Determining if the Neck is the Cause

In Headache and Migraine

One of the confusing phenomena about Cervicogenic Headache is that its symptoms can present as Migraine, Tension Headache or even Cluster Headache.2-6

So even though your headache may have been diagnosed as Migraine, Tension Headache, Cluster Headache etc., it may actually be a ‘Cervicogenic Headache’… and there is one feature, which confirms that the upper neck is responsible for headache, and that is the behaviour of head pain.

If headache is one-sided headache, which, for example occurs on the left, and the next episode on the right, that is, it swaps sides between episodes (or within the same episode) or similarly, headache on both sides of the head at the same time, but is stronger on the left and other times on the right, this confirms that the neck is responsible for headache.2,5

Other features indicating that the neck is the cause of headache are:

  • headache starting in the neck and/or headache that is accompanied by neck discomfort or stiffness
  • one-sided headache or headache on both sides but stronger on the one (always the same) side
  • headache triggered by sustained postures, for example neck forward bending
  • ongoing headache (4 weeks) after head and/or neck injury
  • headache that is gradually becoming more frequent

In summary, a one-sided headache that can occur on either side between episodes (or within the same episode); or headache on both sides that is stronger on one side and then on the other side; or headache that keeps ‘moving around’ confirms Cervicogenic Headache.

Ironically though, even if headache does not have any of these features it still could be Cervicogenic Headache. In this case, a physical examination by a practitioner specifically (post-graduate) trained in examination of the upper cervical spine is required to confirm or rule out a neck disorder as the cause of headache or migraine.3,5

Examination of the upper cervical spine could prevent a lifetime of medication because Headache or Migraine, could be a Cervicogenic Headache and Cervicogenic Headache can be treated.

Specific (non manipulative, that is, not ’cracking’) techniques can correct the responsible disorder, but providing the most advanced treatment techniques to correct the disorder does not necessarily guarantee a successful outcome – the outcome can be affected by other factors.

Therefore an uncomplicated exercise program along with identification and modification of any headache contributing postures and lifestyle activities often complement precise techniques of the Watson Headache® Approach.


  1. Bogduk N. Headaches and the cervical spine. Mar 1984;4(1):7-8.
  2. Rothbart P. The cervicogenic headache: A pain in the neck. Can J Diagnos 1996; 13: 64–71.
  3. Watson DH, Drummond PD. Head pain referral during examination of the neck in migraine and tension-type headache. Headache 2102 52; 8:1226 – 1235.
  4. Gallagher R, Cervicogenic Headache; A special report.  Expert Rev. Neurotherapeutics 2007;7(10) 1279-83
  5. Watson DH, Drummond PD Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014;54:1035-1045)
  6. Goadsby PJ, Bartsch T. Anatomy and physiology of pain referral patterns in primary and cervicogenic headache disorders.  Headache Currents 2005;10:42-48.
  7. Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Aug 1994;14(4):273-279; discussion 257.
  8. Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Kenneth K. Hansraj, MD, Chief of Spine Surgery, New York Spine Surgery & Rehabilitation Medicine, New York 2014
  9. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Jun 1998;38(6):442-445.
  10. Sjaastad O, Fredriksen TA. Cervicogenic headache: criteria, classification and epidemiology. Clin Exp Rheumatol. Mar-Apr 2000;18(2 Suppl 19):S3-6.

Until next time

If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.

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