What Is a Cervicogenic Headache?
This type of headache develops due to a problem in your neck. Your doctor may call it a secondary headache because it's a symptom of an underlying condition. Another term you may hear is referred pain. This means that the source of your pain is different from the part of your body where you feel the pain. In the case of a cervicogenic headache (CH), your pain may be due to a pinched nerve in your neck, even though you feel the pain in your head. But other causes can trigger this type of headache because the area where your spine meets your skull contains many areas that can produce pain, such as the lining of your upper spine, ligaments, and joints.
CH Symptoms
The pain caused by a CH often occurs on only one side of your head. For example, it may begin at the bottom of your head and move up either the right or left side of your head. Sometimes, it develops in the back of the head and radiates to the front of your head, right behind your eyes. This pain can be moderate to severe, but it won't be extremely painful.
One sign of CH is pain that comes from a sudden movement of your neck. Another is that you get head pain when your neck remains in the same position for some time. You also may feel pain in your neck.
Other signs may include:
- Pain on one side of your head or face
- Steady pain that doesn't throb
- Head pain when you cough, sneeze, or take a deep breath
- An attack of pain that can last for hours or days
- Stiff neck — you can't move your neck normally
- Pain that stays in one spot, like the back, front, or side of your head or your eye
CH vs. migraine
A CH sometimes may feel like a migraine, and you can have both at the same time. While the two are not the same, they do share some things in common. They both cause pain on one side of your head. A CH also may trigger migraine symptoms, however they're usually not as strong and happen less often. These include:
- Light sensitivity
- Sound sensitivity
- Blurred vision
- Nausea
- Vomiting
There are significant differences. For example, CHs are secondary headaches, meaning they're a symptom of an underlying condition. Migraines, on the other hand, are primary headaches. That means that the pain itself is the problem.
Also, while experts don't yet fully understand the cause of migraine, it's believed that they're linked to the brain and nerves within your head. CHs develop due to problems in your neck.
CH Causes
Many things can cause a CH. Though sometimes there's no way to figure out exactly what triggered it, a CH may result from injuries or conditions that affect your upper spine — called your cervical spine — or your neck. Problems with the following areas can cause a CH:
- The top three back bones (known as C1, C2, and C3 vertebrae)
- Joints
- Vertebral arteries, which deliver blood to your brain and spinal cord
- Ligaments
- Nerve roots
The neck injuries and conditions that can cause a CH include:
Forward head posture
Also called tech neck, this condition develops when you keep your head tilted forward as you do things like look at your phone or computer. Over time, this can cause strain on your cervical spine and lead to headaches.
Neck injury
Several types of injury to your neck can lead to a CH. These include:
- Fracture, or a broken neck, which is typically caused by weakened bones (osteoporosis) or a traumatic injury, such as a car accident
- Sprained muscle, which occurs when the tissue that connects your bones — called ligaments — gets stretched or torn.
- Slipped, or herniated disk, in which one of the disks that provides cushioning between your vertebrae becomes damaged
- Pinched nerve, a broad term that refers to the compression of nerves in the neck by the tissue that surrounds them
Whiplash
This is a type of neck injury caused by the sudden, forceful forward and backward motion of your neck, which can damage muscle and tissue in the neck. This can occur if you're riding in a car that gets rear-ended. Whiplash also can be a type of sports injury or the result of a trauma, such as from a fall or physical abuse.
Arthritis
If you have arthritis in your neck, it can cause a CH. Arthritis can develop for many reasons. Wear and tear of the joints in your neck, for example, can cause osteoarthritis. Another potential culprit: The autoimmune disease rheumatoid arthritis, which causes your immune system to attack the lining of your joints, often affects the neck.
Tumors
These are clumps of abnormal cells that form into solid lumps. Sometimes, tumors are malignant or cancerous. Many tumors, however, are benign, meaning they don't indicate cancer. However, even benign tumors can cause problems if they grow in certain areas. When a tumor grows in your cervical spine, it can trigger a CH, though this is rare.
CH Diagnosis
Other types of headaches, including migraine and tension headaches, have symptoms similar to CHs. That can make it difficult for your doctor to diagnose CH. To do so, you will undergo a physical exam, as well as imaging tests.
Your doctor will examine you. They may have you move your head and neck a certain way to see what's painful for you and press on certain areas of your neck to see if that causes a headache.
They'll also ask questions about your health, including what you're doing when you get the pain and where it hurts.
Be sure to tell them if:
These might be signs of another health problem that needs attention. Remember: CH is a secondary headache, so there is an underlying cause that your doctor should discover.
To learn more about your headaches, your doctor probably will order one or more of the following tests to get a closer look:
- X-ray. Small doses of radiation are used to make pictures of the bones in your neck and spine.
- CT scan. Several X-rays are taken from different angles and put together to show more information than is on a single X-ray.
- MRI. Powerful magnets and radio waves are used to make detailed images of your head, neck, and spine.
- Blood test. You also may get a blood test to make sure the problem isn't a disease that causes pain.
Such tests will help reveal any injuries or health conditions that affect your cervical spine.
Your doctor also may suggest a "nerve block." This is a shot done by a specialist that puts numbing medicine into certain nerves in the back of your head. If the pain goes away with the nerve block, it means your headache is probably caused by a problem with nerves in your neck. Nerve block is also one way to treat CH.
When to go to the ER for headache
A headache can be a symptom of a life-threatening medical condition, including stroke, meningitis, and encephalitis (inflammation of the brain). You should go to the ER if your headache was sudden and severe or if it's the worst headache you've ever had. You also should go to the ER if you experience any of the following symptoms along with your headache:
- Confusion or trouble understanding someone speaking to you
- Fainting
- High fever, over 102-104 F (39-40 C)
- Numbness, weakness, or paralysis affecting one side of your body
- Stiff neck
- Trouble speaking, walking, or seeing
- Nausea or vomiting not caused things like the flu or a hangover
CH Treatment
If you have CHs, treatment will focus on the cause.
Medicine for headaches
Antiseizure medications like gabapentin (Neurontin) and pregabalin (Lyrica) may provide relief. Your doctor also may prescribe duloxetine (Cymbalta), a type of antidepressant called a selective serotonin reuptake inhibitor. Pain relievers such as nonsteroidal anti-inflammatory drugs also may ease your pain. These include aspirin or ibuprofen (Advil, Motrin). Muscle relaxants are another possible option.
Nerve block
This is an injection of an anesthetic medication into a nerve or cluster of nerves. It provides temporary relief from pain. For a CH, your doctor may inject a nerve block near an occipital nerve located in your neck. Such injections also may include a steroid medication. This reduces inflammation, which can contribute to your CH.
This may temporarily relieve pain and help you better work with physical therapy.
CH exercises
Stretches and exercises can help. Work with your doctor or a physical therapist to find out what kind of exercise is best and safest for you. Warning: Your headache may get worse at the beginning of physical therapy. For that reason, your therapist should move you through treatment slowly with gentle stretches and manipulation of your neck.
Spinal manipulation
Also called chiropractic adjustment, this is a mix of physical therapy, massage, and joint movement. It involves a sudden, forceful, and controlled push to a joint in your neck, which stretches it past its normal range of motion. It should only be done by a physical therapist, a chiropractor, or an osteopath (a doctor who has special training in the way your nerves, bones, and muscles work together).
Radiofrequency ablation
This minimally invasive procedure uses heat to damage the nerves causing your pain. This prevents those nerves from sending pain signals to your brain.
CH natural treatment
Your doctor may recommend relaxation techniques and other forms of natural treatment to ease your headaches. These include:
- Massage can relieve muscle tension that contributes to headache and neck pain.
- Acupuncture, in which a practitioner inserts fine needles into your skin, may ease headache and neck pain. It may be particularly effective when combined with massage.
- Yoga, which focuses on physical postures, breathing techniques, and meditation, may ease both headache and neck pain. It also may improve the range of motion in your neck.
CH surgery
If your CH does not get better with the treatments above, your doctor may recommend surgery, such as occipital nerve decompression. This procedure relieves the pressure on nerves in your neck in order to relieve pain. Surgery is a treatment of last resort.
Takeaways
CHs occur due to problems in your neck. Many different things can cause these headaches, including injuries, tumors, and health conditions like arthritis. Treating the cause of your headache should relieve your pain.
CHs FAQs
What neck problems cause headaches?
Many neck problems can lead to headaches. You can develop headaches due to injuries, such as those that can happen in car accidents and while playing sports. If you have arthritis in your neck, you may develop headaches as a result. Tumors in your neck also can trigger headaches.
How do you fix a CH?
Your treatment will depend on the cause of your headache. Your treatment plan may include physical therapy, medications, minimally invasive procedures, and, if nothing else helps, surgery.
What is a red flag for a CH?
If your headache is accompanied by any of the following symptoms, call 911 because you may be having a stroke.
- Sudden and severe pain in your neck
- Double vision
- A droopy eyelid
- Dizziness or vertigo
- Slurred speech
- Numbness or weakness on one side of your body
Does an MRI show CH?
MRI and other imaging tests may help your doctor identify signs of injury or disease that may be causing your headache.
What can be mistaken for a CH?
Migraine, tension headaches, and other primary headaches may be mistaken for a CH. Your doctor will be able to confirm it's a CH if the source of the pain is in your neck.
