Cervicogenic Headache

Not every headache starts in the head. A cervicogenic headache originates from the neck, joint stiffness, muscle tension, or nerve irritation in the upper cervical spine, and refers pain upward into the head, often mistaken for a tension headache or migraine.

How to recognise a cervicogenic headache

• Pain that starts at the base of the skull or in the neck and spreads forward, often to one side
• Headache that worsens with certain neck movements or positions (looking down at a phone, prolonged desk work)
• Neck stiffness or restricted movement alongside the headache
• Tenderness in the upper neck and base of the skull
• Headaches that follow a pattern linked to posture, screen time, or how you slept

Unlike a typical tension headache or migraine, cervicogenic headaches usually respond well to treating the neck directly, which is exactly why identifying the difference matters, painkillers alone tend to only mask the symptom.

What causes it

The upper three joints of the neck are directly linked, via shared nerve pathways, to sensation in the head and face. When those joints become stiff, or the surrounding muscles develop tight, irritated trigger points, that irritation can be felt as headache pain rather than neck pain, even though the source is the neck itself.

Common contributing factors include prolonged forward head posture (from screens and phones), whiplash-type injuries, stress-related muscle tension, and general neck joint stiffness that’s built up gradually.

What we assess

We check neck range of motion, feel for restricted joints and tight, tender muscles in the upper neck and base of the skull, and often reproduce your headache by moving or pressing on specific neck structures, a useful confirmation that the neck is the actual source.

Treatment approach

Manual therapy to restore movement to stiff upper neck joints and ease surrounding muscle tension is usually the core of treatment, often combined with dry needling for tight trigger points and chiropractic adjustment where joint restriction is significant. From there, posture correction and specific neck strengthening exercises address why the tension built up in the first place, so headaches don’t simply return once treatment stops.

What to expect

Many people notice a reduction in headache frequency and intensity within the first few sessions as neck movement and muscle tension improve, though a full, lasting change usually needs a complete course of treatment plus the postural and strengthening work that maintains it.

When to get it assessed

If you’re getting recurring headaches, particularly ones linked to neck stiffness, screen time, or waking up with them, it’s worth having the neck properly assessed rather than relying on painkillers indefinitely.

Ruling out other types of headache

Not every headache is cervicogenic, and part of a proper assessment is recognising when a headache pattern looks more like a migraine, a tension headache with a different cause, or something that warrants a medical review rather than physiotherapy. We’ll be honest with you about which category your headache falls into, and refer on where that’s the more appropriate path.

Getting started

Alpha Physiotherapy is on PWD Road, Media Town, Rawalpindi. Book an assessment and we’ll check whether your headaches are coming from your neck, and if so, treat the actual source.