Headaches from your neck: cervicogenic, tension, or migraine?
Three different headache types feel similar but respond to very different treatments. How to tell them apart.
"I've had a headache every Wednesday for a year." Some version of this sentence shows up in my exam room almost weekly. By the time someone comes to a chiropractor for headaches, they've usually been told by primary care that it's "tension" and to manage with over-the-counter meds. Sometimes that works. Often it doesn't — because three very different headache types get lumped under the same umbrella.
Type 1: Cervicogenic headache
This is the one we're best positioned to help. The pain originates from the upper cervical spine (C1-C3) and refers up into the head. The hallmarks:
- Pain starts at the base of the skull and radiates forward, often over one side
- It's provoked by neck movement or sustained postures
- Pressing on certain points at the upper neck reproduces the headache
- There's usually limited range of motion in cervical rotation
If you have desk-job posture and recurrent one-sided headaches, this is almost certainly what's happening. The international classification of headache disorders defines cervicogenic clearly — Harvard Health has a useful primer on differentiating headache types.
Type 2: Tension-type headache
The most common headache type globally. Pain is usually bilateral, described as a band or pressure around the head, mild-to-moderate intensity, no nausea, no light sensitivity. It builds gradually over the day.
Tension headaches have overlap with cervicogenic — both involve neck and shoulder muscle tightness — but the pain pattern is different (bilateral and band-like vs. one-sided and pulling forward).
A useful test: cervicogenic headaches reliably worsen with neck movement. Tension headaches don't change much with what your neck is doing.
Type 3: Migraine
Migraines are a neurological event, not a muscular one. They typically have:
- Throbbing, often one-sided pain (but can switch sides between episodes)
- Nausea, often with vomiting
- Sensitivity to light and sound
- Sometimes preceded by aura (visual or sensory disturbance)
- Lasts 4-72 hours and is disabling
Migraines need a neurologist's involvement. We can sometimes help reduce migraine frequency when there's a clear muscular trigger pattern, but we are not the front line of migraine care. The Mayo Clinic's migraine page is the right starting point.
What we do for cervicogenic headaches
Conservative care is very effective for this type. A typical course at The Spine Studio:
- Precision adjustments at the upper cervical segments — restoring motion is the single most impactful intervention
- Dry needling into the sub-occipital muscles — the small muscles at the base of the skull that refer pain forward over the eye
- Soft-tissue work on the upper traps and levator scapulae
- Postural retraining — most cervicogenic headache patients have a forward-head posture component that has to be addressed for long-term resolution
Most patients see meaningful reduction in headache frequency within 3-5 visits. For chronic cases (2+ years), full resolution may take 8-12 visits plus consistent home work.
"Worst headache of your life," sudden onset, headache with fever and stiff neck, headache after head trauma, or new headaches starting after age 50 are all reasons to seek immediate medical care, not a chiro visit. These are uncommon but they're not for us to manage.
If you're not sure which you have
That's exactly what an Initial Assessment will sort out. The exam takes about twenty minutes and is the most reliable way to differentiate. If we find it's not cervicogenic, we'll tell you that and refer you appropriately. We don't treat people we can't actually help.
Get the right diagnosis first.
