Is it a Cervicogenic Headache or a Migraine?
Most people are familiar with migraines and tension-type headaches. But these are not the only types of headaches which are prevalent. One type of headache you may not be as familiar with is what is known as a “cervicogenic headache.”
Even though cervicogenic headaches are common, many people have never heard the term before and have no idea they exist.
You might even have cervicogenic headaches and have no idea because you have mistaken them for migraines. As you will discover in this article, that would be very easy to do since the two have an astonishing number of features in common.
What is a Cervicogenic Headache?
A cervicogenic headache is defined as a type of “secondary headache.” This means that you have an underlying condition causing your head pain.
That condition involves your neck. The American Migraine Foundation writes:
“There must be evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache. Such disorders include tumors, fractures, infections and rheumatoid arthritis of the upper cervical spine. There is debate as to whether cervical spondylosis (age-related wear and tear affecting the spinal disks in your neck) can cause cervicogenic headache.”
Structural problems involving the spine could also lead to cervicogenic headache, as could disorders of the soft tissue.
You might think that pain which is generated in your neck should stay in your neck. But the body is capable of referring pain, and can send those signals to your head and face.
This website is fantastic for learning about those referral patterns and how problems with the neck, back and shoulders can cause pain in the head and face.
To give you an example, I can describe my particular anatomical issues.
I have a permanent misalignment of the jaw which pulls the vertebrae in my neck out of their proper positions. This exerts continuous strain on the soft tissues in my neck, which has led to the development of myofascial pain syndrome (MPS). This causes my muscles to refer pain from my neck to my head and face.
Once I learned that I had these issues, they seemed obvious. I can look in the mirror and clearly see my structural deformity.
But most people who look at me seem to miss it, including medical professionals. So even if you think there is no “obvious” reason to suspect a cervicogenic factor in your head pain, it is worth investigating.
Consider also that many possible causes of cervicogenic headaches could be impossible to detect by the eye alone. Arthritis or a tumor, for example, might only be obvious if proper investigations are conducted.
What is a Migraine?
Now that you know what a cervicogenic headache is, let’s talk about what migraines are. Actually, it is quite difficult to explain what a migraine is. As the American Migraine Foundation points out, even doctors have a difficult time answering this question.
Migraines are often diagnosed according to symptoms rather than cause. This is arguably pretty misleading, as you will understand shortly.
At the link above, the American Migraine Foundation explains, “One is said to have migraine if within his/her lifetime there have occurred 5 or more attacks of unprovoked headache lasting 4-72 hours, severe enough to markedly restrict or even prohibit routine daily activity and accompanied by nausea or light/ sound sensitivity.”
The reason that this definition is so problematic is because it could also describe a cervicogenic headache. I will be explaining this in detail in the next sections.
This is why it is more helpful to think about causes rather than symptoms when attempting to illustrate the differences between different types of headaches.
Here, there are complications as well, because researchers still do not entirely understand what causes migraines in the first place.
Originally, it was believed that migraine pain was vascular in origin. The American Migraine Foundation states, “We now believe that migraine is probably genetic in origin and that the disorder reflects a genetically induced hypersensitivity involving neurons (brain cells) located within the central nervous system.”
This is not to say that there is no involvement of vascular factors. But if there is, it would seem that they are simply one possible triggering event which may activate these neurons and cause the sensation of head pain and other symptoms.
Other potential triggering events could include hormonal changes, bright light, certain foods, and so forth.
Is There a Connection Between Migraines and Cervicogenic Headaches?
Obviously, you only have cervicogenic headaches if you have a structural problem in your neck. If there is nothing wrong with your neck in an underlying sense, but you experience these types of severe headaches, chances are good that you have migraines.
But what if you do have a structural issue with your neck? Does this necessarily mean that you experience cervicogenic headaches, and not migraines?
And if you do have patterns of referred pain which match those which would stem from the neck, but your spine is not structurally compromised, does this mean you don’t have cervicogenic head pain?
The answers to these questions are quite complicated. There are a couple of reasons why:
- First of all, it is possible for migraines to cause tension in the neck. It seems feasible that this could activate trigger points in the neck, causing the same referral patterns which you might have cervicogenic issues.
- Secondly, a migraine could hypothetically be triggered by trigger points, muscle tension, and/or associated stress. So if you have a problem with your neck which could cause cervicogenic pain, it might also trigger migraines. It might even be able to trigger migraines whether or not it causes referred cervicogenic head pain.
- If you have problems with your neck, even if they do not directly cause migraines, you could still have co-morbid migraines which are triggered by something else altogether.
In short, it seems feasible that any possible combination of neck issues, migraines and/or cervicogenic headaches could co-exist.
To read more about muscle tension and head pain, check out “New Research Shows Migraines Can Spawn Muscle Tension.”
Features of Migraines and Cervicogenic Headaches Compared and Contrasted
Now that we have discussed the differences between the causes of migraines and cervicogenic headaches as well with how they might be co-morbid in some patients, let’s analyze the symptoms of each.
As you will discover, it is almost impossible to tell the difference between the two based on symptoms alone.
1. Where the pain occurs.
Migraines are most commonly felt only on one side of the head rather than bilaterally. Nonetheless, this is not always a defining feature. Some people do experience bilateral migraines.
It is particularly common for the pain of a migraine to settle over the temple, the forehead, or the eye. Nonetheless, it is possible to feel pain in other parts of the head or face.
For example, while less commonly discussed, it is possible to feel migraine pain in your cheek (which could be mistaken for sinusitis in some cases).
This is the first similarity with migraines. Just as with migraines, cervicogenic head pain tends to be unilateral, attacking only one side of the head or face at a time. Also like with migraines, this feature is not necessarily ubiquitous. It is possible to feel bilateral pain as well, especially when the pain is switching from one side to the other.
The same sites where pain is common on the head and face with migraines also tend to be affected with cervicogenic headaches.
For example, the trapezius can refer pain up to the temple. The sternocleidomastoid (SCM) can do so as well, while also attacking the forehead, eyebrow, eye and (indirectly) nose. The subocciptal group refers pain to the temple as well. So can the semispinalis capitis. In my experience, it can send pain to the eye too.
In the section above, I mentioned that migraine pain can manifest in the cheek. This is also a common referral site from the SCM, so it may be a manifestation of cervicogenic pain as well.
Key Point: Both migraines and cervicogenic headaches are usually unilateral, but not always. Both can send pain to the temple, eye, forehead, cheek, and other locations on the head and face. That means that the location of the pain alone is not sufficient to make a diagnosis for one type of headache rather than the other.
2. What the pain feels like.
Migraines are typically described as causing moderate to severe pain. But according to Dr. David Dodick, “Yes, indeed, migraine attacks may be associated with headache that is mild or moderate, or severe and incapacitating.”
Migraine pain is usually described as “throbbing,” in quality, but this too is not universal.
Further, it is possible to have a migraine with no head pain whatsoever.
As with migraines, the pain of a cervicogenic headache can range anywhere from mild to severe. At their worst, they too can be incapacitating.
Here is one of the key differentiations with migraines. Whereas migraines usually are described as throbbing pain, cervicogenic headaches usually are described as steady pain.
Note the use of the word “usually,” however. Just as there are exceptions with migraines, there are also exceptions in this respect with cervicogenic headaches.
It is possible for a cervicogenic headache to throb, especially if injury or inflammation is present and drawing blood to the neck or head.
I have also noticed that becoming dehydrated seems to cause this effect as well, especially when moving in certain ways.
Then again, in my case, the jury is still out. I definitely have cervicogenic headaches, but I may or may not have migraines.
Because I have cervicogenic headaches for sure, however, I can tell you a bit more about the sensations they cause for me.
This is one person’s subjective description, so it should be taken with “your mileage may vary” firmly in mind.
Here are some of the different types of pain I experience and the ways that I describe them. All of them are linked to my neck.
- “Malaise” pain. One type of head pain I experience which is cervicogenic in origin is very diffuse. It is low-level, to the point where originally, I did not actually recognize it as a “headache” in the traditional sense. I thought of it as “malaise” or feeling “unwell.” Over time, I have learned that it is a mild but persistent form of head pain which is deeply fatiguing, leading to that “sick” feeling that worsens over time.
- “Dull ache” pain. This is what it sounds like—a dull, low-level to moderate achy sensation. I notice this one is usually unilateral, which leads me to believe this might be a more traditional tension-type headache—but it’s still cervicogenic in a sense, being as my structural problems are what causes the tension.
- “Instability” pain. This is an unusual sensation which is hard to describe, but which often precedes “metallic pain” (see below), especially very bad attacks. It feels kind of like “pressure” all around my head.
- “Prickly, scratchy, crawling” pain. This type of pain really cannot be described any better than the words I have just listed. It is usually a low to moderate sensation. If it becomes severe, it usually converts into the type of pain below. Interestingly, it almost always occurs on the right side of my face, and seems to be referred from the SCM and trapezius in most cases. My understanding of its distinctiveness is incredibly limited, but it is an interesting anecdote about how the very sensation of pain and not just its location can be asymmetric depending on one’s structural abnormalities.
- “Metallic” pain. I have a hard time explaining why I think of this pain by this descriptor, only that it is hard, bright, sharp, unyielding and severe. It is usually steady, but occasionally throbbing. In my case, I have never figured out whether this type of pain is purely cervicogenic or has a migraine component. It can occur anywhere on my head or face, but its favorite locations to manifest are my left temple, eyebrow, behind the eye, and nose. It is the type of pain which I also most associate with abrupt drops or rises in hormone levels.
- Shooting pain. Sometimes I get shooting “electrical” pains in my neck, face or head. I believe that these are usually associated with a relatively recent injury.
Again, all of this is very much anecdotal, but it does serve as an illustration of the diverse possible manifestations of cervicogenic pain even in one individual.
You also can see how at least some of my pain experiences could easily be cervicogenic or migraine-related.
When I was young, I was headache-prone even before I received the injury which offset my jaw and neck. It seems quite likely that those headaches were migraines. If that is the case, I can certainly say that the “metallic” type of pain I get now feels very much the same, despite the changes in its location and the way that it clearly flares in relation to the problems with my neck.
Key Point: Both migraines and cervicogenic headaches can be mild, moderate, or severe. Migraines usually have a throbbing quality, but can be steady. Cervicogenic headaches usually have a steady quality, but can be throbbing. Cervicogenic headaches also seem to be able to take on quite a few other manifestations. This means that in some cases, these two types of headaches can feel very different. But in others, they can feel exactly the same.
3. How severe the pain is.
I have already commented a bit on severity of pain in cervicogenic headaches and migraines in my descriptions above.
But I do want to emphasize this in its own section for those who are skimming over this article to try and establish what types of headache they might have.
Even though migraines are known for being particularly severe and debilitating in many cases, it is worth remembering that they may also be mild or even painless.
As for cervicogenic headaches, the main thing to understand is that they are not by default mild. It would be easy to make the assumption that they are since the pain is frequently related to muscle tension, and classic tension-type headaches are often described as being “mild to moderate.”
But the referred pain involved in cervicogenic headaches can frequently be just as severe and debilitating as what you would expect from a migraine.
Key Point: Severity cannot be used to tell apart a migraine from a cervicogenic headache. Both conditions can be mild or debilitating.
4. How long the pain lasts and how frequently it occurs.
Next, let’s talk about the duration of cervicogenic headaches and migraines. How long do each of these types of headaches potentially last?
WebMD states, “Most migraines last about four hours, but severe ones can last up to a week.
In terms of frequency, the site reports, “How often they happen differs for everyone, but it’s common to get two to four headaches per month. Some people may get migraines every few days, while others get them once or twice a year.”
So if you are “typical,” it would seem that you could expect to be in the throes of a migraine for a few hours several days of the month.
But you could get them far less frequently, or you could wind up experiencing migraines most of the time. After all, if you are prone to getting a migraine every few days, and your migraines last for up to a week, you could be in pain constantly.
I have not been able to locate any data on the typical frequency or duration of cervicogenic head pain, so I can only speak anecdotally from my own experiences.
Here is a very interesting paragraph from a study:
“The profile of sufferers of CGH varies according to the population under review. Hospital-based studies reveal an 85–88% female preponderance8,28; in contrast, a large-scale community-based study revealed a 71% male preponderance8. This difference was explained by the reluctance of males to seek treatment. Mean age at onset has been reported as 33–43 years, and a mean duration of symptoms of 7–17 years. Chronicity appears to develop through increasing frequency of short-lasting headache attacks, rather than continuous unrelenting pain.”
Speaking anecdotally, my own head pain did originally present as continuous unrelenting pain, before switching to frequent attacks.
Again, it is possible that I may have migraines, which could be a confounding variable that might account for the difference in my own pain development. I was fine one day, and broken the next.
My case set in at age 21. Why it was that specific age, I do not know, but I would guess that hormonal changes were responsible for that initial spike, particularly given that my pain follows hormonal patterns based on my monthly cycles now.
In fact, the two principle variables which seem to impact my pain levels include:
- How far out of alignment my spine is as well as the placement of my jaw.
- Factors involving hormones and neurotransmitters and their fluctuations based on the time of day and time of month.
Considering that I have experienced both intractable head pain which lasted for many months as well as time periods my pain has been relatively well-controlled with shorter attacks that are further apart, my guess is that the frequency and duration of cervicogenic pain are likely highly variable from person to person based on the underlying factors which influence the pain.
If underlying factors go untreated and are severe enough to exert continual duress, I’m fairly sure that intractable pain such as what I experienced would be the expected result for others as well.
How frequent were my headaches and how long did they last during the time period when my pain was best-controlled?
I did not take very good notes at the time, and currently I am recovering from a neck injury, so I can only take a guess.
But I would say that this would be a typical pattern throughout the month:
- During my period: Usually I swing back and forth between feeling pretty good and feeling intense pain.
- Follicular phase: During the week to week and a half following my period, I feel my worst overall. Head pain is most frequent and can be moderate to severe. Typically, I’m in pain for all or a significant part of each day, though I often have relief at night.
- Ovulation: Sometimes I feel just fine, but other times I have another pain spike.
- Luteal Phase: This is my best time overall. I often get an intense spike a few days before my period which lasts for several hours, but pain is usually mild to moderate otherwise. Sometimes I have pain-free days, and often have days which are relatively painless, with shorter, milder head pain interludes (i.e. the condition is “present” on those days, but not significantly damaging quality of life).
I would say that the luteal phase at its best can be like life was before I got this problem—back when I was headache-prone, but I didn’t have the sense of a constant presence of dis-ease in my body.
Nonetheless, even when I have no head pain, I usually can sense “wrongness” in my neck or shoulders in the form of mild pain, tightness, immobility, and so forth. There is generally the bodily awareness that if I move in the wrong way or push myself too hard, head pain will result.
Do not forget that I am just one data point. Other people with cervicogenic headaches may have very different experiences. Hopefully some studies will give us insight into the typical frequency and duration of cervicogenic pain.
Key Point: A migraine may last anywhere from 4 hours up to a week in duration. Attacks can happen as infrequently as a few times a year or as frequently as every few days. I was unable to find duration and frequency data for cervicogenic head pain, but in my experience, attacks can last from hours to months in duration, and their frequency depends on the underlying variables driving the pain experience (i.e. structural issues and/or effects of hormones or neurotransmitters).
5. Other symptoms.
You might think that migraines can easily be differentiated from cervicogenic headaches because of the other symptoms they manifest. As you will discover below, that is not the case.
Migraines may or may not include other symptoms besides head pain. Some of these symptoms include fatigue, nausea, vomiting, light sensitivity, and noise sensitivity.
For many people, there is a stage before the full-blown attack sets in where certain symptoms may be detectable. Some of these include stiffness in the neck, thirst or hunger (often for specific foods), and changes in mood.
Those who experience “aura” may experience visual distortions, vertigo, weakness, tingling, and other symptoms before the head pain (“attack”) begins.
Symptoms may resolve after the attack rapidly, or it may take quite some time for them to gradually dissipate. After the attack is over, some symptoms may “echo” as you recover.
This article describes the following accompanying symptoms as “infrequent” with cervicogenic headache:
- Noise sensitivity.
- Light sensitivity.
- Throbbing pain.
- Pain which gets worse when bending forward.
Meanwhile, these symptoms are reported as being frequent or very frequent for migraines. It’s also noted that with cervicogenic headaches, “sustained/awkward neck positions” universally provoke pain, but that this is relatively rare with migraines.
I can certainly say from my experiences that I have had nausea, noise sensitivity, light sensitivity, fatigue, dizziness, and a general feeling of sickness accompanying many of my headaches.
Being as I can often identify a specific problem in my neck at the same time (trigger points activating, spine being extra misaligned, etc.), I feel reasonably confident stating that when I get these symptoms, at least part of the time, they are cervicogenic in origin.
Key Point: Migraines are frequently characterized by nausea, light and noise sensitivity, and other symptoms which go beyond head pain. Cervicogenic headaches may present with the exact same symptoms.
How To Figure Out What Type of Headache(s) You Have?
Perhaps it is obvious to you what type or types of headaches you suffer from, but you may very well find yourself feeling completely uncertain now that you know just how alike migraines and cervicogenic headaches can be.
So what can your next steps be? Here are a few recommendations:
- Let go of your assumptions and keep an open mind. Start keeping a headache diary to track your symptoms and how they correlate with different factors in your body and your environment.
- Do consider seeing a doctor. But do so knowing that many doctors have little or no real knowledge in the area of headaches. You will probably get the best perspective and recommendations from a specialist.
- Visit a chiropractor. A chiropractor can examine your spine and make adjustments. Both the insights from this process as well as the results may shed some light on whether there are structural issues with your neck causing cervicogenic pain.
- Learn about trigger points. Visit https://www.triggerpoints.net/, and refer to the charts which concern pain felt in the head or face. See if any of those pain patterns are familiar to you. If they are, you may be able to figure out which muscles are involved. This may lead you to discover corresponding structural issues if they exist.
- Look in the mirror. In some cases, you may be able to figure out whether you are likely to be suffering from cervicogenic pain simply by looking at your reflection. Some structural abnormalities cannot be distinguished visually, but some can.
- Try treating “as if.” You can also attempt diagnosis through treatment. If you try treating the headaches as if they’re migraines, does that lead to improvement? What if you try treating them as if they are cervicogenic?
Conclusion: Cervicogenic Headaches and Migraines Are Very Hard to Distinguish
The bottom line in this discussion is that you may have a difficult or even impossible time figuring out whether you experience migraines, cervicogenic headaches, or a combination of the two.
While some symptoms are more common with one and less common with another, both can feasibly manifest in identical ways.
Whatever the case may be, you will have the best chances of reducing your pain and improving your quality of life if you consider all possibilities and provide yourself with the most comprehensive treatment you can based on your signs and symptoms.