“Doctor, My Headache Starts Right Here at the Base of My Skull.”
Over the years, I’ve had many patients point to the back of their neck and tell me:
“Doctor, this is where my headaches begin.”
Some describe a dull ache that gradually travels toward the forehead.
Others experience pressure around the temples.
Some say the pain seems to wrap around their head like a tight band.
And occasionally, a patient describes a sudden, sharp, electric-like pain shooting upward from the base of the skull.
Naturally, patients want to know:
“Is this coming from my neck?”
It’s an excellent question.
And the answer isn’t always as straightforward as it might seem.
Some headaches genuinely originate from structures in the cervical spine.
Others involve muscle tension, migraine mechanisms, or irritation of nerves near the back of the head.
And some serious medical conditions can initially produce headache and neck pain.
After nearly four decades of helping patients with spinal and musculoskeletal conditions, I’ve learned that the location of pain is only one piece of the puzzle.
We also need to understand:
How does the headache feel?
Where does it travel?
How long does it last?
What makes it worse?
Are there associated symptoms?
Is there a history of migraine?
Are there neurological warning signs?
At Advanced Integrated Medical, I believe the first step toward helping patients with headaches is understanding what type of headache they may be experiencing.
Because different headaches often require different treatments.
The most important goal isn’t simply relieving the headache—it’s identifying what may be causing it.
Not Sure Where to Start?
Choose the question that sounds most like yours:
- My headache begins at the base of my skull. → See the sections on cervicogenic headaches and occipital neuralgia.
- My head feels like it’s being squeezed by a tight band. → See tension-type headaches.
- My headache throbs and I feel nauseated. → See migraine.
- I get sharp, electric-like pain in the back of my head. → See occipital neuralgia.
- My headache gets worse when I turn my neck. → See cervicogenic headaches.
- I wake up with headaches and neck stiffness. → See sleeping positions and morning headaches.
- I’m wondering whether chiropractic care can help. → See the treatment section.
- I want to know whether ice or heat is better. → See the temperature therapy guide.
What You’ll Learn
In this chapter, we’ll discuss:
- Why headaches may begin near the neck
- The anatomy of the upper cervical spine
- How cervical structures can refer pain into the head
- Cervicogenic headaches
- Tension-type headaches
- Migraine
- Occipital neuralgia
- How these conditions differ
- Why neck pain frequently accompanies migraine
- Common headache triggers
- Why posture may contribute to symptoms
- How sleep and stress affect headaches
- When imaging is appropriate
- Safe exercises and movement strategies
- Ice versus heat
- Chiropractic care and manual therapy
- PRP and regenerative medicine
- When medical or neurological referral is appropriate
- Warning signs requiring emergency care
Quick Answer
Headaches that begin near the neck may have several possible causes.
These include:
- Cervicogenic headache
- Tension-type headache
- Migraine
- Occipital neuralgia
- Other neurological or medical conditions
A cervicogenic headache is attributed to a disorder involving cervical structures.
Tension-type headache often produces bilateral pressure or tightness.
Migraine may cause moderate to severe headache with nausea or sensitivity to light and sound.
Occipital neuralgia may produce sharp, shooting, or electric-like pain along the distribution of occipital nerves.
However, symptoms can overlap.
A headache that begins at the base of the skull does not automatically mean the neck is the source.
First, Let’s Understand the Upper Cervical Spine
Your cervical spine contains seven vertebrae:
C1 through C7
The upper cervical region includes:
- The atlas, or C1
- The axis, or C2
- The C2–C3 region
- Associated joints, muscles, ligaments, and nerves
These structures help support the head and allow movement.
They also contain sensory pathways that may contribute to certain headache patterns.
How Can the Neck Cause Pain in the Head?
Sensory information from the upper cervical region interacts with pathways involved in head and facial pain.
One important anatomical concept is the:
Trigeminocervical Complex
This region involves convergence of sensory information from the trigeminal system and upper cervical nerves.
Because of this convergence, pain originating from certain cervical structures may be perceived in parts of the head.
This is one reason some cervical disorders can produce headaches.
However, the same anatomical relationships do not mean every headache with neck pain is cervicogenic.
Headache Type #1: Cervicogenic Headache
A cervicogenic headache is a secondary headache attributed to a disorder involving cervical structures.
Possible sources include:
- Upper cervical joints
- Certain cervical soft tissues
- Other cervical structures capable of producing referred pain
However, identifying the exact source can be difficult.
What Does a Cervicogenic Headache Feel Like?
Possible features include:
- Headache associated with neck pain
- Pain beginning in the neck or back of the head
- Pain extending toward the forehead, temple, or eye
- Reduced cervical range of motion
- Headache aggravated by certain neck movements
- Symptoms associated with cervical dysfunction
Some patients experience predominantly one-sided pain.
However, symptom patterns vary.
Does a Cervicogenic Headache Always Start in the Neck?
Not necessarily.
The pain may be perceived in different regions of the head.
And some patients have minimal neck discomfort.
Diagnosis requires more than simply identifying where the pain begins.
Can Neck Movement Make a Cervicogenic Headache Worse?
Yes.
Headache provoked by certain neck movements or sustained positions may support a cervical contribution.
However, migraine and other headaches may also involve neck discomfort.
Neck movement sensitivity alone does not establish the diagnosis.
Can Cervical Arthritis Cause Headaches?
Certain cervical conditions may contribute to cervicogenic headaches.
However, degenerative findings on imaging are common in people without headaches.
An X-ray showing cervical arthritis does not automatically prove that arthritis is causing the headache.
Can a Herniated Cervical Disc Cause Headaches?
Some cervical disorders may contribute to headache symptoms.
However, a disc herniation does not automatically explain a headache.
Disc findings must be interpreted alongside symptoms and examination results.
Headache Type #2: Tension-Type Headache
Tension-type headache is one of the most common headache disorders.
Patients often describe:
“It feels like a tight band around my head.”
Possible symptoms include:
- Bilateral head pain
- Pressure or tightness
- Mild to moderate intensity
- Scalp or neck tenderness
- Pain that is not usually worsened by routine physical activity
However, symptoms vary.
What Causes Tension-Type Headaches?
The mechanisms are complex.
Possible contributors include:
- Altered pain processing
- Pericranial muscle tenderness
- Stress-related factors
- Sleep disturbances
- Other biological and behavioral influences
Tension-type headache should not simply be described as muscles squeezing the skull.
Can Tight Neck Muscles Cause Tension Headaches?
Muscle tenderness may be associated with tension-type headaches.
However, the relationship is more complicated than a simple muscle-spasm explanation.
Some patients experience significant neck and shoulder tenderness.
Others do not.
What Does a Tension Headache Feel Like?
Patients often describe:
- Pressure
- Tightness
- A dull ache
- A band-like sensation
- Bilateral discomfort
Tension-type headaches generally do not cause the prominent nausea and vomiting often associated with migraine.
Headache Type #3: Migraine
Migraine is a neurological headache disorder.
It may involve:
- Moderate to severe head pain
- Throbbing or pulsating pain
- Nausea
- Sensitivity to light
- Sensitivity to sound
- Worsening with routine physical activity
Some patients experience visual or sensory aura.
However, not every migraine has these features.
Can Migraine Start in the Neck?
Yes.
Neck pain is common in people with migraine.
Some patients experience neck discomfort before or during a migraine attack.
This can make migraine difficult to distinguish from cervicogenic headache.
Why Is Migraine Sometimes Mistaken for a Neck Problem?
Because migraine may involve:
- Neck pain
- Muscle tenderness
- Pain at the base of the skull
- Headache aggravated by movement
- Other overlapping symptoms
A patient may assume the headache originates from the cervical spine.
However, the neck pain may be part of the migraine process rather than its primary cause.
Neck pain accompanying a migraine does not prove the neck caused the migraine.
Headache Type #4: Occipital Neuralgia
Occipital neuralgia involves pain associated with the occipital nerves.
These nerves provide sensation to portions of the scalp.
Patients may describe:
- Sharp pain
- Shooting pain
- Electric-like pain
- Stabbing sensations
- Tenderness near the back of the head
- Scalp sensitivity
The pain may occur on one or both sides.
Where Are the Occipital Nerves?
Important occipital nerves include:
- Greater occipital nerve
- Lesser occipital nerve
- Third occipital nerve
These nerves are associated with sensory pathways serving parts of the posterior scalp.
What Does Occipital Neuralgia Feel Like?
Patients often describe:
“It feels like an electric shock shooting up the back of my head.”
Or:
“I get sudden stabbing pains behind my ear.”
Some experience tenderness when touching the scalp.
However, other headache disorders can produce similar symptoms.
Is Occipital Neuralgia the Same as Cervicogenic Headache?
No.
These are different diagnoses.
Occipital neuralgia involves pain associated with occipital nerves.
Cervicogenic headache is attributed to cervical structures.
However, symptoms may overlap.
How Are These Headache Types Different?
| Feature | Cervicogenic Headache | Tension-Type Headache | Migraine | Occipital Neuralgia |
| Common pain pattern | Neck-associated head pain | Pressure or tightness | Often throbbing, variable location | Sharp or electric-like pain |
| Typical location | Neck, back of head, temple, forehead | Often bilateral | One or both sides | Posterior scalp |
| Neck pain | Common | May occur | Common | May occur |
| Nausea | Less characteristic | Usually absent | Common | Usually absent |
| Light sensitivity | May occur | Limited or absent | Common | Less characteristic |
| Neck movement sensitivity | May be prominent | Variable | May occur | Variable |
| Important evaluation | Cervical and headache assessment | Headache history | Migraine assessment | Neurological and nerve assessment |
These patterns are helpful but not definitive.
Why Do My Headaches Start at the Base of My Skull?
Several structures and headache disorders may produce pain near the base of the skull.
Possible causes include:
- Cervicogenic headache
- Migraine
- Tension-type headache
- Occipital neuralgia
- Other conditions
The location alone does not establish the diagnosis.
Why Does My Headache Travel From My Neck to My Forehead?
Referred pain from certain cervical structures may contribute to this pattern.
However, migraine and other headache disorders can also involve pain in multiple regions.
A careful history and examination are necessary.
Why Does My Headache Get Worse When I Turn My Neck?
Neck movement may aggravate some cervicogenic headaches.
However, movement sensitivity can occur with other headache disorders.
The clinical pattern matters.
Why Do I Wake Up With Headaches?
Morning headaches may have several possible causes.
These include:
- Migraine
- Sleep disturbances
- Sleep apnea
- Medication-related factors
- Other medical conditions
Neck stiffness may also be present.
However, morning headache does not automatically mean the pillow or cervical spine is responsible.
Can My Pillow Cause Headaches?
An uncomfortable pillow may contribute to neck discomfort.
In some patients, cervical discomfort may be associated with headaches.
However, changing pillows is not a proven treatment for every headache disorder.
Can Poor Posture Cause Headaches?
Certain sustained positions may aggravate neck discomfort in some patients.
However, there is no single posture that reliably causes headaches in everyone.
The relationship between posture, neck pain, and headache is complex.
Can Stress Cause Headaches?
Stress may contribute to headache frequency or severity in some patients.
However, stress should not automatically be blamed for persistent or unexplained headaches.
Can Dehydration Cause Headaches?
Dehydration may contribute to headaches in some circumstances.
Maintaining appropriate hydration is reasonable.
However, persistent headaches should not simply be attributed to dehydration without considering other causes.
Can High Blood Pressure Cause Headaches?
Severely elevated blood pressure may be associated with headache and other symptoms.
However, most routine headaches are not caused by mildly elevated blood pressure.
A severe headache with markedly elevated blood pressure and signs of organ injury requires emergency evaluation.
Can Sinus Problems Cause Headaches?
Yes, certain sinus conditions may cause facial pain or headache.
However, many headaches attributed to “sinus problems” are actually migraine.
A careful history can help distinguish these conditions.
How Are Headaches Diagnosed?
The evaluation begins with the patient’s history.
Important questions include:
Where does the pain begin?
Where does it travel?
How long does it last?
How often does it occur?
Is the pain throbbing, pressure-like, or electric?
Is there nausea?
Is there sensitivity to light or sound?
Does neck movement aggravate symptoms?
Are there neurological symptoms?
Is this a new or unusual headache?
What Should a Physical Examination Include?
Depending on the symptoms, the examination may include:
- Cervical range of motion
- Muscle assessment
- Neurological screening
- Reflex testing
- Strength testing
- Sensory testing
- Cranial nerve examination when indicated
- Other headache-specific assessments
No single examination finding establishes every headache diagnosis.
When Is Imaging Necessary?
Routine imaging is not required for every uncomplicated headache.
However, imaging may be appropriate when:
- Neurological deficits are present
- Serious pathology is suspected
- The headache pattern is new or unusual
- Symptoms are progressively worsening
- There are other concerning findings
The choice of imaging depends on the suspected condition.
What Can Cervical X-Rays Show?
Cervical X-rays may reveal:
- Degenerative changes
- Alignment
- Bone spurs
- Certain structural abnormalities
However, X-rays do not establish that cervical arthritis is causing a headache.
What Can Cervical MRI Show?
Cervical MRI may help evaluate:
- Discs
- Spinal nerve roots
- The spinal cord
- Spinal canal narrowing
- Other soft tissues
However, cervical MRI is not routinely necessary for every headache.
What Can Brain MRI Show?
Brain MRI may be appropriate when a clinician suspects certain intracranial or neurological conditions.
However, brain MRI is not necessary for every typical migraine or tension-type headache.
What Treatments Can Help Headaches That Start Near the Neck?
Treatment depends on the diagnosis.
Treatment #1: Education and Headache Tracking
A headache diary may help identify patterns.
Record:
- Date and time
- Duration
- Pain location
- Pain intensity
- Associated symptoms
- Possible triggers
- Medications used
- Response to treatment
This information may help guide diagnosis and management.
Treatment #2: Exercise and Rehabilitation
Selected patients with cervicogenic headaches may benefit from therapeutic exercise.
Possible goals include:
- Improving cervical movement tolerance
- Strengthening neck muscles
- Improving upper-back function
- Reducing disability
However, exercises should be individualized.
Gentle Neck Movement Routine
The following movements may be appropriate for some patients with uncomplicated mechanical neck discomfort.
Perform them slowly and within a comfortable range.
Stop if symptoms worsen.
Exercise #1: Gentle Neck Rotation
Slowly turn your head to one side.
Return to center.
Then turn toward the other side.
Avoid forcing the movement.
Suggested starting point: 5 comfortable repetitions per side.
Exercise #2: Gentle Chin Retraction
While looking forward, gently draw your chin backward.
Avoid forcing the movement.
Suggested starting point: 5 repetitions.
Exercise #3: Shoulder Blade Squeezes
Gently draw your shoulder blades toward each other.
Hold briefly.
Relax.
Suggested starting point: 5–10 repetitions.
Exercise #4: Shoulder Rolls
Slowly roll your shoulders backward.
Then forward.
Suggested starting point: 5–10 repetitions.
Important Exercise Precautions
Stop exercising and seek medical advice if movements produce:
- Increasing headache severity
- New neurological symptoms
- Dizziness
- Visual disturbances
- Weakness
- Numbness
- Other unusual symptoms
Patients with suspected cervical myelopathy, instability, vascular conditions, or other serious disorders should not begin neck exercises without appropriate medical guidance.
Ice or Heat: Which Is Better for Headaches That Start in the Neck?
This depends on the headache type and associated symptoms.
Some patients prefer heat for neck muscle tightness.
Others prefer a cool pack during headache episodes.
Neither approach is a universal treatment.
When Might Heat Be Helpful?
Heat may be comfortable when symptoms involve:
- Neck stiffness
- Muscle tightness
- General aching
- Associated muscular discomfort
A comfortably warm pack may be used for approximately 15–20 minutes.
Avoid excessive heat.
Do not sleep on a heating pad.
When Might Ice Be Helpful?
Some patients prefer cold therapy during a headache.
A cool pack may provide temporary comfort.
However, ice does not treat every underlying headache mechanism.
How Should I Apply Ice Safely?
A practical approach is:
- Wrap a cold pack in a thin towel.
- Apply it over the painful neck or upper shoulder region.
- Begin with approximately 10–15 minutes.
- Remove the pack and allow the skin to return to normal temperature.
- Repeat later if needed and if the skin tolerates it.
Never apply ice directly to the skin.
Do not fall asleep with a cold pack in place.
Avoid placing cold packs in a way that compresses the throat.
Important Precautions for Patients With Neuropathy
Some patients with headache and neck pain also have peripheral neuropathy or reduced sensation.
They may not accurately detect excessive cold or heat.
This increases the risk of skin injury.
Patients with impaired circulation or certain temperature-sensitive conditions may also require special precautions.
If you have reduced sensation or impaired circulation, seek professional guidance before using ice or heat.
Ice vs. Heat for Neck-Associated Headaches
| Situation | Ice | Heat |
| Neck muscle tightness | Sometimes helpful | Often preferred |
| Cervical stiffness | May help some patients | Often preferred |
| Headache episode | May provide temporary comfort | May help associated neck tension |
| Migraine | Some patients prefer cool packs | May help neck discomfort |
| Occipital neuralgia | May help some patients | May help some patients |
| Reduced temperature sensation | Requires special caution | Requires special caution |
Treatment #3: Physical Therapy
Selected patients with cervicogenic headaches may benefit from physical therapy.
Treatment may include:
- Therapeutic exercise
- Movement education
- Strengthening
- Selected manual therapy
- Functional rehabilitation
The best approach depends on the diagnosis.
Treatment #4: Chiropractic Care
Some patients with cervicogenic headaches or associated mechanical neck pain may benefit from selected conservative chiropractic approaches.
Treatment may include:
- Gentle mobilization
- Selected manual therapy
- Therapeutic exercise
- Movement education
- Other individualized strategies
However, chiropractic treatment is not appropriate for every headache.
Migraine and other primary headache disorders may require medical management.
Does Cervical Manipulation Help Headaches?
Some studies suggest that selected manual therapies may provide benefit for certain cervicogenic headache patients.
However, the evidence varies by intervention and outcome.
Cervical manipulation is not a universal treatment for headaches.
Is Cervical Manipulation Safe for Headache Patients?
Cervical manipulation requires careful screening and informed consent.
Temporary soreness may occur.
Serious adverse events have also been reported.
High-velocity cervical manipulation has been associated with cervical artery dissection and stroke, although the exact causal relationship and absolute risk remain uncertain.
A new, sudden, severe, or unusual headache or neck pain may itself be a warning sign of cervical artery dissection.
Such symptoms require appropriate medical evaluation before manual treatment.
When Should Cervical Manipulation Be Avoided?
High-velocity cervical manipulation should be avoided when certain conditions are suspected or present, including:
- Cervical artery dissection
- Cervical myelopathy
- Significant spinal cord compression
- Cervical instability
- Fracture
- Infection
- Certain malignancies
- Progressive neurological deficits
- Other serious conditions
Treatment #5: Medications
Treatment depends on the headache diagnosis.
For example:
- Migraine may respond to migraine-specific medications.
- Tension-type headache may respond to selected acute treatments.
- Occipital neuralgia may require different approaches.
- Cervicogenic headache may be managed with rehabilitation and other selected treatments.
Medication decisions should be made with an appropriate healthcare professional.
Treatment #6: Occipital Nerve Blocks
Occipital nerve blocks may be considered for selected patients with occipital neuralgia or certain headache disorders.
These procedures involve injecting medication near an occipital nerve.
They may provide temporary relief and can sometimes help clarify the diagnosis.
However, they are not appropriate for every patient.
Treatment #7: PRP and Regenerative Medicine
At Advanced Integrated Medical, we recognize the growing interest in regenerative medicine.
One approach being investigated for selected musculoskeletal and spinal conditions is:
Platelet-Rich Plasma (PRP)
PRP is prepared from a sample of the patient’s own blood.
The blood is processed to produce a preparation containing an increased concentration of platelets.
Platelets contain growth factors and other biologically active substances involved in tissue signaling and repair processes.
Researchers are studying PRP for selected spinal pain conditions.
However, the evidence varies substantially by diagnosis and injection technique.
Can PRP Help Cervicogenic Headaches?
At present, there is insufficient high-quality clinical evidence to establish PRP as an effective routine treatment for cervicogenic headaches.
Research involving PRP for selected cervical pain conditions remains limited.
Can PRP Help Tension-Type Headaches?
PRP has not been established as a standard treatment for tension-type headaches.
Can PRP Help Migraine?
PRP is not an established treatment for migraine.
Migraine management generally involves evidence-based acute and preventive strategies.
Can PRP Help Occipital Neuralgia?
Research involving PRP for selected nerve-related pain conditions is limited.
PRP has not been established as a standard treatment for occipital neuralgia.
Can PRP Regenerate the Occipital Nerves?
There is insufficient high-quality clinical evidence to conclude that PRP reliably regenerates damaged occipital nerves.
Are PRP Injections Around the Cervical Spine Risk-Free?
No.
The cervical region contains:
- The spinal cord
- Spinal nerve roots
- Important blood vessels
- Other sensitive structures
Potential risks may include:
- Bleeding
- Infection
- Neurological injury
- Vascular injury
- Other procedure-specific complications
Cervical spinal injections require specialized training, careful patient selection, sterile technique, and appropriate imaging guidance.
Is PRP FDA-Approved for Cervicogenic Headaches or Occipital Neuralgia?
No PRP injection has been established as an FDA-approved treatment for cervicogenic headaches or occipital neuralgia.
Certain PRP preparation devices may have FDA clearance for specific processing purposes.
However, device clearance does not establish that a particular PRP injection is approved or proven effective for these conditions.
What About Wharton’s Jelly and Umbilical Cord–Derived Products?
Some clinics market umbilical cord–derived products, including preparations described as Wharton’s jelly, for spinal and neurological conditions.
These products are different from PRP.
They should not automatically be described as stem-cell treatments.
Their contents, manufacturing methods, and regulatory status can vary.
Importantly, there are no FDA-approved umbilical cord–derived regenerative products for treating cervicogenic headaches, tension-type headaches, migraine, or occipital neuralgia.
Individual patient improvement or clinical experience does not establish that these products regenerate nerves or treat headache disorders.
Because of important safety, effectiveness, and regulatory considerations, they should not be presented as established treatments for headache disorders.
At Advanced Integrated Medical, we believe patients deserve clear information about the difference between emerging research and established clinical treatments.
Dr. Dee’s Clinical Pearl: Regenerative Medicine and Headaches
A patient may ask:
“Doctor, could PRP fix the nerves causing my headaches?”
My response begins with an important distinction.
PRP is being studied for selected musculoskeletal and nerve-related conditions.
But research has not established that PRP reliably regenerates occipital nerves or treats cervicogenic headaches.
Before considering any injection, we need to understand:
What type of headache is present?
Is the headache actually coming from the neck?
Could migraine be involved?
Are there neurological warning signs?
What evidence-based treatments are available?
The right headache treatment begins with the right headache diagnosis.
When Should I See a Neurologist?
Neurological consultation may be appropriate when:
- Headaches are frequent or disabling
- The diagnosis is uncertain
- Symptoms are progressively worsening
- Neurological symptoms occur
- Migraine treatment is ineffective
- Occipital neuralgia is suspected
- Other concerning findings are present
When Is a Headache an Emergency?
Most headaches are not emergencies.
However, certain symptoms require immediate medical attention.
Seek Emergency Care For:
- A sudden, severe headache that reaches maximum intensity rapidly
- A new severe headache with neurological deficits
- Stroke-like symptoms
- A new severe headache with fever, neck stiffness, or altered mental status
- A headache following significant trauma
- A new severe headache or neck pain with symptoms suggesting cervical artery dissection
- Sudden visual loss
- Other rapidly progressive neurological symptoms
These symptoms may indicate serious neurological, vascular, infectious, or traumatic conditions.
How We Evaluate Neck-Associated Headaches at Advanced Integrated Medical
At Advanced Integrated Medical, I believe headache evaluation begins with identifying the pattern.
We want to know:
Where does the headache begin?
Where does it travel?
Is the pain throbbing, pressure-like, or electric?
Is there nausea?
Is there sensitivity to light or sound?
Does neck movement aggravate symptoms?
Is cervical range of motion limited?
Are there neurological symptoms?
Could migraine be involved?
Could occipital neuralgia be present?
Would imaging change treatment decisions?
Depending on the findings, the evaluation may include:
- Headache history
- Cervical range of motion
- Muscle assessment
- Orthopedic testing
- Neurological screening
- Review of existing imaging
When appropriate, medical or neurological referral may be recommended.
About Dr. Dee
Dr. D. Scott (“Dee”) Stevens has spent nearly four decades helping patients with spinal pain, joint conditions, and nerve-related symptoms.
Throughout his career, he has worked with patients from many backgrounds, including professional, collegiate, and Olympic athletes.
One thing I’ve learned is that patients often assume the location of pain identifies its source.
A patient may point to the base of the skull and say:
“Doctor, my headache must be coming from my neck.”
Sometimes that’s correct.
But sometimes the headache is related to migraine or another condition.
That’s why I believe careful diagnosis matters.
Dr. Dee’s Clinical Pearl
A patient may ask:
“Doctor, if my headache starts in my neck, doesn’t that mean it’s a cervicogenic headache?”
My response is:
“Not necessarily. Migraine, tension-type headache, occipital neuralgia, and other conditions can also produce pain near the neck.”
The location is important.
But so are:
The quality of pain
Associated symptoms
Triggers
Duration
Frequency
Neurological findings
The location of pain is a clue—not the entire diagnosis.
Dr. Dee’s Office Conversation
The following is an illustrative conversation, not an actual patient testimonial.
Patient: “Doctor, my headaches always start at the base of my skull.”
Dr. Dee: “Do you ever feel nauseated or become sensitive to light?”
Patient: “Sometimes I do.”
Dr. Dee: “That makes me consider migraine as one possibility, even though the pain begins near your neck.”
Patient: “But my neck is always tight.”
Dr. Dee: “Neck tightness can occur with several headache disorders. We need to evaluate the full pattern.”
Patient: “Could an adjustment help?”
Dr. Dee: “Selected conservative treatments may help some cervicogenic headache patients, but we first need to understand what type of headache you’re experiencing.”
Patient: “What about PRP?”
Dr. Dee: “PRP hasn’t been established as a routine treatment for these headache disorders. The diagnosis should guide the treatment.”
Facing One of the Biggest Fears
“Does a Headache at the Base of My Skull Mean Something Is Wrong With My Brain?”
This is an understandable concern.
A patient may experience recurring pain near the back of the head and worry about a serious neurological condition.
Most headaches are not caused by dangerous disease.
However, certain headache patterns require urgent evaluation.
The important questions include:
Is this a new or unusual headache?
Did it begin suddenly?
Are neurological symptoms present?
Is there fever or altered mental status?
Was there significant trauma?
Are symptoms progressively worsening?
Most headaches are not emergencies—but unusual warning signs should never be ignored.
Back & Spine Health Success Principle #13
Identify the Headache Before You Treat the Neck
Patients sometimes assume that a headache beginning near the neck must be caused by the cervical spine.
But that’s not always true.
Migraine may involve neck pain.
Tension-type headache may involve neck tenderness.
Occipital neuralgia may cause sharp pain near the skull.
And cervicogenic headache may arise from cervical structures.
The treatment depends on the diagnosis.
Don’t treat every headache as a neck problem—identify the headache first.
Ask Dr. Dee
“Doctor, how do I know whether my headache is coming from my neck or whether it’s a migraine?”
The symptoms can overlap.
Cervicogenic headaches may be associated with restricted neck movement and pain aggravated by certain cervical movements.
Migraine may involve nausea, light sensitivity, sound sensitivity, and worsening with routine physical activity.
However, neck pain is also common during migraine.
A careful headache history and examination are often necessary.
A Lesson I’ve Learned in Nearly 40 Years
The Location of Pain Doesn’t Always Reveal the Source
Over the years, I’ve learned that patients often assume pain must originate exactly where they feel it.
But the nervous system doesn’t always work that way.
Pain may be referred from one structure to another region.
And different conditions may produce similar symptoms.
That’s why I believe good healthcare begins with careful questions.
Not simply:
“Where does it hurt?”
But also:
“What does it feel like?”
“When does it happen?”
“What makes it worse?”
“What other symptoms occur?”
Understanding the pattern is often more valuable than simply locating the pain.
The Hope Principle
Recurring headaches can be exhausting.
They may interfere with:
- Work
- Sleep
- Family activities
- Exercise
- Concentration
- Quality of life
But many headache disorders have effective management options.
The important thing is identifying the type of headache and choosing appropriate care.
Some patients benefit from rehabilitation.
Others require migraine-specific treatment.
Some may need neurological evaluation.
And occasionally, urgent medical assessment is necessary.
A recurring headache doesn’t have to control your life—but understanding the diagnosis is the first step toward better management.
“I believe the best healthcare decisions are made when patients understand their condition. My job isn’t simply to treat symptoms—it’s to help you understand why they’re happening and what your options are.”
— Dr. D. Scott (“Dee”) Stevens
Frequently Asked Questions
- Why do my headaches start at the base of my skull?
Possible causes include cervicogenic headache, migraine, tension-type headache, occipital neuralgia, and other conditions.
- What is a cervicogenic headache?
It is a secondary headache attributed to a disorder involving cervical structures.
- Can cervical arthritis cause headaches?
Certain cervical conditions may contribute to headaches, but arthritis on imaging does not automatically establish the cause.
- Can migraine start in the neck?
Yes. Neck pain is common in people with migraine.
- What does a tension headache feel like?
It often produces pressure or tightness, sometimes described as a band-like sensation.
- What does occipital neuralgia feel like?
It may produce sharp, shooting, or electric-like pain in the posterior scalp.
- Can a pinched nerve in the neck cause headaches?
Certain cervical conditions may be associated with headache symptoms, but a pinched nerve does not automatically explain every headache.
- Can poor posture cause headaches?
Certain sustained positions may aggravate symptoms in some patients, but posture alone does not explain every headache.
- Can stress cause headaches?
Stress may contribute to headache frequency or severity in some patients.
- Can dehydration cause headaches?
Dehydration may contribute to headaches in some circumstances.
- Can my pillow cause headaches?
An uncomfortable pillow may contribute to neck discomfort, but changing pillows is not a universal headache treatment.
- Should I use ice or heat?
Either may provide temporary comfort. Heat is often preferred for muscular tightness, while some patients prefer cool packs during headaches.
- Can chiropractic care help cervicogenic headaches?
Selected conservative approaches may help some patients, but treatment should follow an appropriate evaluation.
- Does cervical manipulation help migraine?
Cervical manipulation is not an established substitute for evidence-based migraine management.
- Can PRP help cervicogenic headaches?
There is insufficient high-quality clinical evidence to establish PRP as a routine treatment for cervicogenic headaches.
- Can PRP regenerate occipital nerves?
There is insufficient high-quality clinical evidence to conclude that PRP reliably regenerates occipital nerves.
- Do I need a brain MRI?
Not necessarily. Imaging depends on the headache pattern, examination, and warning signs.
- When should I seek emergency care?
Sudden severe headache, neurological deficits, stroke-like symptoms, fever with severe headache and neck stiffness, or other concerning symptoms require emergency evaluation.
Key Takeaways
- Headaches that begin near the neck have several possible causes.
- Cervicogenic headache is attributed to cervical structures.
- Tension-type headache often produces pressure or tightness.
- Migraine may involve nausea and sensitivity to light or sound.
- Neck pain is common during migraine.
- Occipital neuralgia may cause sharp or electric-like pain in the posterior scalp.
- The location of pain alone does not establish the diagnosis.
- Cervical arthritis on imaging does not automatically explain a headache.
- A headache diary may help identify patterns.
- Gentle exercise may help selected patients with cervicogenic headache.
- Ice or heat may provide temporary comfort.
- Chiropractic care may help selected patients with cervicogenic headache or mechanical neck pain.
- Cervical manipulation is not appropriate for every headache patient.
- PRP has not been established as a routine treatment for cervicogenic headache, migraine, tension-type headache, or occipital neuralgia.
- Umbilical cord–derived regenerative products are not FDA-approved for headache disorders.
- Neurological evaluation may be appropriate for frequent, disabling, unusual, or progressive headaches.
- Sudden severe headache or neurological deficits require emergency evaluation.
- The most important step is identifying the headache type before choosing treatment.
Why Patients Choose Advanced Integrated Medical
At Advanced Integrated Medical, we believe patients deserve a thoughtful evaluation of headaches associated with neck discomfort.
We want to understand:
Where does the headache begin?
Where does it travel?
Is the pain throbbing, pressure-like, or electric?
Is there nausea?
Is there sensitivity to light or sound?
Does neck movement aggravate symptoms?
Could migraine be involved?
Could occipital neuralgia be present?
Are there neurological warning signs?
Would imaging change treatment decisions?
Would exercise or rehabilitation help?
Could ice or heat provide safe temporary relief?
Is chiropractic treatment appropriate?
Would medical or neurological referral be beneficial?
Our goal is to help patients understand their condition and make informed decisions about their care.
Continue Exploring the Back, Neck & Sciatica Learning Center
You may also want to read:
- Article #66: Why Does My Lower Back Hurt? Understanding the Most Common Causes of Back Pain
- Article #67: What Is Sciatica, and What Causes It? Understanding Pain That Travels Down Your Leg
- Article #68: What Is a Bulging or Herniated Disc—and Does It Always Cause Pain?
- Article #69: What Is Lumbar Spinal Stenosis—and Why Do My Legs Hurt When I Walk?
- Article #70: Why Does My Back Hurt When I Sit? Understanding Disc Pain, Posture, and Prolonged Sitting
- Article #71: Can Chiropractic Treatment Help Lower Back Pain? What the Research Really Says
- Article #72: How Many Chiropractic Treatments Will I Need for Lower Back Pain?
- Article #73: Why Does My Neck Hurt? Understanding the Most Common Causes of Neck Pain
- Article #74: What Is a Pinched Nerve in the Neck? Understanding Cervical Radiculopathy, Arm Pain, and Hand Numbness
- Article #75: What Is Cervical Spinal Stenosis? Understanding Spinal Cord Compression, Hand Clumsiness, and Balance Problems
- Article #76: Why Do I Wake Up With Neck Pain? Understanding Sleeping Positions, Pillows, Morning Stiffness, and Cervical Arthritis
- Article #77: Why Does My Neck Crack or Pop? Understanding Cervical Crepitus, Joint Sounds, and When to Be Concerned
Medical Disclaimer
This article is intended for educational purposes only and does not replace individualized medical diagnosis or treatment.
Headaches may result from primary headache disorders, cervical conditions, neuralgias, vascular disorders, infections, intracranial conditions, medication-related causes, or other medical problems.
The location of headache pain does not establish the diagnosis.
Patients with new, unusual, severe, progressively worsening, or disabling headaches should seek appropriate medical evaluation.
Sudden severe headache, neurological deficits, stroke-like symptoms, fever with severe headache and neck stiffness, significant trauma, sudden visual loss, or other concerning symptoms may indicate a medical emergency.
High-velocity cervical manipulation may be inappropriate in patients with suspected cervical artery dissection, spinal cord compression, progressive neurological deficits, instability, fracture, infection, or other serious conditions.
High-velocity cervical manipulation has been associated with cervical artery dissection and stroke, although the exact causal relationship and absolute risk remain uncertain.
Ice and heat may provide temporary symptom relief but are not established treatments for every headache disorder. Patients with reduced sensation, peripheral neuropathy, impaired circulation, or certain temperature-sensitive conditions should seek professional guidance before using thermal therapies.
PRP injections for cervical spinal and headache conditions remain investigational. PRP has not been proven to regenerate occipital nerves or reliably treat cervicogenic headaches, migraine, tension-type headaches, or occipital neuralgia.
FDA clearance of a PRP preparation device does not establish FDA approval of PRP as a treatment for headache disorders.
Umbilical cord–derived regenerative products are not FDA-approved for treating cervicogenic headaches, tension-type headaches, migraine, or occipital neuralgia.
Exercise, rehabilitation, medications, injections, and other treatments are not appropriate for every patient.
Treatment decisions should be individualized based on the patient’s history, examination, neurological findings, imaging when appropriate, medical conditions, available evidence, and preferences.
Ready to Learn More?
If your headaches begin near the neck, don’t automatically assume:
“It must be a problem with my cervical spine.”
Instead, ask:
Could this be a cervicogenic headache?
Could migraine be involved?
Does the pain resemble a tension-type headache?
Could occipital neuralgia explain the symptoms?
Are there neurological warning signs?
Would a clinical evaluation help?
What treatments are supported by the evidence?
Would exercise or rehabilitation help?
Is chiropractic treatment appropriate?
Would medical or neurological referral be beneficial?
At Advanced Integrated Medical, we believe understanding the headache type is the first step toward choosing appropriate care.
Understand the headache. Recognize the warning signs. Choose the right treatment. Protect your neurological health.
Advanced Integrated Medical
1635 N 200 E
Logan, UT 84341
Phone: (435) 999-3953
Advanced Care • Natural Healing • Real Results
Selected Scientific References and Further Reading
- Headache Classification Committee of the International Headache Society. (2018). The International Classification of Headache Disorders, 3rd Edition. Cephalalgia.
- Bogduk N, Govind J. (2009). Cervicogenic Headache: An Assessment of the Evidence on Clinical Diagnosis, Invasive Tests, and Treatment. The Lancet Neurology.
- Blanpied PR, et al. (2017). Neck Pain: Revision 2017. Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy.
- American Headache Society. Educational resources on migraine and headache disorders.
- Biller J, et al. (2014). Cervical Arterial Dissections and Association With Cervical Manipulative Therapy. Stroke.
- American College of Radiology. ACR Appropriateness Criteria: Headache.
These references provide background on headache classification, cervical headache disorders, conservative treatment, imaging, and safety. They do not establish that every treatment discussed is effective or appropriate for all patients.