with your GP and your physiotherapist. Dr Ron Granot trained at Prince of Wales Hospital, Sydney, and sees patients in Bondi Junction. For the wider picture, read our migraine overview.

Frequently Asked Questions

What does a cervicogenic headache feel like? +

Usually a steady, non-throbbing ache on one side of the head — always the same side — that starts in the neck or at the base of the skull and spreads forward to the forehead, the temple or around the eye. Neck movements, holding the head in one position, or pressure on the upper neck typically bring it on, and the neck is often stiff. Nausea and sensitivity to light can occur but are usually milder than in migraine.

What causes cervicogenic headache? +

A problem in the upper neck — most often one of the small joints between the top three neck bones, less often a disc or the muscles. Whiplash and other neck injuries are common causes; after whiplash, the joint between the second and third neck bones is the most common single source. Age-related wear can also be responsible. Rarely, inflammatory arthritis, infection, a fracture or a tumour is the cause.

What is a red flag for a cervicogenic headache? +

Call 000 for a sudden, severe headache that peaks within a minute; neck pain or headache after an injury together with dizziness, double vision, slurred speech, trouble swallowing or weakness; headache with fever and a stiff neck; or new weakness or numbness in both arms or both legs, or new trouble controlling your bladder or bowels. See a doctor the same day for a new headache after 50, a headache that is worse lying down or with coughing, or one that is steadily getting worse.

How do you get rid of a cervicogenic headache? +

The best-supported treatment is physiotherapy: hands-on treatment of the upper neck joints and a specific exercise program for the deep neck and shoulder-blade muscles, usually combined; in an Australian trial the benefit lasted at least a year. Staying active and breaking up long periods in one posture also help. When that is not enough, a nerve block, or radiofrequency treatment of the nerve supplying the painful joint, can give longer relief. If migraine is part of the picture, it needs its own treatment.

Is cervicogenic headache dangerous? +

No. It comes from an irritated joint or muscle in the neck and does not damage the brain or the spinal cord. What matters is making sure the diagnosis is right, because a few serious conditions — a tear in an artery in the neck, an infection, or pressure on the spinal cord — can also cause neck pain with headache. They usually come with other warning signs, which are listed at the top of this page.

Is there a test for cervicogenic headache? +

No blood test or scan can prove it. The diagnosis is made from your history and an examination that reproduces your familiar headache from the neck. The most reliable confirmation is a diagnostic block: guided by X-ray, local anaesthetic is placed on the nerve supplying one joint in the upper neck, and if your usual headache disappears while the anaesthetic works, that joint is the source. Scans are used to rule out other causes when needed.

Can a cervicogenic headache feel like migraine? +

Yes, and the two are often confused. Neck pain is common in migraine, and cervicogenic headache can bring mild nausea or light sensitivity. The clues that point to the neck: the pain stays on one side, starts at the back, is brought on by neck movement or pressure, and comes with a stiff neck. Some people have both, and then each needs its own treatment.

How long does a cervicogenic headache last? +

Episodes typically last hours to days, and for some people the pain becomes almost constant, with flare-ups after particular movements or postures. Without treatment it can persist for months or years, especially after an injury. With a targeted physiotherapy program, many people improve substantially within six to eight weeks.

Important: This page is general health information for adults living in Australia and is not a substitute for individual medical advice. If you have a sudden, severe headache, neck pain with dizziness, double vision, slurred speech or weakness after an injury, or a headache with fever and a stiff neck, call 000. Diagnosis and treatment decisions are made on an individual basis with your treating doctor.

Headaches That Start in Your Neck?

Book a consultation with Dr Ron Granot — neurologist with a special interest in headache, Bondi Junction. Ask your GP for a referral, then get in touch.

Book a Consultation

Call Us02 9388 0615

LocationSuite 301, Bondi Junction

Emailreception@eastneurology.com.au

Last reviewed: 17 October 2026 by Dr Ron Granot, FRACP — Consultant Neurologist, East Neurology, Bondi Junction.