Headache From the Neck (Cervicogenic Headache)

A headache from the neck (cervicogenic headache) is pain that starts in the upper neck and spreads up over one side of the head, often toward the forehead, temple or behind the eye. It usually stays on the same side each time. Neck movements, pressing on the upper neck or long spells in one position tend to bring it on, and the neck is often stiff. The source is usually the joints, nerves or muscles of the top three neck levels. With treatment aimed at the neck, many people notice fewer and milder headaches over 4 to 12 weeks.

Many people with this headache are first told they have migraine or tension headache. The patterns overlap, and some people have more than one type.

Key takeaways

Where it starts: in the upper neck, spreading over one side of the head.
Usual triggers: neck movement, pressure on the upper neck, or holding the head in one position for a long time.
Side: usually the same side every time, with reduced neck movement.
Usual course: many people notice fewer and milder headaches over 4 to 12 weeks of neck-focused care.
Emergency signs: a sudden, severe headache that peaks within about a minute, or headache with weakness, confusion or slurred speech, needs emergency care.

How it differs from migraine and tension headache

No single feature settles it. A doctor or physical therapist looks at the whole pattern. These are the features that tend to set the three apart.

Feature	Headache from the neck	Migraine	Tension-type headache
Side	Usually one side, the same side each time	Often one side, can switch sides	Usually both sides
Feel	Steady ache spreading from neck to head	Throbbing or pulsing	Pressing or tight band
Triggered by neck movement	Yes, often	Not usually	Not usually
Nausea, light or sound sensitivity	Mild or absent	Common	Rare
Neck movement	Reduced, especially turning	Usually normal between attacks	Usually normal
Effect of walking or stairs	Little change	Often worse	Not worse

Neck pain is common during migraine too, so neck pain alone does not mean the headache comes from the neck.

Where are you right now?

A new kind of headache: check the safety lists at the end of this page first. A new headache pattern after age 50 needs a doctor.
Months of one-sided headaches with a stiff neck: read the week-by-week section and “If it isn’t going to plan”.
After a nerve block or injection: your doctor’s plan comes first. The weeks after are often a good time to work on neck movement and strength.
Headaches at work: the page on neck pain from desk work and forward head posture covers setup and breaks.

Week by week

Weeks 1 to 2: keep a simple diary of headache days, the side, and what you were doing beforehand. Patterns linked to screens, driving or sleep position often show up quickly.
Weeks 2 to 4: with neck-focused care, such as joint mobilization and exercises for the deep neck muscles and shoulder blade, some people notice headaches are a little shorter or milder. Headache days may not drop yet.
Weeks 4 to 8: many people have fewer headache days. Neck turning is often easier.
Weeks 8 to 12: many people have had a clear drop in how often and how strongly the headaches come. Keeping up the exercises helps hold the change.
After 3 months: if there has been little change, the diagnosis and plan are worth reviewing with your doctor.

Where else this could be coming from

Occipital nerve irritation (occipital neuralgia): brief, sharp, shooting pain from the base of the skull over the back of the scalp, rather than a steady ache.
The jaw joint: pain at the temple and in front of the ear, often with clicking, jaw tiredness or soreness on chewing.
Upper trapezius and muscles at the base of the skull: tight, tender muscles can refer pain into the head. Pressing a knot often reproduces the headache.
Medication overuse headache: taking pain relief on 10 to 15 or more days a month can itself keep headaches going.
Eyes and sinuses: eye strain or sinus congestion can add a frontal ache, usually without neck stiffness.

Is this normal?

“It is always on the same side.” That is typical of a headache from the neck. Sides that switch are more typical of migraine.
“Pressing the base of my skull brings it on.” Common. Pressure on the upper neck joints or muscles can reproduce the headache.
“Pain relief only takes the edge off.” Medicines often help less with this type than with tension headache. Treatment usually focuses on the neck itself.
“My scan was normal.” This is expected. Imaging rarely shows the cause, and age-related changes on a scan are common in people with no headaches.

When the headache starts in the neck, the neck is usually where the work needs to happen.

If it isn’t going to plan

It is the third headache this week, starting at the same spot under the skull and spreading behind the right eye. The pill bottle lives on your desk now. The thought in your head is that you will try a different painkiller and see if that one works.

Changing the painkiller treats the pain where you feel it, in the head. When the source is the upper neck, the irritated joints and muscles there stay stiff and sensitive. Frequent pain relief can also add a second headache problem of its own.

Headache from the neck usually responds to care aimed at the upper neck: improving joint movement, retraining the deep muscles at the front of the neck that support the head, strengthening around the shoulder blade, and changing the positions that set it off. Studies support combining hands-on treatment with exercise.

If headaches are frequent and have not eased after a few weeks, see your doctor first to confirm the type, then a physical therapist. Useful questions to ask:

Type: what makes you think this headache comes from my neck, or not?
Medication: how many days a month is it safe for me to take pain relief?
Progress: how will we track headache days, and when should we review the plan?

When can I…

Activity	Typical range
Sleep on that side	Usually possible throughout, with a pillow that keeps the neck level
Drive	Usually fine between headaches; avoid driving during a headache that affects vision or concentration
Reach overhead	Usually no restriction; avoid tipping the head back for long periods
Lift	Usually no restriction; hold loads close and avoid straining with the breath held
Desk work	Usually continues, with breaks every 30 to 45 minutes and the screen at eye level
Manual work or sport	Usually continues; build up overhead or neck-loaded work gradually over 2 to 6 weeks

If you have had surgery, your surgeon’s protocol comes first.

Call your local emergency number or go to the emergency department if

Thunderclap headache: a sudden, severe headache that reaches full strength within about a minute, often described as the worst ever.
Stroke signs: a drooping face, arm or leg weakness, slurred or confused speech, sudden loss of vision, double vision or loss of balance.
Headache with fever and a stiff neck: especially with a rash, confusion or drowsiness.
After a head or neck injury: a new or worsening headache, vomiting, confusion or drowsiness.
New neck pain and headache after neck manipulation or sudden neck movement: with dizziness, vision changes or trouble speaking or swallowing.

See a doctor today if

Over 50 with a new headache: especially with scalp tenderness, jaw pain when chewing or changes in vision.
Worse lying down or on coughing: a headache that wakes you, is worst on waking, or worsens with coughing, straining or bending.
Pregnancy or recent birth: a new or severe headache.

Get it checked soon if

A changing pattern: headaches that are steadily more frequent or severe over weeks.
Frequent pain relief: you are taking pain relief for headaches on more than about 10 days a month.
A weakened immune system or history of cancer: with any new headache pattern.