Written and reviewed by the BPR clinical team. Last reviewed: 30 July 2026. This article is for education and is not a substitute for individual assessment, diagnosis or treatment by a qualified healthcare professional.
Some headaches don't start in the head at all. If yours tends to begin at the base of your skull or the back of your neck and spread forward — often on one side, and worse after a long day at the screen — the source may be your neck. This is a cervicogenic headache, and because the cause is the neck rather than the head, the treatment is different from what you might expect.
What is it?
A cervicogenic headache is a headache that's actually driven by structures in the neck — usually the joints and muscles of the upper cervical spine — which refer pain up into the head. It's distinct from migraine and tension-type headache, and recognising the difference matters, because treating the neck is what resolves it (Bogduk and Govind, 2009).
Why does it happen?
It's typically linked to dysfunction and stiffness in the upper neck joints, sustained postures and long hours at screens, and sometimes a previous neck injury such as whiplash. In other words, the same modern habits that drive neck pain can also drive these headaches.
What does it feel like?
Cervicogenic headaches are usually one-sided, starting at the back of the neck or base of the skull and spreading to the forehead, temple or behind the eye on the same side. They're often triggered or worsened by neck movements or holding a position, and come with reduced neck movement or neck tenderness. Unlike migraine, they don't usually bring pronounced nausea or sensitivity to light and sound.
How it's assessed
The key is reproducing your familiar headache by examining the neck — particularly the upper cervical joints — and assessing your neck movement and the strength and control of the deep neck muscles. We use recognised criteria to distinguish it from migraine and tension-type headache, because the management differs.
What the evidence says
- Exercise and manual therapy work. In a landmark randomised controlled trial, low-load neck exercise and manual therapy reduced headache frequency and intensity, with benefits sustained at 12 months (Jull et al., 2002).
- Conservative care is first-line. Authoritative reviews support conservative, neck-focused management as the initial treatment of choice for cervicogenic headache (Bogduk and Govind, 2009).
- Treat the neck, not just the head. Because the driver is cervical, neck-specific strengthening and joint treatment address the cause rather than masking symptoms.
How it's treated
Treatment targets the neck. Neck-specific strengthening — particularly of the deep neck flexors and the muscles around the shoulder blade — combined with manual therapy to the upper cervical joints has the strongest evidence (Jull et al., 2002). Alongside that, we address posture, movement habits and your workstation, and give you a simple routine to keep the neck resilient. As with neck pain, moving regularly matters more than holding one “perfect” position.
What you can do yourself
Work on neck and shoulder-blade strengthening, take regular movement breaks from screens, and set up your workstation so the screen is at eye level. Pay attention to sleep and stress, which influence neck tension, and keep moving through the day rather than holding one posture.
When to seek help
When to seek help. Seek urgent medical attention for a sudden, severe “thunderclap” headache; a new headache if you're over 50; a headache with fever, a rash, neurological symptoms, or unexplained weight loss; or a headache that's worse lying down or wakes you. These need to be checked promptly and are not typical of a simple cervicogenic headache.
Frequently asked questions
How is a cervicogenic headache different from a migraine?
Cervicogenic headaches are usually one-sided, start in the neck, and are triggered by neck movement or posture, without the strong nausea and light sensitivity typical of migraine. A clinician can help tell them apart.
Can neck problems really cause headaches?
Yes. The upper neck joints and muscles can refer pain into the head, and treating the neck often resolves the headache (Jull et al., 2002).
Will exercise really help my headaches?
For cervicogenic headache, neck-specific exercise and manual therapy have good evidence for reducing frequency and intensity, with lasting benefit (Jull et al., 2002).
How long does it take to improve?
Many people improve over several weeks of consistent neck-focused treatment, with benefits that can last well beyond the programme.
When should I be worried about a headache?
Sudden severe headaches, new headaches over 50, or headaches with fever, neurological symptoms or that wake you from sleep need prompt medical review.
How BPR can help
At BPR we'll work out whether your neck is driving your headaches, rule out the features that need onward referral, and build a neck-focused plan to reduce how often they strike. You can book an assessment at bpr.rehab.
References
- Jull, G., Trott, P., Potter, H. et al. (2002) 'A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache', Spine, 27(17), pp. 1835–1843. doi:10.1097/00007632-200209010-00004.
- Bogduk, N. and Govind, J. (2009) 'Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment', The Lancet Neurology, 8(10), pp. 959–968. doi:10.1016/S1474-4422(09)70209-1.