Cervicogenic headache is pain that originates in the upper cervical spine and is felt in the head. It is usually one-sided, tends not to switch sides between attacks, and is provoked by neck posture or movement. Reduced neck rotation is the examination finding that most often separates it from migraine.
Cervicogenic headache is pain that originates in the upper cervical spine and is felt in the head. It is usually one-sided, tends not to switch sides between attacks, and is provoked by neck posture or movement. Reduced neck rotation is the examination finding that most often separates it from migraine.
The structures implicated are in the upper neck: the joints between the top three cervical vertebrae, the discs, the ligaments and the deep neck muscles. Sensory fibres from those levels converge on the same brainstem nucleus that receives input from the trigeminal nerve serving the face and head. That shared relay is why a problem in the neck is genuinely felt behind the eye or across the temple, rather than the patient misreporting the location. Pain typically starts at the base of the skull and spreads forwards.
Three features do most of the work. Cervicogenic headache is side-locked, staying on the same side rather than alternating. It is reproduced or worsened by neck movement or by sustained posture. And range of neck rotation is measurably reduced on examination. Migraine more often alternates sides, comes with nausea or light sensitivity, and throbs. Occipital neuralgia produces brief shooting pain in the distribution of the occipital nerve with tenderness over it. The distinctions matter because the treatments diverge sharply.
Assessment is clinical and largely physical: a headache history detailed enough to establish the pattern, then examination of neck movement, segmental tenderness and muscle findings, along with a neurological examination to exclude anything else. Imaging is frequently unremarkable and degenerative change on a scan is common in people with no headache at all, so it rarely settles the question. MRI and CT are arranged at an imaging centre when indicated. Where there is arm pain, numbness or weakness, EMG and nerve conduction studies are used to look for a cervical root problem.
Treatment aimed at the neck is what distinguishes management here. Physiotherapy targeting the upper cervical segments and the deep neck flexors has the most support. Workstation height, screen position, pillow choice and sustained postures are worth real attention. Medication is used by class and sparingly, since frequent analgesic use is itself a route to more headache days. In selected cases, image-guided injections around the implicated joints or nerves are considered, and those are arranged with the appropriate service.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: neck injuries and disorders; MedlinePlus: headache; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.