Chronic Conditions
Chronic Headaches
Frequent headaches including cervicogenic and occipital neuralgia patterns arising from the neck.
What chronic headaches is
Many persistent headaches originate in the upper cervical spine. Irritated upper facet joints and the occipital nerves refer pain forward over the scalp, behind the eye and into the temple — a pattern often mistaken for migraine.
When a cervical source is present, treating it directly can reduce headache frequency substantially where oral medication alone has not.
Common symptoms
- Headache beginning at the base of the skull
- One-sided pain that spreads over the scalp or behind the eye
- Headaches triggered by neck posture or movement
- Scalp tenderness
Common causes
- Irritation of the upper cervical facet joints from prior neck injury or arthritis
- Occipital nerve irritation or entrapment at the base of the skull
- Prolonged poor neck posture, such as extended computer or phone use
- Prior whiplash injury that was never fully treated
- Migraine or tension headache patterns that overlap with a cervical component
How it is diagnosed
The evaluation focuses on where the headache begins and how it spreads. A headache that starts at the base of the skull and moves forward over the scalp or behind the eye, especially when triggered by neck movement or posture, suggests a cervical origin.
The exam checks for tenderness over the upper cervical facet joints and the occipital nerves, along with neck range of motion. Imaging of the cervical spine may be used if a structural cause such as significant arthritis is suspected.
A diagnostic block of the occipital nerve or the upper cervical medial branch nerves can confirm a cervical source when the pattern is unclear, distinguishing it from primary migraine, which is managed somewhat differently.
Treatment options we offer
Which of these applies depends on your examination and, where appropriate, a diagnostic block confirming the source of your chronic headaches.
- Nerve BlocksTargeted injections that interrupt pain signals along a specific nerve or nerve plexus.
- Medial Branch BlocksA precise diagnostic block of the small nerves carrying pain from a facet joint, used to plan longer-lasting treatment.
- Radiofrequency AblationRadio waves used to interrupt pain signals from confirmed facet or sacroiliac nerves, often giving relief for a year or more.
- Trigger Point InjectionsSmall injections into taut, tender muscle bands that release the knot and reduce referred pain.
When to see a specialist
- Headaches that begin at the base of the skull on a recurring basis
- One-sided head pain that spreads over the scalp or behind the eye
- Headaches clearly triggered or worsened by neck position or movement
- Headaches that have not responded well to typical over-the-counter or prescribed headache medication
- A sudden, severe 'worst headache of your life,' headache with fever and neck stiffness, or headache after a head injury, which need emergency evaluation
Common questions
How can I tell if my headache is coming from my neck?
Are cervicogenic headaches the same as migraines?
What is an occipital nerve block and how long does relief last?
Can treating my neck actually reduce headache frequency?
Related conditions
- ArthritisDegenerative and inflammatory joint disease of the spine, hips, knees and shoulders.
- NeuropathyNerve damage causing burning, numbness and tingling, most often in the feet, legs and hands.
- Complex Regional Pain SyndromeA disproportionate pain response after injury, with skin, temperature and swelling changes in a limb.
- FibromyalgiaWidespread musculoskeletal pain with fatigue, sleep disturbance and heightened pain sensitivity.
Ready to get a real diagnosis?
Most patients are seen within two weeks. Call our office or send a request and our staff will help you choose the most convenient location.