Neck Pain Radiating to the Back of the Head: When It’s Not a Migraine
Many people experience headaches that start at the back of the head(occiput) and spread upward toward the temples or behind the eyes. These headaches are often mistaken for migraines, but in many cases, the real culprit lies in the neck — a condition known as cervicogenic headache.
Understanding Cervicogenic Headache
A cervicogenic headache is a secondary headache, meaning it originates from a problem in the cervical spine (neck region) rather than within the brain itself. The pain is referred from irritated joints, nerves, or muscles in the neck, especially from the upper cervical segments (C1–C3). These structures share pain pathways with the head and occipital area, which is why the discomfort can mimic a migraine.
Common features that help distinguish cervicogenic headache include:
- Pain starting in the neck or base of the skull and radiating to the back of the head or around the eyes
- Stiffness or limited range of motion in the neck
- Pain that worsens with neck movement or sustained posture (such as looking down at a phone or looking upward)
- One-sided pain that doesn’t shift sides
Common Causes
Cervicogenic headaches are often related to:
- Facet joint dysfunction — irritation or degeneration of the small joints connecting the vertebrae
- Poor posture — prolonged computer or phone use causing chronic neck strain
- Whiplash or neck injuries
- Arthritis or disc degeneration
Treatment Options
Management focuses on addressing the underlying neck pathology and relieving referred pain.
- Medication
Initial treatment may include oral or topical anti-inflammatory medications, muscle relaxants, or neuropathic pain modulators to reduce inflammation and nerve irritation. - Physiotherapy
Targeted physiotherapy plays a crucial role — stretching tight muscles, strengthening deep neck stabilizers, and correcting posture can significantly reduce recurrence. Manual therapy and ergonomic adjustments are also beneficial. - Pain Interventions
For patients who continue to experience pain despite conservative care, interventional pain management offers precise diagnostic and therapeutic options:
- Diagnostic Medial Branch Block (MBB):
This procedure involves injecting a small amount of anesthetic near the medial branches of the cervical nerves that supply the facet joints. If pain relief occurs, it confirms that the facet joints are the pain source. - Radiofrequency Ablation (RF):
Once the source is identified, radiofrequency energy can be used to selectively heat and deactivate the sensory nerves transmitting pain from the affected joints. Pain relief may last for 6-12 months or longer. - Cooled Radiofrequency (Cooled RF):
A newer technology using controlled cooling around the probe tip allows for a larger treatment area, which result in longer-lasting relief and better coverage of the target nerve branches. Pain relief may last for 12-24 months or longer.
Takeaway
Not every headache is a migraine. If your headache begins in the neck or worsens with neck movement, it may be cervicogenic in origin. Accurate diagnosis through physical assessment and diagnostic blocks is key to effective treatment. With the right combination of medication, physiotherapy, and advanced pain interventions, long-term relief and improved quality of life are achievable.
