Cervicogenic Headache vs. Migraine: What’s the Difference?
Headaches are incredibly common. But not every headache is the same.
If your headache starts in your neck, travels up the back of your head, or gets worse when you turn your head, the problem may not be a typical migraine.
It could be a cervicogenic headache.
A cervicogenic headache is a headache in which pain is referred from structures in the neck. Because cervicogenic headaches and migraines can share some symptoms, it isn't always easy to tell them apart.
Understanding the difference can help determine what should be evaluated and what type of treatment may be appropriate.
Quick Summary
Cervicogenic headaches originate from a problem in the neck, while migraine is a neurological headache disorder.
A cervicogenic headache may:
Begin in the neck or base of the skull
Affect one side of the head
Travel toward the forehead, temple, or behind the eye
Occur with neck pain or stiffness
Get worse with certain neck movements
Be associated with limited neck motion
A migraine is more likely to involve:
Throbbing or pulsating pain
Moderate to severe headache pain
Nausea or vomiting
Sensitivity to light or sound
Symptoms that worsen with normal physical activity
Sometimes visual or sensory symptoms called an aura
There can be overlap between the two. Having neck pain does not automatically mean you have a cervicogenic headache, because people with migraines can experience neck symptoms as well.
About the Author
Dr. Tim St. Onge, DC is a chiropractor at Thrive Chiropractic & Functional Health in Branson, Missouri. He works with patients experiencing musculoskeletal pain, including neck pain and headaches that may have a cervical or mechanical component.
At Thrive, our approach focuses on identifying factors that may be contributing to a patient's symptoms rather than simply focusing on where the pain is felt.
What Is a Cervicogenic Headache?
The word cervicogenic gives us a clue.
Cervico refers to the cervical spine, or neck.
Genic means originating from.
A cervicogenic headache is therefore a headache caused by a disorder or problem involving structures in the neck.
The International Classification of Headache Disorders classifies cervicogenic headache as a secondary headache. That means the headache occurs because of another condition rather than being the primary disorder itself.
This is different from migraine, which is considered a primary headache disorder.
How Can Your Neck Cause Pain in Your Head?
Your neck and head are closely connected through the nervous system.
Sensory information from structures in the upper cervical spine can converge with sensory information coming from parts of the head and face.
Because these nerve pathways overlap, your brain may sometimes perceive pain originating from your neck as pain somewhere in your head.
This is known as referred pain.
Think about it like a problem with an electrical circuit.
You may feel the pain in one place even though the source of the signal is somewhere else.
That is why simply focusing on where the headache hurts doesn't always tell us what is causing it.
What Does a Cervicogenic Headache Feel Like?
Cervicogenic headaches often have a recognizable pattern.
The pain may begin around the:
Upper neck
Base of the skull
Back of the head
From there, it can travel toward the:
Side of the head
Temple
Forehead
Area behind the eye
The headache is frequently one-sided, although headache patterns can vary from person to person.
Another important clue is neck movement.
If turning, extending, or holding your neck in certain positions consistently triggers or worsens the headache, the neck deserves a closer look.
Some people also notice that their headaches occur after spending long periods:
Looking at a computer
Looking down at a phone
Driving
Reading
Sitting at a desk
Working with their head in one position
These patterns alone don't prove that a headache is cervicogenic, but they can provide useful information during an examination.
What Is a Migraine?
A migraine is more than simply a bad headache.
Migraine is a neurological disorder that can produce significant headache pain along with other symptoms.
Migraine headaches are often described as throbbing or pulsating and can range from moderate to severe.
Common migraine symptoms can include:
Nausea
Vomiting
Sensitivity to light
Sensitivity to sound
Sensitivity to smells
Headache that worsens with normal physical activity
Some people also experience a migraine aura.
An aura can include temporary neurological symptoms such as flashing lights, blind spots, tingling, or other sensory changes.
Not everyone with migraine experiences an aura.
Cervicogenic Headache vs. Migraine: How Can You Tell the Difference?
There isn't one symptom that perfectly separates the two.
But certain patterns can provide clues.
Cervicogenic headache may be more likely when:
The headache begins in the neck.
Pain may start around the upper neck or base of the skull and move upward.
Neck movement changes the headache.
Turning or positioning the neck may reproduce or increase the symptoms.
Your neck movement is restricted.
You may notice difficulty turning your head or moving normally.
The headache is consistently on one side.
Cervicogenic headaches frequently occur on one side, although this isn't an absolute rule.
Neck pain occurs with the headache.
The headache and neck symptoms often occur together.
Migraine may be more likely when:
The pain is throbbing or pulsating.
This is a classic migraine feature.
You experience nausea.
Nausea or vomiting is much more characteristic of migraine.
Light or sound bothers you.
Significant sensitivity to light and sound commonly occurs during migraine attacks.
Normal activity makes the headache worse.
Walking, climbing stairs, or other normal physical activities can make migraine symptoms worse.
You experience an aura.
Visual or sensory symptoms before or during a headache can occur with migraine.
Can Migraines Cause Neck Pain?
Yes.
This is one of the reasons distinguishing between these headaches can be difficult.
Someone may think:
"My neck hurts when I get headaches, so the headache must be coming from my neck."
That isn't necessarily true.
People with migraine can experience neck pain or stiffness as part of their migraine symptoms.
The reverse can also happen. Someone with a cervicogenic headache may experience symptoms that resemble features of other headache disorders.
The distinction is based on the overall pattern, history, and examination, not simply the presence of neck pain.
How Do We Evaluate a Headache That May Be Coming From the Neck?
When someone comes into our office with recurring headaches, we don't simply ask, "Where does it hurt?"
We want to understand the entire pattern.
An evaluation may include looking at:
When the headaches started
Where the pain begins
Where the pain travels
How frequently headaches occur
What triggers them
Neck range of motion
Joint movement
Muscle tenderness or tension
Posture
Previous injuries
Work and daily activities
Neurological symptoms
One particularly important question is whether movements or positions involving the neck reproduce the person's familiar headache.
That can provide valuable information about whether the cervical spine may be contributing.
Can Chiropractic Care Help Cervicogenic Headaches?
For appropriately selected patients, conservative treatment may be helpful.
Research has examined several approaches, including:
Spinal manipulation
Joint mobilization
Soft tissue therapy
Exercise
Cervical strengthening
Postural and movement rehabilitation
Systematic reviews have found evidence that manual therapy and exercise may reduce headache intensity, frequency, and headache-related disability in people with cervicogenic headache. However, study quality varies, and researchers continue to call for higher-quality trials.
This is an important distinction.
Chiropractic treatment isn't a treatment for every headache.
The first question should be:
What type of headache are we dealing with?
If the examination suggests that the cervical spine is contributing to the headaches, treatment may focus on improving neck movement and function.
At Thrive, a treatment plan may include a combination of chiropractic manipulation, soft tissue treatment, mobility work, and specific exercises based on the individual's examination.
What About Posture and “Text Neck”?
Posture isn't automatically the cause of headaches.
But spending long periods in one position can aggravate the neck in some people.
Think about how much time many of us spend each day:
Looking down at a phone.
Working on a laptop.
Driving.
Watching television.
Reading.
Sitting at a desk.
The issue isn't necessarily that there is one "perfect posture" everyone needs to maintain.
The bigger problem may be spending too much time in the same position without movement.
Changing positions regularly, moving your neck, strengthening the muscles around the neck and shoulders, and improving your workstation may help reduce unnecessary strain.
When Should You Be Concerned About a Headache?
Most headaches are not medical emergencies.
However, some headaches require prompt medical evaluation.
Seek urgent medical care for symptoms such as:
A sudden, extremely severe headache
A major change in your normal headache pattern
Headache after significant trauma
Headache with fever and severe neck stiffness
New weakness or numbness
Difficulty speaking
Confusion
Fainting or loss of consciousness
New significant vision changes
A new or unusual headache should not simply be assumed to be coming from the neck.
Frequently Asked Questions
Can neck problems really cause headaches?
Yes. Cervicogenic headache is a recognized secondary headache disorder in which pain is referred from structures in the cervical spine and perceived in the head.
Where does a cervicogenic headache usually hurt?
Pain commonly begins around the neck or base of the skull and may travel toward the side of the head, temple, forehead, or area behind the eye.
Can a cervicogenic headache feel like a migraine
Yes. There can be overlap between headache types, which is why symptoms alone may not always provide a clear diagnosis.
Does neck pain mean my headache is cervicogenic?
No. Migraine sufferers can also experience neck pain and stiffness. Neck pain alone isn't enough to diagnose a cervicogenic headache.
Can chiropractic adjustments help cervicogenic headaches?
Research suggests that manual therapy, including spinal manipulation, may help reduce headache symptoms in some people with cervicogenic headache. Exercise may also be beneficial. Treatment should be based on an appropriate evaluation and the individual's clinical situation.
Can exercises help cervicogenic headaches?
They may. Research has found that therapeutic exercise may help reduce headache intensity, frequency, and disability in people with cervicogenic headache. The most appropriate exercises depend on the person's examination and contributing factors.
How do I know if my headaches are coming from my neck?
Clues can include headaches that begin around the neck or base of the skull, reduced neck movement, and headaches that are consistently triggered or worsened by particular neck movements or positions. An examination can help determine whether the neck appears to be contributing.
The Bottom Line
Where you feel your headache isn't always where the problem begins.
Migraine and cervicogenic headache are different conditions.
Migraine is a neurological headache disorder.
Cervicogenic headache is a secondary headache in which pain is referred from structures in the neck.
The symptoms can overlap, which is why simply labeling every recurring headache a "migraine" — or assuming every headache with neck pain comes from the neck — can miss important information.
If your headaches frequently start around your neck or the base of your skull, seem connected to neck movement, or occur along with ongoing neck stiffness, it may be worth having your neck evaluated.
At Thrive Chiropractic & Functional Health in Branson, Missouri, we evaluate the way your neck moves and functions to determine whether it may be contributing to your headaches.
Schedule a Complimentary Pain Relief Consultation to talk with our team and find out what your next step should be.
References
Headache Classification Committee of the International Headache Society. International Classification of Headache Disorders (ICHD-3). Cervicogenic Headache.
Núñez-Cabaleiro P, Leirós-Rodríguez R. Effectiveness of manual therapy in the treatment of cervicogenic headache: A systematic review. Headache. 2022;62(3):271-283.
Bini P, Hohenschurz-Schmidt D, Masullo V, Pitt D, Draper-Rodi J. The effectiveness of manual and exercise therapy on headache intensity and frequency among patients with cervicogenic headache: a systematic review and meta-analysis. Chiropractic & Manual Therapies. 2022;30:49.
Demont A, et al. Efficacy of physiotherapy interventions for the management of adults with cervicogenic headache: A systematic review and meta-analyses. PM&R. 2023.
Fernández-de-Las-Peñas C, et al. Effectiveness of therapeutic exercise for the management of cervicogenic headache: A systematic review. 2023
Medical Disclaimer: This article is for educational purposes only and is not intended to diagnose or treat any medical condition. Headaches can have many causes. New, severe, unusual, or changing headaches should be appropriately evaluated by a healthcare professional.
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