Cervicogenic Headaches vs. Migraine: How to Tell the Difference—and What to Do
Headaches are common, but not all headaches are the same. Two that often get confused are cervicogenic headaches (coming from the neck) and migraines (a brain-based condition). Knowing the difference matters, because the right treatment depends on the right diagnosis.
Key Differences
Where it starts
Cervicogenic: Pain begins in the neck, often one-sided, and travels forward.
Migraine: Pain usually starts in the head itself, one-sided but can switch sides.
What it feels like
Cervicogenic: Dull, aching, or pressure-like.
Migraine: Throbbing or pulsing, moderate to severe.
What makes it worse
Cervicogenic: Neck movement, poor posture, or pressing on sore spots in the neck.
Migraine: Routine activity (stairs, walking fast), but not specific neck movements.
Other symptoms
Cervicogenic: Sometimes mild light or sound sensitivity, but not always.
Migraine: Often strong sensitivity to light, sound, nausea, and sometimes visual changes (“aura”).
How long it lasts
Cervicogenic: Can hang around, often linked to posture or activity.
Migraine: Lasts 4–72 hours if untreated, often in attacks.
How Physiotherapy Can Help
For neck-driven headaches, physio works on easing stiff joints, strengthening deep neck and shoulder support muscles, and improving posture. Gentle hands-on therapy and tailored exercises reduce flare-ups and help prevent recurrence.
For migraines, physio plays more of a supportive role—helping manage neck and shoulder tension, improving fitness, and teaching relaxation or pacing strategies. Medication and medical input are usually essential here, but physio can still reduce triggers and improve quality of life.
Whole-Person Management
Whether the pain comes from the neck or from migraine:
Sleep: keep regular bed and wake times.
Work set-up: adjust screens, posture, and breaks.
Exercise: start small, build gradually.
Stress & lifestyle: breathing exercises, pacing daily tasks, hydration, and balanced meals all matter.
Bottom Line
Neck-first, side-locked, worse with neck movement → think cervicogenic.
Throbbing, activity-worsened, light/sound sensitive, lasting hours to days → think migraine.
Physiotherapy has a main role in cervicogenic headaches and a supporting role in migraine. If you’re unsure which one you have, or if headaches keep coming back, a proper assessment is the best next step.
References:
Bogduk, N. (2014). Cervicogenic headache: Anatomic basis and pathophysiologic mechanisms. Current Pain and Headache Reports, 18(10), 1–8.
Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1–211.
Vincent, M. B. (2010). Cervicogenic headache: A review comparison with migraine, tension-type headache, and whiplash. Current Pain and Headache Reports, 14, 238–243.
Fernández-de-Las-Peñas, C., & Cuadrado, M. L. (2015). Physical therapy for headaches. Cephalalgia, 35(9), 806–818.
American Migraine Foundation. (2020). Cervicogenic headache: What it is and how it’s treated.
