My Headache Started in My Neck

THE 30-SECOND VERSION

A sore neck can cause a real headache because the top three neck nerves and the main head nerve share a relay station in the brainstem, and the brain misreads where the pain starts.

HOW IT WORKS

How a Stiff Neck Sends Pain Into Your Head

The top three bones in your spine share wiring with the nerve that covers your face and skull.

I sat at the kitchen table last fall with a thick paperback propped against the salt shaker. My head was tilted forward, chin nearly on my chest, for close to two hours. When I stood up, a dull ache bloomed behind my right eye and wrapped around the base of my skull. I took two aspirin and went to bed early.

The next morning, Carol watched me over her coffee. She said I kept rubbing the back of my neck, not my forehead. I stopped and thought about that. Then I rolled my neck slowly, side to side, and the headache softened. That got my full attention.

So I looked it up. A 2004 review by a pain researcher named Nikolai Bogduk, published in Neurological Clinics, laid out the wiring. The top three neck bones send their nerve signals to a small patch of the brainstem. That same patch handles feeling from the forehead and face. When those neck nerves fire hard, the brain can't sort which signal came from where. It reads neck pain as head pain.

Doctors call this a cervicogenic headache. That means the headache's real source is the neck, not the head. A 2023 review in Frontiers in Neurology studied the pattern. The share of all headaches that start this way is higher than most people guess. And most people who have one blame stress or bad eyesight instead.

QUICK QUIZ · TAP TO ANSWER

What share of all headaches may start in the neck?

Tap your guess and a ready-to-send reply opens. Just press send. The answer is below, under The why.

About 2 percent

About 15 to 20 percent

About half

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THE WHY

The Switchboard at the Top of Your Spine

Quiz answer: About 15 to 20 percent. A 2023 review in Frontiers in Neurology found neck problems cause a large share of headaches.

That number surprises most people. One in five or six headaches may trace back to the neck. The reason sits in a piece of wiring most of us never hear about. It is called the trigeminocervical nucleus. In plain words, it is a small cluster of nerve cells in the brainstem and upper spinal cord. The brainstem is the lowest part of the brain, right where it meets the spinal cord.

Two sets of nerves feed into this cluster. The first runs from the top three neck bones. Doctors label them C1, C2, and C3, where C stands for cervical, the medical word for neck. The second is the trigeminal nerve, the main nerve that carries feeling from your forehead, cheeks, and jaw. Bogduk mapped this overlap in his 2004 review.

When both sets dump signals into the same relay, the brain can't sort them. A stiff joint at C2 fires a pain signal that lands in the same cluster as signals from the forehead. So the brain reads it as a headache. Doctors call this referred pain. In other words, the brain gets the address wrong. A heart attack can cause arm pain the same way.

What this means for a sore neck

When the small muscles that hold up the top of the neck weaken, those upper joints work harder. They stiffen. That stiffness sends more pain signals into the relay. The brain reads them as headache, not neck trouble. Building those muscles back up, the kind of work we looked at yesterday, quiets the signal at its source.

Ylinen and colleagues tested this in a 2010 trial in the Journal of Rehabilitation Medicine. They split 180 women with long-term neck pain into three groups: strength, endurance, or stretching. After a year, headaches fell by 69 percent in the strength group and 58 percent in the endurance group. One caveat: these women had chronic neck pain, not a formal cervicogenic headache label. So the numbers may not transfer exactly. But the direction is clear.

⚠ WHEN TO STOP

When to stop and call your doctor

These are uncommon, but they’re signals to get checked promptly rather than move through:

● Pain that shoots down a leg

● Numbness between your legs or around your groin

● New trouble controlling your bladder or bowels

● Trouble walking or new leg weakness along with neck pain

● Sudden bad headache with stiff neck and fever (possible meningitis, call 911)

When in doubt, get it checked. PainFree is not medical advice. It complements your doctor’s care and never replaces it.

THIS WEEK’S QUICK WINS

Three Habits to Quiet a Stiff Neck

📖 Prop your reading angle

If your book or tablet sits flat on a table, your head tilts forward and loads the top of the neck. Lean it against a pillow or a cookbook stand so your eyes meet the page without dropping your chin.

10 seconds • Less strain on the top three neck joints

🤔 Notice where a headache starts

Next time a dull headache creeps in, press gently at the base of your skull with two fingers. If the spot is tender and pressing reproduces your headache, the neck may be the source, and worth telling your doctor.

30 seconds • A clue for your next visit

🔄 Roll your neck once an hour

Set a kitchen timer and slowly turn your head left, then right, then tilt each ear toward the shoulder. Five seconds each way. Gentle motion keeps those upper joints from locking up.

30 seconds • Keeps joints loose

RESEARCH BRIEF

Neck Exercises Cut Cervicogenic Headache for a Full Year

Jull and colleagues studied 200 people who met the criteria for cervicogenic headache, published in Spine in 2002. They split them into four groups: targeted exercise, hands-on therapy, both combined, or a control group. At the 12-month check, both exercise and hands-on therapy had cut headache frequency and force, and the gains held.

200

people with neck-caused headache

12 months

the results held

3.5%

dropped out, very low for a pain trial

Targeted neck exercises cut headache that starts in the neck, and the benefit lasted a full year in this trial.

WHAT THE EVIDENCE SAYS

Three Things People Try for Neck Headaches

Acupuncture

A Cochrane review by Trinh and colleagues in 2016 pooled 27 studies of 5,462 people with neck pain. Acupuncture beat sham or no treatment for pain and daily function, but the evidence was low to moderate quality. A real but modest benefit.

TENS (electrical nerve pulses)

The Kroeling Cochrane review in 2013 found the team could not make firm statements on electrical therapy for neck pain. The evidence was low or very low quality, so TENS may ease pain briefly, but the case is too thin to count on.

Magnesium supplements

Teigen and Boes reviewed the evidence for oral magnesium in Cephalalgia in 2015 and concluded the evidence was limited. Cervicogenic headache is not migraine, so the case here is even weaker.

Always check with your doctor before starting a new treatment or supplement.

WORTH KNOWING

203 million

That is how many people were living with neck pain around the world in 2021, with 42 million new cases that year alone.

GBD 2021 Neck Pain Collaborators, published in The Lancet Rheumatology, 2024.

Here's to a neck that keeps its pain to itself,
Walt

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