Neck-related headache (cervicogenic)

Overview

A cervicogenic headache is head pain that comes from a problem in the neck. The pain is referred, which means you feel it in your head even though the source is in the bones, joints, muscles, or nerves of the neck.

The pain usually starts at the base of the skull and spreads to one side of the head, sometimes to the forehead or behind the eye. It's less common than tension headaches or migraines and is sometimes mistaken for them.

Symptoms

The headache is usually on one side and tied to neck movement.

• Headache at the back of the head that spreads up one side
• Headache on one side of the head
• Neck pain or stiffness
• Headache worse with neck movement or certain positions

Less common

• Pain spreading to the forehead or behind the eye
• Pain in the shoulder or arm
• Trouble turning the head

How it usually goes

• At first: Pain comes and goes.
• Over time: May become constant if untreated.
• With physical therapy: Many people have far fewer headaches after a few weeks of therapy.

Look up a symptom: Headache

When to get medical care

Causes

Problems in the neck cause it, such as whiplash, arthritis in the neck, a slipped disk, a pinched nerve, strained neck muscles, or poor posture from sitting with the neck bent down.

Does it spread or run in families?

• It isn't contagious. You can't catch it from someone else.

Who is more likely to get it

• Neck injury, like whiplash
• Neck arthritis
• Long hours looking down at a desk or phone
• Being female and age 30 or older

Diagnosis

A healthcare professional asks about your headaches and checks your neck.

Questions you may be asked

• Where the pain starts and spreads
• Whether neck movement or position brings it on
• Past neck injury, like whiplash
• Long hours at a desk or looking down

The exam

They'll check how well your neck moves, look for tender spots, and see whether certain neck movements trigger the headache.

Tests

Tests may include:

• X-ray, CT, or MRI of the neck: To look for arthritis, disc problems, or injury. A normal scan doesn't always rule it out.
• Nerve block: A numbing shot in the neck. If the headache goes away, the neck is likely the source.

Treatment

Treatment focuses on the neck, not just the head.

Self-care

• See a physical therapist for neck exercises and hands-on treatment
• Fix your posture, especially at a desk or on your phone
• Set up your desk so you don't look down for long periods
• Try massage to ease tight neck muscles
• Use a pillow and mattress that support your neck

Medicines

Unlike migraines, these headaches may respond well to common pain relievers.

If pain continues, your healthcare professional may suggest nerve blocks or other shots. Surgery is rarely needed, such as for a pinched nerve.

How it compares

Prevention

You can lower your risk:

• Keep good posture
• Take breaks from looking down
• Set up your desk so the screen is at eye level
• Use a supportive pillow
• Keep neck muscles strong with exercise

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a physical therapist or a neurologist (brain and nerve doctor).

Children, pregnancy, and older adults

• Office workers: Desk setup and posture breaks make a big difference.
• After an injury: See a doctor for headaches after whiplash or a fall.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Neck-related headaches can be long-lasting, but most people improve with physical therapy and posture changes.

Getting ready for your visit

A headache diary helps.

What to bring

• When headaches start and how long they last
• Neck positions or activities that trigger them
• Past neck injuries
• Medicines you've tried and how often

Questions to ask

• Is my neck causing my headaches?
• Should I see a physical therapist?
• What desk setup or pillow should I use?
• Do I need a scan or a nerve block?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Neck-related headache (cervicogenic)