Cervicogenic headaches: when your headache may be coming from your neck
A headache doesn’t always start in your head.
If your headaches often come with a stiff or sore neck, start around the base of your skull, or seem to travel from your neck up towards your temple, forehead or behind your eye, the neck may be part of the problem.
This is what we call a cervicogenic headache: a headache where pain is referred from structures in the neck and felt elsewhere in the head.
And this is one reason why, when someone comes to my clinic with headaches, I don’t just ask where their head hurts. I want to understand what their neck and shoulders are doing too.
What is a cervicogenic headache?
Cervicogenic headaches originate from the cervical spine and the muscles, joints and other structures around it.
The pain is often one-sided, although it doesn’t have to be. It may begin at the back of the head or upper neck and travel forwards. Some people notice that their headache is brought on or made worse by certain neck movements, or after spending a long time with their neck in one position.
You might also notice:
stiffness or reduced movement in your neck
tenderness around the upper neck or base of your skull
pain spreading towards the temple, forehead or behind the eye
headaches that seem to coincide with neck or shoulder pain
symptoms that are aggravated by particular neck movements or positions
Not every headache accompanied by neck pain is cervicogenic. Migraine and other headache disorders can also cause neck symptoms, so assessment matters.
How can your neck cause pain in your head?
The answer lies partly in the way nerves from the neck and head communicate.
Sensory information from the upper cervical nerves, particularly C1-C3, converges with sensory information carried by the trigeminal nerve, which supplies much of the face and head. This provides a neurological pathway through which pain arising from structures in the upper neck can be experienced as pain in the head.
There are also several muscles around the neck and shoulders capable of referring pain away from the muscle itself.
For example, the upper trapezius can produce pain into the back of the head and temple. Muscles deeper in the upper neck can refer pain towards the head and around the eye.
This means that the place where you feel your headache isn't necessarily the place I need to treat.
Finding the structures contributing to your headache
This is an important part of how I approach cervicogenic headaches with acupuncture.
Rather than starting with a standard set of acupuncture points for headaches, I first want to work out what appears to be contributing to your symptoms.
I'll look at how comfortably your neck moves in different directions and whether particular movements reproduce your familiar pain. I'll also assess and palpate muscles around your neck, the base of your skull and your shoulders.
Sometimes pressing a particular area reproduces a very recognisable pattern:
“That's my headache.”
That is useful information.
Some of the muscles I may assess include the small suboccipital muscles at the base of the skull, semispinalis capitis, sternocleidomastoid (SCM), upper trapezius and levator scapulae.
These muscles have different jobs, but they all contribute to the way the head, neck and shoulders move and are controlled.
Why I look at your shoulders too
Your neck doesn't work independently of the rest of your upper body.
The shoulder blade is connected to the cervical spine through muscles including the levator scapulae, and to the thoracic spine through muscles such as the trapezius and the rhomboids.
So if someone has recurring neck pain and headaches, I'll often look at how their shoulders are moving and how the muscles around the shoulder blades are functioning too.
One pattern described in musculoskeletal medicine is sometimes called an upper crossed pattern.
This can involve greater activity or tension in muscles such as the upper trapezius, levator scapulae and neck extensors, alongside less effective contribution from muscles including the deep neck flexors and some of the muscles that stabilise the shoulder blades.
That doesn't mean that having rounded shoulders or a forward head position automatically causes headaches. Bodies are much more adaptable than that.
What matters more to me is how your neck and shoulders are functioning and whether I can find something that relates to the symptoms you actually experience.
How can acupuncture help cervicogenic headaches?
Once we have an idea of which structures may be contributing, acupuncture gives us several ways of approaching the problem.
1. Treating painful muscles that refer pain into the head
If I find a muscle that is tender and reproduces your familiar headache pattern, I may needle that muscle directly.
This might involve traditional acupuncture needling, trigger point treatment or a motor point, depending on what I find during the assessment.
The aim isn't simply to put needles into the place where it hurts. I'm looking for tissues that may be contributing to the pain being referred into your head.
2. Using motor point acupuncture
A motor point is an area where the motor nerve enters a muscle and is particularly responsive to stimulation.
I use motor point acupuncture frequently when treating musculoskeletal problems. In some cases, I also connect the needles to a very gentle electrical current, known as electroacupuncture.
This can create a small, controlled contraction of the muscle.
I find this particularly useful when the issue isn't simply that a muscle feels “tight”. Sometimes one muscle is working harder because another isn't contributing effectively.
This is why my treatment isn't necessarily about trying to relax every tight muscle I find.
3. Giving the nervous system useful sensory input
The cervical spine contains a large amount of sensory information that helps your nervous system understand the position and movement of your head and neck. This is part of proprioception, our body's awareness of where it is and how it is moving. The musculoskeletal framework I use considers the joints, muscles, tendons, fascia and nervous system together as part of this sensorimotor system.
Needling provides sensory input into this system.
So when I use motor points or electroacupuncture, I'm not only thinking about reducing pain or muscle tension. I'm also using stimulation that can influence the nervous system's response to the muscle, which may be useful when addressing altered muscle activity as part of a wider neck and shoulder problem.
There's another reason I use acupuncture and electroacupuncture around the neck.
What happens after the acupuncture?
Acupuncture can be very useful for reducing pain, but with recurring cervicogenic headaches, I also want to understand why your neck keeps becoming irritated in the first place.
That will be different for different people.
For one person, we might need to work on neck movement. For someone else, shoulder blade control may be relevant. Another person may be repeatedly aggravating their neck through their work, training or another activity.
The teaching that informs my musculoskeletal approach emphasises restoring comfortable movement and addressing muscle imbalances before progressively retraining movement and control.
So where appropriate, I'll give you a small amount of specific work to do between treatments or refer you to a movement specialist.
Is your headache actually cervicogenic?
Headaches can have many causes, and cervicogenic headache is only one possibility.
Migraine, tension-type headache and cervicogenic headache can share some features, and it's possible to experience more than one type of headache.
A new or significantly different headache also needs appropriate medical assessment, particularly if it is sudden and severe or accompanied by symptoms such as weakness, numbness, confusion, fever, fainting or changes in vision or speech.
But if you've noticed a clear relationship between your headaches and your neck, perhaps your neck becomes stiff first, certain movements aggravate the headache, or the pain regularly travels from the base of your skull upwards, it's worth considering the neck as part of the picture.
Acupuncture for cervicogenic headaches in Honor Oak
When I treat headaches that appear to have a musculoskeletal component, I don't use the same acupuncture prescription for everyone.
I assess your neck and shoulders first and use what I find to decide where and how to treat.
Depending on your presentation, that might include Western medical acupuncture, traditional acupuncture, motor point acupuncture and electroacupuncture, alongside simple exercises or changes you can work on between appointments.
The aim is to look beyond where the headache is felt and work out what may be contributing to it.
If you're living with recurring headaches alongside neck pain or stiffness, you can book an acupuncture appointment at my Honor Oak clinic in South East London.
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