Understanding Neck Pain & Cervicogenic Headaches (CH)

Headaches happen for many different reasons. More often than not, it can be hard to determine the type and cause of a given headache. Sometimes, a headache will affect other areas of the body, such as the upper spine, or cervical region.

A cervicogenic headache (CH) feels very similar to a migraine, so they are easy to misdiagnose. That said, there is one major difference between the two. A (CH) stems from a problem in the cervical spine, whereas migraines arise from the brain. Stress, tiredness, eye strain and trauma can all cause headaches. A (CH) is different in this regard, as they are caused by problems with the neck muscles, bones, or nerves. Although a patient may report pain from the head, it doesn’t necessarily start there. With a (CH), the pain is actually referred pain from another location in the body.

Symptoms of Cervicogenic Headaches (CH)

Numerous pain-sensitive structures exist both in the back of the head and the upper neck. The junction where the base of the skull and the neck meet have regions that are pain-generating. These regions include the joints, the lining of the cervical spine, ligaments, cervical nerve roots, and some vertebral arteries. There are two common pain-related complaints with a cervicogenic headache. Namely, many report pain stemming from a sudden movement of the neck. In other cases, patients report pain when the neck remains in a stationary position for a long period of time.

Other symptoms may include:

  • A stiff neck
  • Pain surrounding the eyes
  • Discomfort caused by coughing or sneezing
  • Pain on one side of the head/face
  • Steady pain that doesn’t throb
  • Pain attacks that last for hours or days
  • Pain that stays in one spot

Although a (CH) and a migraine are two different types of headaches, some symptoms can be compared. Many people experience:

  • Nausea
  • Vomiting
  • Shoulder pain
  • Bright light sensitivity
  • Noise sensitivity
  • Blurry vision

In some instances, a person can have a migraine and a (CH) at the same time. In cases like this, it can be very hard to give an accurate diagnosis.

Causes of Cervicogenic Headaches (CH)

We know that a (CH) stems from problems in the neck. Because of this fact, different conditions can trigger this kind of pain. Such conditions include whiplash injuries, osteoarthritis, and prolapsed discs.

Playing sports and falling down can also cause injury to the neck, leading to a (CH). People in certain jobs–such as truck drivers, carpenters, and hair stylists–are prone to developing a (CH). This is because of the way that they hold their heads while working. “Forward head motion” is what doctors call this position. It describes a posture where the individual holds the head out in front of the body. This puts extra strain on the neck and upper back, and over time, may lead to a (CH). Similarly, falling asleep in an awkward position can cause these types of headaches. This normally occurs when a person falls asleep while sitting up in bed or in a chair. In some cases, a pinched nerve may also result in a (CH).

Affected Nerves

Doctors and scientists still have trouble explaining the exact cause of a (CH). While this may be, pain from this condition is referred to the first three spinal nerves (C1-C3). The location of all of these nerves are in the upper neck.

The suboccipital nerve (posterior ramus of C1) supplies the atlanto-occipital joint with nerves. Because of this, an injury involving this joint may result in a potential source of pain in the occipital region.

Trauma or pathological changes in the occipital joints of the C2 nerve can cause deep or dull pain. This pain can also radiate to other regions. These regions include the occipital, temporal, frontal, periorbital, and parietal regions. Furthermore, It is not uncommon for patients to feel a shock-like pain superimposed over the constant pain. It is presently believed that C2 neuralgia is caused by the compression of the C2 spinal nerve.

An existing pathological condition or injury can cause pain from the C2-3 zygapophyseal joint. Injury to this region is a common cause of (CH). Additionally, most (CHs) that appear after a whiplash injury resolve within a year of the trauma.

Though uncommon, treatments to the C5-6 spinal levels can sometimes alleviate chronic headache pain. This is, however, not often identified as a cause of (CHs).


As previously mentioned, diagnosing a (CH) can be challenging. This is because it shares symptoms with other types of headaches. Not only that, diagnostic approaches on this disorder are widely debated by the medical community. Presently, there are two sets of criteria described by two different groups. One set of criteria is published by the International Headache Society (IHS) and the other is from the Cervicogenic Headache International Study Group (CHISG).

According to the (IHS), one of the three signs must be present for a (CH) diagnosis:

  • Imaging Sign: Evidence of an abnormality consistent with headache causation must be shown by an MRI or CT scan.
  • Clinical Sign: Such as a patient feeling pain when a doctor puts pressure on the neck joints
  • Positive Diagnostic Blockade: A (CH) diagnosis is supported if a patient feels relief from a nerve block injection into the neck.

According to the (CHISG), a person with a cervicogenic headache must have one of the following headache triggers:

  • Sustained, awkward head positions
  • Specific neck movements
  • Pressing on the neck or the back of the head

Additionally, this criteria may be fulfilled if a person experiences limited neck range of motion. Same-sided shoulder, neck, or arm pain related to headaches is also an acceptable trigger.

Notify a doctor immediately if the headache gets worse over a period of time. Additionally, you should contact a doctor if a fever develops or if the headache results from trauma. These signs may indicate another type of health problem that needs attention. Also, a blood test is sometimes necessary to make sure that the problem isn’t from a pain-causing disease. Sometimes, the headache may come on all of a sudden, or is very painful and causes dizziness. Get emergency medical care immediately in such cases.


Treatments for (CH) pain are as follows:

  • Pain Relievers: NSAIDs such as ibuprofen or aspirin may lessen the pain. Muscle relaxants are also commonly used for (CH) treatment.
  • Spinal Manipulation: A mix of joint movement, massage, and chiropractic care may be used by a specialized practitioner to treat (CHs).
  • Surgery: Depending on the severity of the condition, a doctor may recommend a minimally invasive surgical procedure to relieve nerve pressure. For example, a person with degenerative disc disease may find headache relief from a cervical nucleoplasty. Sometimes, radiofrequency neurotomy is used as a form of therapy. This involves transmitting radio waves through needles to heat up affected nerves. These cases, however, are rare.
  • Physical Therapy: Stretching and exercising can relieve (CH) pain. A physical therapist will be able to recommend the best exercise for respective patients.
  • Other Options: Relaxation techniques, acupuncture, yoga, and deep breathing can be effective in treating (CH). Doctors also sometimes use biofeedback as a treatment. This method gives live readings of the body’s physiological responses and provides a tool to control them. Generally, biofeedback relies on machines that measure muscle tension, heart rate, and even brain waves to incorporate lifestyle changes.


In some cases, (CHs) are not preventable. Headaches stemming from osteoarthritis are an example as they set in with age. Most preventative measures involve maintaining good posture during mostly stationary activities. Such activities include sleeping, sitting, and driving. A neck brace or posture corrector are cheap yet effective aids for maintaining good posture and are often recommended. If the patient plays sports, it is important to avoid neck and head collisions to prevent trauma to the cervical spine.

Contact Us

If you are experiencing neck pain and accompanying headaches, contact The Advanced Spine Surgery Center in New Jersey. Our multispecialty spine care facility is home to board-certified and fellowship-trained physicians. It is our mission to find the best solutions for patients on a case-by-case basis. Each of our orthopedic surgeons have been recognized by New Jersey Monthly Magazine as a Top Doctor. Additionally, our treatment approaches are very conservative and we always exhaust all non-surgical options first. We help patients suffering from congenital spine conditions, spinal injuries, herniated discs and more. Improve your quality of life today by giving us a call!