Headaches That Start in the Neck: Cervicogenic Headache and How Chiropractic Care Can Help

Most of us get a headache from time to time. But if yours tends to start at the back of your head, creep forward over one side, and go hand in hand with a stiff, sore neck, it’s reasonable to wonder whether your neck is part of the story. Sometimes it is. Headaches that genuinely come from the neck have a name, cervicogenic headache, and they tend to behave in recognisable ways.

People often ask us at Chiropractic First in Hove whether their headaches could be coming from their neck. This guide explains what a cervicogenic headache is, how it feels, how it differs from the more common tension-type headache and migraine, how it’s assessed, and how chiropractic care can help. It also covers the warning signs that mean a headache needs a doctor rather than a chiropractor. Whatever kind of headache you get, please read that section.

What is a cervicogenic headache?

“Cervicogenic” simply means “coming from the neck” (the cervical spine). A cervicogenic headache is a headache caused by a problem in the neck, most often in the small joints, muscles and other soft tissues of the upper neck, which you feel as pain in your head.

The International Headache Society classifies it as a secondary headache. That means the headache isn’t a condition in its own right; it’s a symptom of a problem somewhere else, in this case the neck. It’s an important distinction, because it tells us where to look for the cause.

Why can a neck problem be felt in your head?

It comes down to wiring. The nerves from the top three levels of your neck feed into the same relay station in the brainstem as the trigeminal nerve, which carries sensation from your face and much of your head. Because those signals converge, the brain can’t always tell exactly where they started. Irritation in the upper neck can therefore be felt at the back of the head, across the top, at the temple or even around the eye. This is called referred pain, and it’s the same reason a hip problem can sometimes be felt in the knee.

What does a headache from the neck feel like?

No single symptom confirms a cervicogenic headache, but it often follows a recognisable pattern. Common features include:

• One-sided pain that stays on the same side. The headache usually affects one side of the head and doesn’t swap sides from one episode to the next.
• Pain that starts in the neck or at the base of the skull and spreads forwards, often towards the temple, forehead or around the eye.
• A link with neck movement or posture. Certain movements, or holding your head in one position for a long time (at a desk, driving, reading, or sleeping awkwardly), can set it off or make it worse.
• A stiff neck. Turning or tilting your head may feel restricted, particularly towards the painful side.
• Tender spots at the back of the neck. Pressing on certain areas near the base of the skull may bring on your familiar headache.
• An ache in the neck, shoulder or sometimes the arm on the same side.

The pain is usually a steady, non-throbbing ache of moderate intensity, and it may come and go over days or weeks. Some people also notice mild nausea or sensitivity to light, although these are usually far less prominent than in migraine.

Cervicogenic headache, tension-type headache or migraine?

Neck pain is common with many kinds of headache, so a sore neck doesn’t automatically mean your neck is the cause. Plenty of people with migraine or tension-type headache feel neck tension too. The table below shows some typical differences, but headaches don’t always follow the textbook, and some people have more than one type.

If you think you might have migraine, or your headaches are frequent, changing or affecting your daily life, it’s worth talking to your GP, who can confirm the diagnosis and go through your options. Migraine is a neurological condition, and it’s managed differently from a headache that comes from the neck. For some people, chiropractic care may form part of a migraine prevention plan alongside their GP’s advice, but it isn’t a treatment for a migraine attack, and migraine isn’t the focus of this article.

What causes headaches that come from the neck?

Cervicogenic headache usually relates to the upper part of the neck: the small facet joints between the top vertebrae, the muscles and connective tissues at the base of the skull, and sometimes the discs. Factors that commonly contribute include:

• Sustained postures: long hours at a laptop, looking down at a phone or leaning towards a screen. This overlaps with what’s often called “tech neck”.
• Long drives or repetitive work that keeps the head in one position.
• Sleeping position and pillow. Waking with a stiff neck and a one-sided headache is a common story.
• Reduced strength and endurance in the deep neck muscles that help hold the head steady.
• Stiffness or age-related changes in the upper neck joints. These are extremely common in people with no symptoms at all, so a scan finding on its own doesn’t explain a headache.

Headaches after an injury. If your headaches began after a fall, a blow to the head or a road traffic accident, including whiplash, please have them checked by your GP or NHS 111 first. Headaches after an injury need medical assessment and are managed differently from the everyday neck-related headaches described here.

How we assess a headache at Chiropractic First

Because headaches have so many possible causes, the most important thing we do is work out what kind of headache you have, and whether chiropractic care is appropriate at all. Your first appointment includes:

• A detailed history: when your headaches started, where you feel them, how often they happen, how long they last, what sets them off and what eases them. A headache diary kept for a couple of weeks beforehand is really useful.
• Screening for warning signs that need medical attention (see the box below).
• A physical and neurological examination: how your neck moves, the joints and muscles of the upper neck and upper back, your posture, and checks of nerve function such as sensation, strength and reflexes.
• Checking whether particular movements, or pressure on specific areas, reproduce your familiar headache.
• A look at the day-to-day factors: your workstation, phone use, driving, sleep and activity levels.

Most people with a headache from the neck don’t need a scan. Clinical guidance advises against routine imaging for these headaches; it’s kept for when there are warning signs, significant or worsening nerve symptoms, or when things aren’t improving as expected. Chiropractic First has on-site digital X-ray, but we only use it when it’s clinically justified for you as an individual. An X-ray can’t diagnose a headache.

If your assessment points towards migraine, tension-type headache or anything that needs medical investigation, we’ll tell you honestly and point you to your GP, with a letter summarising our findings if that’s helpful.

How chiropractic care can help

Chiropractic care can help with headaches arising from the neck. The approach is aimed squarely at where this type of headache comes from: the joints, muscles and movement of the neck.

A 2026 clinical practice guideline on the chiropractic management of cervicogenic headache, developed from a review of the published research and agreed by a large panel of clinicians, recommends spinal manipulation and supports joint mobilisation, soft-tissue work and targeted exercise as part of care. That fits closely with how we work. Depending on your assessment and your preferences, your care may include:

• Spinal manipulation or gentle mobilisation: hands-on techniques to the neck and upper back to help improve how the joints move. We’ll always explain what we’re proposing and why, and gentler techniques are available if manipulation isn’t suitable for you or you’d rather not have it.
• Soft-tissue work to the muscles at the base of the skull, neck and shoulders.
• Targeted exercises, particularly for the deep neck muscles that support your head, plus mobility work you can do at home.
• Practical advice on workstation set-up, phone use, driving position, sleep and pillow choice, and pacing your day.

What to expect

Every plan is individual, so we don’t quote a fixed number of sessions. Care is usually more frequent at first and then spaced out, and we review your progress with you as we go. If you’re not responding as we’d expect after the first few weeks, we’ll talk openly about other options, including referral to your GP. The aim is to help you understand and manage your headaches yourself, not to keep you coming back.

Everyday steps that can make a difference

• Raise your screen to eye level, and bring your phone up to your eyes rather than dropping your head to it.
• Change position every 30-40 minutes. Stand up, roll your shoulders and turn your head gently through a comfortable range.
• Try a gentle chin nod. Lying on your back with a folded towel under your head, slowly nod as if making a small “yes”, hold for a few seconds, then relax. Keep it gentle, stop if it brings on your headache, and ask us to check your technique.
• Check your pillow keeps your neck roughly in line with the rest of your spine when you lie on your side.
• Adjust your car seat and head restraint so you can sit upright without craning forward.
• Look after the basics that affect every kind of headache: regular meals, enough water, good sleep and regular exercise.
• Keep a headache diary. It helps you, and anyone assessing you, spot patterns and triggers.

Is chiropractic treatment for neck-related headaches safe?

For most people, yes. The most common after-effects are mild and short-lived: some soreness or stiffness, tiredness, or occasionally a brief headache, usually settling within a day or two. Serious complications from neck treatment are rare. We reduce the risk further by screening carefully before any treatment, choosing techniques that suit you, using gentler methods where appropriate, and discussing the benefits and risks with you before we start, so you can make an informed choice. If anything in your history or examination suggests a problem that needs medical care, we’ll refer you rather than treat.

Frequently asked questions

How do I know if my headache is coming from my neck?

Headaches that come from the neck usually affect one side of the head, start at the back of the head or base of the skull and spread forwards, and are brought on or made worse by neck movements or by holding one position for a long time. Your neck may also feel stiff. These clues are useful, but they aren’t conclusive on their own, so a clinical assessment is the best way to find out whether your neck is involved.

Can a chiropractor help with headaches?

Chiropractic care can help with headaches arising from the neck, known as cervicogenic headaches. At Chiropractic First we start by assessing you to work out what type of headache you have. If it looks like a different type, such as migraine, or a headache that needs medical investigation, we’ll explain that and point you to your GP.

What’s the difference between a cervicogenic headache and a migraine?

A cervicogenic headache comes from a problem in the neck. It’s usually a steady, one-sided ache that stays on the same side and is linked to neck movement or posture. Migraine is a neurological condition that typically causes a throbbing headache, often with nausea and sensitivity to light and sound, lasting from a few hours up to three days. Neck pain is common during a migraine, which is one reason the two can be confused.

Can poor posture or desk work cause headaches?

Spending long periods with your head forward, at a laptop, looking down at a phone or driving, loads the joints and muscles of the upper neck, and in some people that contributes to headaches that come from the neck. Setting your screen at eye level, taking regular movement breaks and keeping your neck muscles strong all help to reduce that load.

Is it safe to see a chiropractor for headaches?

For most people, yes. Mild, short-lived soreness, stiffness or tiredness is the most common after-effect of treatment, and serious complications are rare. A careful assessment beforehand screens for warning signs and for anything that makes a particular technique unsuitable, gentler techniques are available, and the benefits and risks should always be discussed with you before treatment starts.

When should I worry about a headache?

Call 999 if a headache comes on suddenly and is extremely painful, follows a head injury, or comes with confusion, drowsiness, loss of vision, problems speaking, weakness, a stiff neck with a high temperature or rash, or a red eye. Get urgent advice from NHS 111 or your GP if your jaw hurts when you eat, your scalp feels sore or your vision changes, especially if you’re over 50. See your GP if your headaches are new and getting steadily worse.