Cervicogenic headache

What it is

The upper three cervical nerve roots and the trigeminal nerve, which supplies sensation to the head and face, converge on the same relay station in the brainstem - the trigeminocervical nucleus. The brain cannot always tell which input arrived, so neck signals are experienced as head pain.

The features that identify it are useful: the pain is usually one-sided and does not swap sides, it starts in the neck and spreads forward, it can be provoked by neck movement or by pressing on the upper neck, and there is usually reduced neck range on the painful side.

What it feels like

• Pain starting at the base of the skull and spreading over one side of the head
• Always the same side, rather than swapping
• Provoked or worsened by neck movement or a sustained neck position
• Reduced neck rotation, usually toward the painful side
• Sometimes pain behind the eye or into the shoulder on the same side

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Upper cervical joint dysfunction

The joints of the top three vertebrae are the main source. Stiffness, irritation or degenerative change there refers pain into the head through the shared nucleus.

Suboccipital muscle tension

The small muscles at the base of the skull refer pain in a well-mapped pattern over the back and side of the head. They are held on continuously in a forward-head posture.

Forward-head posture

Sustained forward-head position loads the upper cervical joints in extension for hours and keeps the suboccipitals working. It is the most common everyday driver.

Weak deep neck flexors

Deep cervical flexor weakness is a consistent finding in cervicogenic headache, and strengthening them is one of the two interventions with the best evidence.

A previous neck injury

Whiplash is a common precursor, sometimes years earlier. The joint changes and the guarding habit both persist.

Sustained postures at work

Screens off to one side, phone held between ear and shoulder, and any task with a fixed head position for hours.

Poor sleeping position

A pillow that is too high or too low, or front sleeping with the head fully rotated, holds the upper neck at end range for seven hours.

Degenerative change in the upper cervical spine

Common with age, and a plausible contributor - though as elsewhere in the neck, the imaging correlates weakly with symptoms.

Being mistaken for migraine or tension headache

Not a cause, but a reason it persists. Treated as migraine it does not respond, and years can pass before the neck is examined.

Who tends to get it

• Desk and screen workers with sustained forward-head posture
• Anyone with a history of whiplash or another neck injury
• People with existing neck pain and reduced rotation
• Anyone whose headaches have not responded to migraine treatment
• Front sleepers and people with poorly chosen pillows

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineNeck Relief & Range

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Same as tension headache; plus dizziness or visual disturbance on neck movement needs assessment

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Combined neck strengthening and manual therapy produces good results over six to twelve weeks and the improvement is often durable, which is unusual among headache types. The key is identification: it is frequently treated as migraine for years without response. A headache that is always on the same side, starts in the neck and is provoked by neck movement is worth having a physiotherapist examine. A sudden severe headache unlike any before, or one with fever, neurological signs or after head injury, needs urgent assessment.

Prevalence basis: Headache classification epidemiology

Others the same routine covers

These share the Neck Relief & Range routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.