Cervicogenic Headache

What is Cervicogenic Headache?

Cervicogenic headache is head pain referred from the upper cervical spine. The source is in the neck: most often the C2-C3 facet joint, the atlanto-axial joint, or the muscles and ligaments attached to the upper vertebrae. Because the upper cervical nerves share pathways with the trigeminal nerve, pain from these structures is perceived in the head, typically on one side, starting at the neck or base of skull.

It is commonly misdiagnosed as migraine or tension-type headache. The distinguishing feature is that the pain is consistently triggered or worsened by neck movement or sustained neck positions, and it does not occur without the neck being involved in some way. A diagnostic nerve block that abolishes the headache confirms the cervical origin.

The condition is more common in people with cervical spondylosis, whiplash injury, or those who spend long hours in a fixed head position. Unlike primary headaches, it responds well to interventions targeting the specific cervical pain generator.

Symptoms

• One-sided head pain starting at the back of the neck or base of skull
• Pain that spreads forward to the forehead, temple, or eye on the same side
• Neck stiffness or restricted range of movement alongside the headache
• Pain triggered or worsened by specific neck positions or movements
• Tenderness over the upper cervical joints or suboccipital muscles on the painful side
• Nausea may occur but visual aura and throbbing quality are usually absent

How We Treat It

We confirm the diagnosis first with a small-volume diagnostic block targeting the C2-C3 medial branch or the third occipital nerve. If this relieves the headache, we know the source. Therapeutic steroid injections at the identified joint then provide sustained anti-inflammatory relief, typically over several weeks. Many patients go through two to three injection cycles alongside targeted physiotherapy, which addresses the posture and muscle dysfunction that load the painful joint.

For patients who get good but short-lived relief from steroid injections, radiofrequency ablation of the medial branch nerves at C2-C3 is a durable option. The goal is not just pain control: by reducing the headache frequency and severity, we give you the space to rebuild neck strength and correct the contributing mechanical factors.