Cervicogenic headache: symptoms, treatment and exercises

The Berkshire trust says symptoms can improve in a few months, but treatment and full recovery can take time. Its self-care advice includes regular movement such as gentle daily walking or gardening, activity changes to avoid repetitive bending, strong gripping or vibrating tools with breaks between heavy tasks, and checking the desk setup so that the keyboard and mouse are close and at elbow height with regular screen breaks.

It suggests paracetamol or ibuprofen for short-term pain relief, following the GP or label advice, heat packs, stress management, and checking that your eyes are not playing a part in the headaches.

Four gentle exercises are described: neck rotation with the chin gently drawn back, a side neck stretch, an upper body stretch kneeling with the chest lowered, and shoulder circles. They are done little and often, 10 to 20 repetitions twice a day, and may be uncomfortable but should not significantly increase symptoms. If they make symptoms worse, take a break and speak to a GP, who may refer you to a physiotherapist.

The NHS neck pain page adds that most neck pain only lasts a few weeks, and that you should not wear a neck collar because it is better to keep your neck moving unless a doctor tells you not to. For heat or cold it suggests a pack of frozen peas wrapped in a tea towel for 5 minutes, 3 times a day, or a hot water bottle wrapped in a tea towel for 20 minutes, 2 to 3 times a day.

The NHS also says that in many areas you can get help such as physiotherapy from NHS community musculoskeletal (MSK) services without needing a referral from a GP. See a GP if neck pain or stiffness does not go away after a few weeks, if painkillers have not worked, or if you have other symptoms such as pins and needles or a cold arm.

The CSP article says a good history and a headache diary are vital, and that headache patients have been successfully treated with manual therapy for many years but benefit from a wider range of physiotherapy skills too, including education through self-management groups. Headaches that do not match diagnostic criteria should be discussed with the GP.

It also notes that the more serious causes of headache, such as vascular conditions including subarachnoid haemorrhage or cervical artery dissection, are extremely rare but can cause major harm, which is why a proper assessment matters. For these reasons, a sudden severe headache that comes on within minutes is a different situation from a slowly recurring neck-related headache and needs emergency care.

The Berkshire trust lists symptoms that may include:

• Commonly one-sided neck and head pain.

• Headaches caused by moving your neck.

• Pain, pressure or stiffness at the top of the neck or the bottom of the head.

• Trouble moving the head or neck.

• Pain on one side of the neck, shoulder or arm.

The word cervicogenic means arising from the neck. Berkshire Healthcare NHS Foundation Trust explains that these headaches may be caused by pain from the joints and muscles in the neck, and that they often start on one side of the neck and move into the head.

The Chartered Society of Physiotherapy (CSP) describes cervicogenic headache as a secondary headache, meaning it is caused by another problem rather than being a primary headache disorder such as migraine. It notes that people with it are often referred to physiotherapy because they have neck pain with headache.

The Berkshire trust describes cervicogenic headaches as caused by pain from the joints and muscles in your neck. The CSP article places them among the secondary headaches, meaning they come from another problem rather than being a primary headache disorder such as migraine.

The sources reviewed do not give a single cause. The NHS neck pain page lists the most common causes of neck pain: the neck becoming locked in an awkward position while sleeping, bad posture (for example sitting at a desk for a long time), a pinched nerve, and an injury such as whiplash from a traffic accident or fall. The NHS headaches page also lists bad posture among common headache causes.

Neck pain and headache also sit together in other conditions. The CSP article explains that migraine studies show a coupling of nerve signals from the neck with pain pathways in the head, which helps explain why neck pain is so common in migraine and why a neck cause can be wrongly assumed.

The CSP article stresses that without clear provocative cervical movements causing headache, the cervical spine is unlikely to be the cause. Neck pain is common with other headaches: because migraine and tension-type headache are often accompanied by neck pain, cervicogenic headache is over-diagnosed. It points out that migraine in women can be triggered by menstruation, for example, which may be missed if the headache is assumed to come from the neck.

It gives practical pointers for clinicians. A cervicogenic headache is normally on one side, whereas migraine is often worse on one side but spreads to both. Cervical spine movement reproduces the headache in cervicogenic headache, while menstruation, hunger and alcohol are listed as migraine triggers. Features such as a preference for resting in a dark, quiet place, sensitivity to light and noise and nausea, even if mild, are migraine characteristics.

It also warns about medication overuse headache. People using simple painkillers on 15 or more days a month, or triptans or opiates on 10 or more days a month, should see their GP about the possibility of medication overuse headache, which can be a cause of constant daily headache.

A typical cervicogenic headache is slowly recurring and linked to neck movement. A sudden severe headache, or one that comes with the features below, is a different situation and needs prompt assessment rather than home treatment. The Berkshire trust and the NHS headaches page set out which features need which response.

• Contact your GP (Berkshire trust): a recent head injury that is causing headaches, light-headedness or dizziness, difficulty talking or swallowing, worsening headaches despite painkillers, sudden fainting, nausea or vomiting, numbness or tingling on the face, or double vision or a sudden change in vision.

• Ask for an urgent GP appointment or call NHS 111 (NHS): a headache with vision or eye problems, a headache triggered or made worse by coughing, sneezing, bending down or exercising, a headache with being sick, or a headache with jaw pain when eating or a sore or tender scalp.

• Call 999 or go to A&E (NHS): a headache with a seizure, numbness or weakness in the body or face, a sudden and extremely painful onset, a head injury within the last 3 months, difficulty speaking, balancing, walking or remembering things, drowsiness or confusion, loss of vision, a rash that does not fade when a glass is rolled over it, or a very high temperature, a stiff neck or bright lights bothering you.

Most cervicogenic headaches are not serious, and the Berkshire trust says they can improve with simple changes and exercises. Persistent symptoms, or a diagnosis that is in doubt, are worth taking back to the GP, because the label may need revisiting. The CSP article points out that cervicogenic headache has a quoted prevalence of 0.17 to 4.1 per cent, which is a wide range that reflects how difficult it is to diagnose consistently.

On the NHS the first step is a GP or, in many areas, a self-referral musculoskeletal physiotherapy service. Waiting times for physiotherapy vary. Private physiotherapists and headache clinics can offer faster access, but it is worth checking that anyone treating headache screens for red flags, takes a headache history, and considers migraine and medication overuse before settling on a neck cause.