Most chronic headaches feel like a head problem. They start somewhere above your eyebrows, sometimes behind one eye, and you spend years trying to treat your head. But the trouble often starts a few inches lower.
If you've been chasing headache relief with limited success — through over-the-counter painkillers, prescription medication, screen-time limits, sleep changes, hydration — there's a good chance the actual driver of your pain isn't your head at all. It's your neck.
This kind of headache has a name: cervicogenic, meaning "originating in the cervical spine." And in my practice, it's one of the most under-recognized causes of long-running headache pain I see.
Let me explain why it happens, how to tell if your headaches might be cervicogenic, and what you can do about it.
How a neck problem becomes a headache
Your head sits on top of seven small vertebrae (the cervical spine), held in place by layers of muscle, fascia, and ligaments. The top two vertebrae especially — the atlas and axis — are surrounded by a tight cluster of small muscles called the suboccipitals. They're tucked at the base of your skull, right where your hairline ends.
These muscles do something easy to overlook: they hold your head up against gravity, all day, every day. Eight hours at a screen, hours behind a steering wheel, an evening on the couch reading a phone — every one of those positions asks the suboccipitals to work statically. When they get tight, restricted, or develop trigger points, two things happen:
- They directly compress and irritate nerves that exit the upper neck, including branches of the occipital nerve.
- They refer pain forward, wrapping over the skull to the forehead, temple, behind the eye, or the crown of the head.
This is the part most people don't realize: a muscle in the back of your neck can produce pain that feels like it's coming from your eyebrows, your eye socket, or your temple. The pain travels along well-mapped pathways, but the source and the symptom are in completely different places.
That's why headache treatments targeting the head — painkillers, eye drops, sleep changes — often help only a little, or not at all. They're addressing the symptom, not where it's coming from.
How to tell if yours might be cervicogenic
A few patterns are common in cervicogenic headache. None of these are diagnostic on their own, but if several feel familiar, the neck is worth investigating:
- Pain is usually one-sided, or starts on one side and spreads
- Pain begins or worsens with certain neck positions (turning your head, looking down at a phone, leaning forward at a desk)
- You can sometimes find a tender spot at the base of your skull that, when pressed, reproduces or intensifies the head pain
- Pain feels like a band, a vise, or a deep ache rather than a sharp throb
- Painkillers help only briefly, or not at all
- Mornings are often the worst, and you suspect your pillow
The morning piece is telling. If you wake up with the headache, the position your head was in for hours overnight is doing something to your neck.
What actually helps
Two things, in this order:
First, reduce the load on the suboccipitals during the day. This isn't a stretch — it's a posture change. If you spend hours at a screen, the screen needs to come up to eye level. If you drive a lot, the headrest should support the back of your skull, not push it forward. If you sleep on your stomach (turning your head sideways for hours), trying a side or back position for a few weeks can be informative.
Second, get the muscles released. This is where bodywork helps in a way painkillers can't. The suboccipitals respond well to specific, sustained pressure — but the work is delicate. They're small muscles next to a lot of important anatomy, and pressing harder isn't the answer. Trained release is.
In a session, I'll usually spend a lot of time on the neck before I touch the base of the skull, because the suboccipitals are often only one piece of a larger pattern. The trapezius, the levator scapulae, even the muscles of the jaw can all be part of what's referring pain into your head. Treating the suboccipitals alone, without addressing the rest of the chain, gives temporary relief but doesn't change the underlying setup.
A small thing you can try tonight
Find the spot where your skull meets your neck — the soft hollow just below the bony ridge at the base of your skull. Lie on your back. Place two tennis balls in a sock (knotted so they sit side-by-side), and let the back of your head rest on them so the balls press into that hollow on either side of your spine.
Stay there for a few minutes. Breathe. Don't push or move. The pressure itself, sustained and gentle, is often enough to ease the suboccipitals.
If that reproduces your headache, or makes it worse, or makes you feel a little dizzy, stop. That's information, and it's worth bringing into a session.
When to get help
If you've been living with chronic headaches for months or years, you probably don't need me to tell you that pushing through them isn't a strategy. What I will say: it's worth investigating the neck before you settle for "this is just how my body is now." A lot of people have been told that. A lot of people have been wrong.
If you want to investigate, that's the work I do. We start by mapping out where your pain lives and tracing it back. Often the answer is somewhere you'd never have looked.