---
title: "Cervicogenic Headaches"
---
## Your Headaches May Actually Be Coming From Your Neck
Cervicogenic headache is one of the most commonly misdiagnosed headache conditions. Patients often arrive having been treated as migraine patients for years, having tried multiple migraine medications without adequate response, before anyone evaluates whether their headaches are actually originating from their cervical spine.
The clue is in the name. Cervicogenic means originating from the cervical (neck) region. These headaches start from structures in your neck, particularly the upper cervical facet joints and surrounding nerves, and refer pain forward into the head. The result is a headache that feels like it is in your forehead or temples but is actually being generated several inches lower. This is meaningfully different from migraine, which involves specific brain pathways and responds to migraine-specific medications. Cervicogenic headaches do not respond well to triptans because the source is not being addressed, but they do respond well to treatments that target the cervical source directly.
## What Cervicogenic Headache Feels Like
The pattern is often distinctive once you recognize it:
- Pain that starts in the back of the head or upper neck and travels forward into the temple, forehead, or behind one eye
- Pain that is typically one-sided and stays on the same side
- Pain triggered or worsened by neck movement, sustained postures, or pressure on specific points in the upper neck
- Pain that may worsen with prolonged screen time, driving, or other sustained neck positions
- Restricted neck range of motion, particularly when turning the head
- Tenderness in specific points in the upper neck or at the base of the skull
- Pain that has not responded well to standard migraine medications including triptans
Many patients have both cervicogenic headache and migraine. Sorting out which is which is part of comprehensive evaluation, and treating the cervical source can significantly reduce overall headache burden even in patients who also have migraine.
## What Causes Cervicogenic Headaches
The cervicogenic pain pathway typically involves the upper cervical spine (C1 to C3). Common contributors include cervical facet arthritis in the upper cervical joints, whiplash injuries (sometimes with symptoms developing months or years after the original event), persistent forward head posture from screen work, occipital neuralgia (irritation of the occipital nerves at the base of the skull), atlanto-axial joint dysfunction, and combined sources involving multiple cervical structures. Identifying which specific structures are involved guides treatment selection.
## How PHI Treats Cervicogenic Headaches
The first step is comprehensive evaluation: a detailed history of your headache pattern and prior treatment response, an examination of cervical range of motion and tender points, review of imaging, and sometimes a diagnostic injection to confirm the specific cervical source.
Treatment options include cervical facet injections, which target the upper cervical facet joints and both diagnose and treat facet-mediated headache pain; occipital nerve blocks, which target the greater and lesser occipital nerves at the base of the skull, where both of our physicians have specific expertise; and cervical radiofrequency ablation for patients whose facet injections confirm the source but produce shorter-than-desired relief, providing relief that typically lasts 6 to 18 months. Therapeutic neurotoxin may be used in selected patients when significant muscle hyperactivity in the cervical and shoulder muscles contributes to the pattern; the brand is not specified, and the neurotoxin may be Botox or Xeomin depending on the case. PHI performs every cervical procedure in our affiliated surgical suite under image guidance, and coordinates with neurologists for patients whose headaches involve both cervical and migraine components.
## Why PHI for Cervicogenic Headaches
## Frequently Asked Questions
**Q: How do I know if my headaches are cervicogenic versus migraine?**
The patterns differ. Cervicogenic headaches typically start from the neck and refer forward, are triggered by neck movements or positions, are usually one-sided, and do not respond well to migraine medications. Migraines typically involve throbbing pain, light and sound sensitivity, nausea, and respond to triptans. Some patients have both, and a diagnostic injection can clarify which is dominant.
**Q: Why didn't my migraine medications work?**
Migraine medications target specific brain pathways involved in migraine. They do not address pain originating from cervical structures. If your headaches are actually cervicogenic, the medications would not be expected to work because they are addressing the wrong source.
**Q: Can a diagnostic injection confirm cervicogenic headache?**
Yes. A targeted injection that significantly reduces your typical headache pattern in the hours following the procedure provides strong confirmation that the targeted structure is contributing to your headaches. This is one of the most reliable ways to confirm cervicogenic involvement when imaging alone is inconclusive.
**Q: What if I have both cervicogenic headache and migraine?**
Many patients do. Treating each component appropriately can produce significant overall improvement. The cervical source typically responds to interventional treatments at PHI; the migraine component may benefit from coordinated care with a neurologist or from therapeutic neurotoxin for chronic migraine, which PHI also offers.
**Q: How long does treatment take to work?**
Many patients experience relief within hours of a successful diagnostic injection due to the local anesthetic effect. Sustained relief from cortisone develops over days to weeks. Radiofrequency ablation produces gradual improvement over several weeks as the targeted nerves stop transmitting pain signals.
**Q: Will the relief last?**
Duration varies. Some patients experience months of relief from a single facet injection. Others benefit more from radiofrequency ablation, which typically provides 6 to 18 months of relief and can be repeated when relief diminishes.
**Q: Can I exercise with cervicogenic headaches?**
In most cases yes, often with modifications. Specific exercises that strengthen the neck and improve posture often help. Activities involving sustained neck extension or rapid head movement may temporarily aggravate symptoms. A physical therapist familiar with cervicogenic headaches can help.
**Q: Will I need surgery?**
Most patients with cervicogenic headaches do not need surgery. The vast majority find meaningful relief through targeted injections and radiofrequency ablation. Surgery is reserved for specific situations.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Cervicogenic Headaches
PHI offers the full range of evidence-based treatments for cervicogenic headache. Your physician will recommend the right option based on the specific cervical structures involved in your case.
- Cervical Facet Injections, target the upper cervical facet joints
- Occipital Nerve Blocks, target the occipital nerves at the base of the skull
- Radiofrequency Ablation, 6 to 18 months of relief
> International Classification of Headache Disorders, 3rd edition: cervicogenic headache. International Headache Society.
— [International Headache Society](https://ichd-3.org/secondary-headaches/headache-attributed-to-disorder-of-the-cranium-neck-eyes-ears-nose-sinuses-teeth-mouth-or-other-facial-or-cervical-structure/)
> Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020.
— [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/)
## Schedule Your Cervicogenic Headache Consultation
A 60-minute consultation will evaluate whether your headaches are originating from cervical structures, walk through the treatment options that match your specific source, and give you a clear plan. Call (310) 856-9488 or book online now.
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