Written by Dr. Sam McDonald, DC (Colorado Chiropractic License CHR.0007574), Omega Functional Health.

When a headache keeps coming back from the same spot in your neck, you start collecting advice. Stretch more. Get a new pillow. Take something before it gets bad. It is probably stress. It is probably your posture.

Some of that advice helps. Some of it keeps people stuck for years.

Here are seven of the most common myths we hear about cervicogenic headache relief, along with answers to the questions people ask most often.

Myth 1: “It is just a tension headache.”

Tension-type headaches and cervicogenic headaches can feel similar, and they can involve the same muscles. But they are not the same thing.

Tension-type headache is usually felt on both sides of the head, like a band or pressure. Cervicogenic headache is more often one-sided, starts in the neck or at the base of the skull, and is linked to reduced or painful neck movement. If your headache consistently starts in your neck and stays on one side, calling it “just tension” may mean the neck never gets properly examined.

Myth 2: “My imaging was normal, so my neck is not the problem.”

An X-ray or MRI is good at showing structure: bone, discs, alignment. It is not very good at showing how joints move, how muscles are behaving, or how the neck and balance system are working together.

Many people with neck-driven headaches have imaging that looks fairly ordinary for their age. Cervicogenic headache is diagnosed mainly from the pattern of symptoms and a hands-on examination, not from a scan. A normal scan is reassuring, but it does not rule out the neck as the source.

Myth 3: “Stretching the tight spot will fix it.”

Stretching the back of the neck often feels good for a few minutes. The problem is that tight muscles at the base of the skull are frequently tight for a reason. They may be guarding a joint that is not moving well, or working overtime because the balance system is not pulling its weight.

If that underlying reason does not change, the muscle usually tightens right back up. Stretching can be part of the picture, but on its own it rarely resolves a long-standing pattern.

Myth 4: “Pain relievers are fine as long as they work.”

Occasional use is one thing. But taking pain relievers on many days each month can contribute to medication overuse headache, where the medication itself helps keep the headache cycle going.

If you are reaching for something most days of the week, that is worth tracking and discussing with whoever prescribes or recommends your medications. It is also a sign that the underlying driver has not been found yet.

Myth 5: “A cervicogenic headache is the same as a migraine.”

The two can overlap and can even occur in the same person, which is one reason they are often confused. But there are some typical differences.

Migraine often comes with sensitivity to light and sound, nausea, and a throbbing quality, and attacks can occur without any neck involvement. Cervicogenic headache is usually tied to the neck: it tends to start there, is often provoked by neck movement or sustained postures, and comes with reduced neck motion. Treating a neck-driven headache purely as migraine can leave the neck unaddressed.

Myth 6: “Posture is the whole story.”

Posture matters. A head that sits forward of the body puts extra load on the upper neck all day. But posture is often the visible result of something else, not the root cause.

The way your body holds itself upright depends on your inner ear, your eyes, and sensors throughout your joints and muscles. When one of those systems is underperforming, posture can shift to compensate. That is why simply being told to “sit up straight” rarely changes much for long.

Myth 7: “Once you have these headaches, you are stuck with them.”

Many people come to believe their headaches are simply part of who they are. For a lot of people, that is not the case. Headaches that have lasted a long time usually have something maintaining them, whether that is an upper neck joint that never regained normal motion, overloaded tissue, or a balance system that needs retraining.

Finding what is maintaining the pattern is a different project than managing the pain, and it is the approach behind our cervicogenic headache treatment, which looks at the upper neck, the balance system, and local tissue together.

Frequently asked questions

Are cervicogenic headaches dangerous?

In most cases, no. Cervicogenic headaches can be painful and disruptive, but they are generally not a sign of a dangerous condition. However, a sudden, severe headache unlike any you have had before, or a headache with fever and a stiff neck, confusion, weakness, numbness, or changes in vision or speech, is an emergency and needs immediate care.

How long do cervicogenic headaches last?

An individual headache can last from a few hours to several days, and some people have a low-level headache most of the time. How long the overall pattern lasts varies widely. Longstanding problems usually take longer to improve than recent ones, and many people notice better neck movement before the headaches themselves change.

Can a cervicogenic headache cause dizziness?

Some people with neck-driven headaches also feel dizzy, unsteady, or off-balance, because the upper neck contributes to the brain’s sense of where the head is in space. We cover that connection in Can Neck Pain Cause Dizziness?

Do exercises help cervicogenic headaches?

They can. Exercises that train the deep muscles at the front of the neck and the muscles around the shoulder blades have some of the better research support for cervicogenic headache. The catch is that generic exercise sheets do not account for why your neck is overloaded. Exercises tend to work best when they are chosen based on what an examination actually finds, including whether balance or eye movement problems are part of the picture.

Is a cervicogenic headache the same as occipital neuralgia?

No, although both can be felt at the back of the head. Occipital neuralgia usually causes sharp, shooting, or electric pain along the nerves of the scalp. Cervicogenic headache is more often a deep, steady ache that starts in the neck and spreads forward. It is possible to have features of both.

What is the best sleeping position for cervicogenic headaches?

Many people do best sleeping on their back or side with a pillow that keeps the neck roughly level with the rest of the spine. Stomach sleeping, which holds the neck turned for hours, tends to aggravate things for a lot of people.

What actually helps cervicogenic headache relief?

For short-term relief, many people find heat, gentle movement, frequent breaks from screens, and better pillow support helpful. For lasting relief, the most important step is finding out what is maintaining the headaches in the first place.

Who may benefit from a closer look?

• Adults whose headaches start in the neck or at the base of the skull
• People who have been told it is “just tension” but keep getting the same one-sided headache
• Anyone taking pain relievers several days a week
• People with normal imaging whose headaches continue
• Anyone with headaches plus dizziness or unsteadiness

What does the research say?

Cervicogenic headache is recognized as a distinct diagnosis by the International Headache Society, based on evidence that a neck problem is causing the head pain. A review of the evidence notes that diagnosis relies largely on clinical features and examination rather than imaging. Research on medication overuse headache supports the concern that frequent pain reliever use can sustain a daily headache pattern. Studies on manual therapy and exercise for cervicogenic headache are encouraging, though many are modest in size.

What this article does and does not claim

This article is educational. It does not diagnose your headaches, promise a particular outcome, or suggest that every headache comes from the neck. Its purpose is to help you ask better questions about what may be driving yours.

Ready to find out what is driving yours?

If you are in the Denver area and want someone to take a thorough look, our guide to choosing a headache chiropractor near you explains what a good evaluation should include and what a first visit at Omega Functional Health looks like. We serve Wheat Ridge, Denver, Arvada, Lakewood, Golden, Littleton, and surrounding Colorado communities.

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References

• Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
• Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. The Lancet Neurology. 2009;8(10):959-968.
• Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. The Lancet Neurology. 2019;18(9):891-902.
• Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27(17):1835-1843.