There are over 300 classified types of headache. The two most common — tension-type headache and migraine — are diagnosed entirely on the basis of symptom patterns. Neither diagnosis tells you anything about where the pain is actually being generated.
Research published in the journal Headache found that when people diagnosed with migraine and tension-type headache had their upper cervical joints manually assessed, the vast majority had identifiable dysfunction at C1, C2, or C3 that reproduced their typical headache pain. The cervical spine was involved in far more headaches than the diagnostic label suggested.
The five questions below are based on the clinical features that research has identified as most predictive of a cervicogenic component to headache. They are not a diagnostic tool — a proper assessment requires a clinician. But they can give you a strong indication of whether the neck is worth investigating further.
Important note
This self-assessment is for educational purposes only. If you experience sudden severe headaches, headaches with neurological symptoms (weakness, vision changes, confusion), or headaches following a head injury, seek medical attention immediately. These questions are not appropriate for those presentations.
The 5-Question Self-Assessment
Does your headache start or worsen with sustained neck positions — like looking at a screen, driving, or reading?
If yes:
Cervicogenic headaches are consistently provoked or aggravated by sustained cervical postures. This is one of the most reliable distinguishing features.
Do you have neck stiffness or reduced neck movement alongside your headaches?
If yes:
Restricted cervical range of motion — particularly rotation — is strongly associated with a cervicogenic component. Research shows people with cervicogenic headache have measurably less cervical rotation than headache-free controls.
Does pressing on the base of your skull or the top of your neck reproduce or intensify your headache?
If yes:
This is the most diagnostically significant sign. Watson and Drummond's research demonstrated that manual pressure on the atlanto-occipital and C2-3 joints reproduced typical headache pain in the vast majority of migraine and tension-type headache patients tested.
Does your headache ease when you move your neck gently — for example, on waking, after a short walk, or after gentle stretching?
If yes:
Movement-related relief suggests the cervical spine is involved. Organised cervical movement generates fresh proprioceptive input to the brainstem that temporarily modulates the sensitised pain processing system.
Do you have a history of neck injury, whiplash, or prolonged periods of poor posture (desk work, driving, phone use)?
If yes:
A history of cervical loading or injury is a significant risk factor for cervicogenic sensitisation. The upper cervical joints are particularly vulnerable to sustained load and cumulative strain.
Interpreting Your Answers
If you answered yes to three or more of these questions, there is a strong likelihood that the upper cervical spine is contributing to your headaches. This does not mean your migraine or tension-type headache diagnosis is wrong — it means the cervical spine may be one of the drivers of the sensitisation that makes those headaches happen.
If you answered yes to question three specifically — pressing on the base of your skull reproduces your headache — that is the most clinically significant finding. It suggests the upper cervical joints are actively referring pain into your head, and that addressing them directly is likely to produce results.
The key principle:
Whatever diagnosis you have been given, if your headaches have a cervicogenic component, they will respond to cervical rehabilitation. The label does not determine the treatment. The mechanism does. And the mechanism — sensitisation of the trigeminocervical nucleus driven by upper cervical dysfunction — is the same regardless of whether your headaches are called migraine, tension-type, or cervicogenic.
What to Do Next
If this self-assessment suggests a cervicogenic component to your headaches, there are two paths forward:
The first is to see a physiotherapist with post-graduate training in upper cervical assessment and headache management. A proper manual assessment of C1-C3 will confirm or rule out cervicogenic involvement and give you a clinical diagnosis to work from.
The second — if you want to start addressing it yourself immediately — is to begin the cervical rehabilitation protocol in the HeadacheFix eBook. The protocol is based on the same principles used in clinical practice: cervical mobility work to reduce sensitisation, followed by progressive deep flexor strengthening to make the changes last. If your headaches have a cervicogenic component, you will typically notice a reduction in frequency or intensity within the first one to two weeks of consistent work.
That early response is your signal. If you feel better in the first two weeks, keep going. The lasting changes come at weeks eight, ten, twelve, and beyond.
If the answer is yes
Here Is What to Do About It
The Headache Fix is an 8–12 week self-treatment protocol built on the research that proves cervical rehabilitation works.
Get The Headache Fix — $19