Headaches from the neck and \"cervical migraine\": a complete guide

A cervicogenic headache is pain that starts in the neck (its joints, muscles and nerves) and is felt in the head, usually on one side. It's what many people call a "cervical migraine", but it isn't a migraine: migraine has a different, neurological origin. You can have both, and telling them apart comes first, because they are treated differently.

Why the neck can cause a headache

The nerves from the top three vertebrae of the neck share connections in the brainstem with the nerves that carry sensation from the head. So when the joints or muscles at the top of the neck are irritated, the brain can feel that pain at the base of the skull, the temple or behind the eye.

Most common causes

Holding your head forward for long periods at a computer or phone.
Muscle tension from stress.
Previous whiplash or a knock.
Limited movement in the vertebrae at the top of the neck.
Sleeping in awkward positions or on a pillow that doesn't support your neck.

How to tell it apart from migraine

	Cervicogenic headache	Migraine
Where it starts	At the base of the skull, moving up to the forehead or eye	Often at the temple or forehead
Side	Almost always the same side	Can switch sides
What makes it worse	Moving your neck or holding a position	Light, noise, exertion
What comes with it	Neck stiffness, tenderness at the base of the skull	Nausea, sensitivity to light and noise, sometimes aura

If your headaches look more like the migraine column, see your doctor or a neurologist, who can prescribe preventive treatment.

Which treatment has evidence

For cervicogenic headache, combining manual therapy with exercises for the deep neck muscles reduced how often and how badly people had headaches in a clinical trial, with the effect lasting at a year (Jull et al., Spine, 2002). That's what we do at the clinic:

Assessment of how the top of your neck and upper back move, and of your working posture.
Gentle adjustments and mobilisation for the stiffest segments.
Exercises for control and strength of the deep neck muscles, which do the most to keep the pain from coming back.
Advice on screens, breaks and pillows.

Many people feel relief within the first few sessions. If nothing changes within a few weeks, we refer you to your doctor.

When to see a doctor straight away

Go to A&E or your doctor if your headache:

Comes on suddenly and is extremely severe, "the worst of your life".
Comes with fever and a stiff neck.
Comes with weakness, numbness, double vision, confusion or trouble speaking.
Follows a blow to the head.
Is new and different after age 50, or gets worse week by week.

Frequently asked questions

Is "cervical migraine" real? Not as a medical diagnosis. It's the popular name for cervicogenic headache, which is real and starts in the neck.

How do I know if my headache comes from my neck? If it starts at the base of your skull, stays on one side and gets worse when you move your neck or spend hours in one position, it probably has a neck component. We check this at your first visit.

How long does it take to improve? Many people feel relief within the first few sessions. Getting the neck's movement and strength back takes several weeks.

Can I prevent it? Yes: screen at eye level, a break every hour, and a few minutes a day of the exercises we give you.

Does chiropractic help migraine? The evidence is much weaker than for cervicogenic headache. If you have migraine, your doctor should lead the treatment; we can help with the neck tension that sometimes comes with it.