If you’ve been getting recurring headaches and nothing seems to explain them, your neck might be the reason why.
Cervicogenic headache is one of the most common causes of recurring headache and one of the most commonly missed. A significant proportion of people managed as migraine or tension headache sufferers may have a cervical contribution to their symptoms that hasn’t been properly assessed.
My name is Fardis. I’m a physiotherapist at The MSK Studio in Adelaide, and I work specifically with people dealing with spinal conditions, including cervicogenic headaches.
In this post I’m going to explain what cervicogenic headaches are, how they differ from migraine and tension headaches, what the signs are that your neck might be driving your headaches, and what a physiotherapy assessment and management approach looks like.
If you’ve been dealing with recurring headaches and you also notice tightness or stiffness in your neck, this post is for you.
Dealing with recurring headaches and neck pain in Adelaide? Our headache physiotherapy service includes upper cervical assessment specifically for cervicogenic headache. Book an initial session
What Is a Cervicogenic Headache?
Let’s start with the basics. What actually is a cervicogenic headache?
The word breaks down simply. Cervico means neck. Genic means originating from. So a cervicogenic headache is a headache that originates from the neck, specifically from the upper cervical spine.
The upper three vertebrae in your neck, C1, C2 and C3 — share a pain pathway with the nerves that supply your head. This shared pathway exists in a region of the brainstem called the trigeminal cervical nucleus. When the joints at C1, C2 or C3 become stiff or dysfunctional, that shared pain pathway means symptoms can be felt in the head rather than just the neck, or both at the same time.
Cervicogenic headache is estimated to account for around 15 to 20 percent of chronic headache cases. That’s a significant number of people whose headaches may have a cervical contribution that hasn’t been identified. You can read more about the condition itself on our cervicogenic headache conditions page.
Cervicogenic Headache vs Migraine vs Tension Headache
One of the reasons cervicogenic headache gets missed is that its symptoms can closely resemble other headache types — particularly migraine and tension headache. Getting this right matters because it directly affects how the headache should be managed.
Tension headache typically presents as a bilateral, pressing or tightening sensation across both sides of the head. It’s generally mild to moderate in intensity and isn’t worsened by physical activity. Neck pain can be present but it tends to be a secondary feature rather than the primary driver.
Migraine is a primary neurological condition, it originates within the central nervous system rather than from a musculoskeletal structure. Migraine typically presents with moderate to severe one-sided head pain, often accompanied by nausea, light sensitivity, sound sensitivity and sometimes visual disturbances. It is not caused by a neck problem, although people with migraine can also have neck stiffness and upper cervical dysfunction.
Cervicogenic headache has a different pattern to both. The key distinguishing features are:
- The headache typically starts at the base of the skull or upper neck and radiates upward into the head — often travelling to the forehead, temple or behind the eye on the same side.
- The headache is triggered or worsened by neck movement or sustained postures. If your headache consistently gets worse after prolonged sitting at a desk, driving, or looking down at a screen — that’s a significant indicator the neck may be involved.
- It comes with neck stiffness or reduced cervical movement — not just as a secondary complaint but as a consistent associated feature.
- Pressing on the upper cervical joints or suboccipital muscles on the same side as the headache can reproduce or intensify the head pain. This is the finding on physical assessment that most strongly confirms the cervical origin.
One important point worth noting here. Research by Watson and Drummond demonstrated that examination of the upper cervical joints reproduced headache symptoms in all patients with tension-type headache and in 94 percent of patients with migraine examined. This finding suggests the neck may be playing a contributing role in a much larger proportion of headache sufferers than is commonly recognised, not just those specifically diagnosed with cervicogenic headache.
If you’re also experiencing neck pain and stiffness alongside your headaches, that’s worth factoring into the picture. Our post on 4 physiotherapy exercises for a stiff neck is a useful starting point for managing that at home.
What Causes Cervicogenic Headache?
So what actually causes the upper cervical dysfunction that drives a cervicogenic headache?
The most common contributing factors seen in clinic are:
- Sustained desk, screen or driving postures.
When you hold your head in a forward position for prolonged periods — which most people do during a typical working day — it places increased load on the upper cervical joints and the suboccipital muscles at the base of the skull. Over time this can create joint stiffness, muscle imbalance and increased sensitivity through the upper cervical region. This is the same mechanism behind neck pain physiotherapy presentations more broadly. - Upper cervical joint stiffness.
Reduced movement specifically at C1, C2 and C3 is consistently found on assessment in people with cervicogenic headache. This stiffness can develop gradually over time without any specific injury. A history of whiplash is one of the more common contributors to residual upper cervical stiffness — even when the original injury occurred years earlier. - Muscle imbalances in the deep cervical flexors.
The deep muscles at the front of the neck play an important role in controlling the position and movement of the upper cervical spine. When these muscles are underactive, the suboccipital muscles at the base of the skull tend to become overloaded and tight, increasing load on the joints at C1 to C3. Addressing this imbalance is a key component of clinical pilates and rehabilitation for cervicogenic headache at The MSK Studio. - A history of whiplash or cervical trauma.
Previous neck injuries, even those that occurred years ago, can leave residual joint stiffness and muscle imbalance in the upper cervical region that may contribute to cervicogenic headache later. Our whiplash conditions page covers this in more detail. - Jaw clenching, grinding or temporomandibular joint dysfunction.
The muscles of the jaw and the upper cervical spine are closely related, and tension through the jaw can contribute to upper cervical load and sensitivity.
Signs You Might Have a Cervicogenic Headache
If you get recurring headaches and you’re not sure what’s driving them, here are the signs worth paying attention to:
- Your headaches start at the base of your skull or upper neck before spreading into your head
- The headache is consistently on one side and doesn’t switch sides
- It gets worse after time at a desk, driving, or looking down at a screen
- You also notice neck stiffness or tightness, even if that doesn’t feel like the main problem
- Your headaches haven’t responded well to migraine medication or general pain relief
- You’ve been told it might be tension headache or migraine but the diagnosis never quite felt right
Any of these patterns is worth having properly assessed — specifically with an upper cervical examination, not just a general neck assessment. Our headache physiotherapy service at The MSK Studio is built around exactly this kind of assessment.
How Cervicogenic Headache Is Assessed and Managed
Assessment of cervicogenic headache should focus on the upper cervical spine specifically C1, C2 and C3. This involves examining the mobility of these joints and applying gentle pressure to identify whether the upper cervical joints reproduce the client’s typical headache pattern. When this is positive, when the assessment actually triggers the familiar head pain, it strongly confirms that the cervical spine is a driver of the headaches.
This is different from a general neck assessment, and it’s one of the reasons cervicogenic headache can be missed if the upper cervical region isn’t specifically examined.
In terms of management, the evidence supports manual therapy directed at the upper cervical joints as the primary physiotherapy treatment for cervicogenic headache. This typically involves joint mobilisation at C1 to C3 to restore mobility, reduce sensitivity and interrupt the pain pathway between the upper cervical spine and the head. This is part of the hands-on treatment approach within our headache physiotherapy service.
Alongside manual therapy, a home exercise program targeting the deep cervical flexors is an important part of long-term management. Building control and endurance in these muscles helps address the underlying muscle imbalance that contributes to upper cervical load and headache recurrence. This is incorporated through clinical pilates and rehabilitation at The MSK Studio.
Postural education and load management, understanding which sustained postures are contributing to upper cervical load during the day, helps reduce the frequency of headache triggers over time. The same load and capacity principle covered in our post on why lower back pain keeps flaring up applies equally to the cervical spine, capacity can be quietly reduced before a headache is triggered.
To Bring It All Together
If recurring headaches and neck tightness are something you’ve been managing around, and especially if those headaches haven’t responded to the usual approaches, it’s worth getting the upper cervical spine properly assessed.
A cervicogenic headache is not a migraine. It’s not a tension headache. It originates from the neck, which means the neck is where the assessment and treatment needs to be directed.
If you’re based in Adelaide and want to understand whether your neck is contributing to your headaches, you can book an initial headache physiotherapy session at The MSK Studio. The session includes a thorough upper cervical assessment and a clear picture of what’s contributing and what to do about it.
We see clients at our Adelaide location:
Clovelly Park – 1140 South Road, Clovelly Park SA 5042
