A headache that starts in your neck

If you’ve ever experienced pain that starts at the base of your skull and spreads to one side of your forehead, it may be a cervicogenic headache. The name for these headaches comes from the Latin word cervix (meaning neck) and the Greek word gen (meaning “to give origin to”).

“These recurrent headaches stem from an underlying problem with the bones and nearby structures of the cervical spine,” says Dr. Sait Ashina, associate professor of neurology and assistant professor of anesthesia at Harvard Medical School, and director of the Comprehensive Headache Center at Beth Israel Deaconess Medical Center. Cervicogenic headaches are often triggered by neck movement, usually in people who have a tender, achy neck with a limited range of motion, he adds.

Who gets cervicogenic headaches, and why?

Cervicogenic headaches account for up to 20% of chronic headaches. They occur more often in women and often arise starting around age 30. Cervicogenic headaches are sometimes mistaken for tension-type headaches or migraines, which can also cause or be associated with neck pain. But those headaches are far more common: in any given year, up to 4% of people have a cervicogenic headache, while about 12% of people have a migraine and up to 38% have a tension-type headache. Known as primary headaches, these headaches are thought to be caused at least in part by factors within the brain or nervous system itself.

In contrast, cervicogenic headaches are secondary headaches, which means they’re caused by an underlying medical condition, Dr. Ashina explains. “Cervicogenic headaches often originate from a problem in the upper cervical spine, which can initiate pain signals along nerves known as C1, C2, and C3,” says Dr. Ashina. Possible causes include a herniated (andamp;ldquo;slipped”) disk, arthritis, or an injury such as whiplash.

Keeping your head in an unnatural position for long periods of time (what doctors refer to as “postural muscle dysfunction”) may also contribute to cervicogenic headaches. For example, hunching over electronic devices such as a smartphone, tablet, or laptop can make your head tilt forward. The resulting pain and stiffness is sometimes called “tech neck” or “text neck.”

What are the symptoms?

The pain of a cervicogenic headache starts at the back of the neck at the base of the skull and radiates to the head and face — usually to the forehead and sometimes behind the eyes, or even to the shoulder and arm. While typically described as one-sided, these headaches may affect both sides of the head. Symptoms that are common with migraines, such as nausea and sensitivity to light and sound, usually don’t occur with cervicogenic headaches. “But some people have both types of headaches, which is one reason cervicogenic headaches can be challenging to diagnose,” says Dr. Ashina.

How are these headaches diagnosed?

Ideally, people with recurrent headaches should see a neurologist who specializes in treating headaches. Primary care physicians often diagnose cervicogenic headaches, but referral to a specialist such as a general neurologist, pain specialist, physiatrist (who specializes in physical medicine and rehabilitation), or orthopedist can be helpful.

Imaging tests such as x-rays, CT, or MRI are typically used to help pinpoint injuries or conditions that affect the cervical spine. “In about 70% of cases, the disorder results from problems with the discs or facets in the C2 and C3 area,” says Dr. Ashina. (Facets are small joints between the vertebrae that provide stability and flexibility.)

The physician will also perform a thorough physical examination, including assessing the range of motion in the person’s neck and checking whether certain movements provoke the headache or make it worse.

Treating cervicogenic headaches

Unlike migraines, cervicogenic headaches may respond well to pain relievers, including acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin). But physical therapy, which includes manual therapy and therapeutic exercises, is also considered first-line treatment for cervicogenic headaches (although it can temporarily make the headaches worse).

According to one study, 72% of people who completed six weeks of physical therapy reduced their headache frequency by 50% or more after a year. Other therapies include injections of steroids or anesthetics, targeted nerve-block procedures, or surgery (but only as a last resort and when the cause is amenable to surgical intervention).

Some people with spinal conditions seek treatment from chiropractors. Those who do should be sure that any manipulation around the neck area is very gentle, with no high-velocity thrusts, Dr. Ashina cautions. These brief but rapid manipulations can lead to a tear in one of the neck’s main arteries — a rare cause of stroke.

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