Neck-related headache (cervicogenic headache)

Not every headache starts in the head. In cervicogenic headache the cause lies in the upper cervical vertebrae and the muscles and joints around them. The pain radiates from the neck to the back of the head, the temple or behind the eye, usually on one side. This type of headache is often mistaken for migraine or tension-type headache, and responds poorly to ordinary painkillers.

​

Does this sound familiar?

• Headache that starts on one side, often from the neck or the back of the head.

• Worse with certain neck movements, long hours at a screen or pressure on the neck.

• A stiff neck or limited rotation to one side.

• Painkillers help little; rest or warmth on the neck sometimes does.

• Previous treatment of "the neck" helped briefly, then the headache came back.

​

First establish whether it really comes from the neck

Treatment of cervicogenic headache differs from that of migraine or tension-type headache. That is why we start with examination, not with treatment. Alexander Kudus is a headache physiotherapist and works with the International Classification of Headache Disorders (ICHD-3). At the intake we examine:

• the mobility of the upper cervical vertebrae and whether pressure on them reproduces your familiar headache;

• the muscles of the neck, shoulders and jaw, and where needed muscle tension with sEMG;

• your posture and the load on the neck during work and sleep;

• whether there are signs of another type of headache or a reason to involve your GP or a neurologist.

We ask you to keep a headache diary for a few weeks before the appointment: when, how long, how severe and what you were doing. That makes the diagnosis more reliable.

​

Treatment

If the headache comes from the neck, treatment consists of mobilisation of the neck, treatment of the muscles involved, exercises for the deep neck muscles and adjustment of posture and workplace. You take the exercises home with video instructions. How many sessions are needed depends on how long you have had the complaints; after the intake you receive an estimate.

If the headache turns out not to come from the neck, we tell you so and advise on the next step.

​

Practical

• No referral needed; reimbursed through your supplementary insurance for physiotherapy.

• Intake 60 minutes, usually within a week.

• Amsterdam West, tram 1 stop Rhijnvis Feithstraat. English spoken.

​

Read more: Cervicogenic headache — cause, diagnosis and treatment (blog, in Dutch)