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Can Neck and Spine Misalignment Cause Migraines?

By preventing shoulder stiffness and misalignment of my neck, I get far fewer headaches than I used to.

Neck out of alignment headaches

Neck out of alignment headaches

What Is a Cervicogenic Headache?

Have you ever woken up with a headache and a nasty crick in the neck? The two symptoms are probably related! A neck ache combined with a headache could indicate a cervicogenic headache.

Cervicogenic comes from "cervico," meaning "neck," and "genic," meaning "relating to." These headaches originate from the neck and by some definitions the spine.

How Is It Different From a Tension Headache?

Tension headaches are more common and are caused by the tightening of muscles on or around the head and neck. The tightening can be due to stress or staying in one position for too long. On the other hand, a cervicogenic headache is caused by a partial misalignment (subluxation) of one or more of the neck vertebrae.

If you have a headache and neck pain, it's probably cervicogenic.

The misalignment can be isolated to just the neck vertebrae, but it can also originate from subluxation of another joint, most commonly in the thoracic or lumbar spine, shoulders, ribs, and pelvis. People with hypermobile joints are more likely to experience these headaches.

Nerves and blood vessels are tightly packed between the cervical vertebrae and muscles. Misalignment of the vertebrae can irritate these nerves and cause a headache.

Nerves and blood vessels are tightly packed between the cervical vertebrae and muscles. Misalignment of the vertebrae can irritate these nerves and cause a headache.

How Does It Cause So Much Pain?

The base of the skull is a very dense and complex region filled with joints, nerves, blood vessels, and a multitude of muscles, both large and small. All of this to support your head, and most importantly, your brain! With so much going on, it's easy to see why a misalignment can cause problems—like a truck tipped over in Manhattan traffic.

When the vertebrae aren't in position, they can directly or indirectly rub up against the nerves, especially the occipital nerve (to your eye). According to the National Institute of Neurological Disorders and Stroke, the pain caused by occipital nerve irritation starts at the base of the neck and spreads up to the scalp. Sometimes, the pain can be felt on the scalp, forehead, and behind the eyes.

What Causes a Cervicogenic Headache?

Any condition or disorder of the cervical spine or tissue can cause cervicogenic headaches. These include:

  • Whiplash or other neck injuries
  • Spinal misalignment
  • Crick in your neck
  • Arthritis
  • Elhers-Danlos syndrome (this is what caused my headaches)
  • Posture and other lifestyle factors

Modern life includes sitting in front of computers, driving, hand-held devices, and watching TV—all of these activities create severe stress on our neck and shoulders. While we know we should take constant breaks from these activities, we often "forget!"

Holding our arms out in front of us and/or cocking our necks to see the screen properly, we put pressure on our necks and shoulders that they weren't built to handle. This sets us up for muscle and joint strain and often leads to tension headaches. Over time, repetition of poor posture can weaken muscles that normally hold our necks in the correct alignment. When they weaken over time, the cervical bones can move around in ways that they shouldn't, pinching, squishing, and generally wreaking havoc. Muscle spasms, also caused by long-term bad posture, can do the same thing.

What Kind of Headache Do You Have?

About 42 million Americans suffer from headaches. Twenty percent of chronic headaches are said to be cervicogenic, and four times as many women as men experience these.

There are many types of headaches, including migraines, tension, and sinus headaches. There is also a variety of causes. However, migraine and tension headaches most closely mimic a cervicogenic headache. You are much more likely to be diagnosed with a migraine or tension headache because so many of the symptoms are the same. For instance, they all can affect one side, and consist of severe throbbing pain, nausea, and a sensitivity to sound and/or light.

Because diagnostic tests (blood work, X-rays, and MRIs) are mostly ineffective in this case, cervicogenic headaches are still widely underdiagnosed. According to the National Institute for Health, some doctors don't even believe they exist.

If a practitioner does suspect a cervicogenic headache, the traditional way of diagnosing it is to do a neural blockade in the neck. However, according to The Journal of the American Osteopathic Association, diagnostic criteria have been developed to provide "a detailed, clinically useful description of the condition." This allows for a diagnosis without the need for the neural blockade.

Approaching Your Doctor About Your Headache

As I always recommend for conditions that are uncommon or, at least, not commonly diagnosed, do your research. Spend time looking for information about your headache. When you find information pertinent to your specific case, print it out. Highlight the information that resonates with you.

If you find that your headaches fit into the cervicogenic profile, make an appointment with your health care provider to discuss this. When you schedule the appointment, be sure to ask for a consultation so you have adequate time to talk without either of you feeling rushed.

Bring copies of your printed information that you can give them along with a list of your particular symptoms and experiences. This helps keep the consultation on track. It's also helpful if you know which direction you'd like to go for treatment.

Important: Be sure your information is from a reputable source that your health care provider is probably familiar with.

If your practitioner seems skeptical, give them time to digest this new information and do their own research, and make another consultation appointment. No practitioner can know everything. If they are not willing to listen, look for another practitioner.

Remember, this is your body, and you deserve the best care you can get, but it is your responsibility to take proactive steps to get the care you need.

Don't Treat Yourself

If your headaches are severe or do not go away, don't attempt to diagnose or treat yourself. Do your own research, but always consult your healthcare provider before starting any treatments.

Different types of physical therapy can help relieve headache symptoms.

Different types of physical therapy can help relieve headache symptoms.

How Do You Ease Cervicogenic Headaches?

Generally, cervicogenic headaches are treated most effectively with a multi-faceted approach. Since no real studies have been done, this information is gleaned from anecdotal evidence.

  • Pain Medications: Although considered a temporary fix, pharmaceuticals can be helpful to survive a headache and relieve the stress the pain causes. Generally, a combination of medicines for migraines, NSAIDs, and perhaps anti-convulsive, antidepressants, or muscle relaxants can be helpful. Narcotic medicines are not considered effective in this case. Important: You must discuss these medicines with your primary care practitioner since the side effects need to be monitored with regular blood work.
  • Manual Therapy: Manipulation of the musculoskeletal system can help correct the misalignment. Reputable chiropractors, osteopathic doctors who specialize in manipulation, and physiotherapists can help realign the joints, often permanently, after a series of visits.
  • Physical and Occupational Therapy: Physical therapy can help treat cervicogenic headaches. Both of these therapies are important modalities to help you correct posture and other lifestyle habits that created the misalignment and muscle spasms in the first place. Long-term results are the goal and are achievable for most people.
The Xs mark potential trigger points on the sternocleidomastoid muscle that is often the culprit of headaches.

The Xs mark potential trigger points on the sternocleidomastoid muscle that is often the culprit of headaches.

Trigger Point Therapy Might Help!

I wanted to add information about my discovery of trigger point therapy. This is therapy I can do myself when I need it most. I don't think I'm being too dramatic by saying that this has been a game-changer for me.

While the physiology of trigger points isn't well-understood, we can all find spots on a muscle that hurt more intensely than the rest of the muscle. By searching for these spots and massaging them, the muscle can often be coaxed into releasing the stored energy that is causing it to be so tense. For cervicogenic migraines, there are specific trigger points that definitely help.

For instance, you can get amazing relief from finding the trigger points on the sternocleidomastoid muscle. This is a very large muscle attached to the clavicle bone in the front and the base of the head towards the back. However, there are major nerves and arteries located in this region of the neck. It's very important that you research how to properly find and massage these trigger points so that you don't accidentally damage the nerves and arteries.

Trigger point charts and books are good starting points. However, you must get familiar with your own trigger points and the muscles involved with your pain. For example, trigger points in my gluteus maximus and gluteus minimus muscles are sometimes the keys to relieving my cervicogenic migraine!

The best part about trigger point therapy is that it's something you can do to help yourself when you probably feel the most desperate and helpless. There are lots of charts, guides, and books. The only tools you need are your fingers, knuckles, or tennis ball. This therapy is well worth a try.


You must be very familiar with the anatomy surrounding your trigger points to avoid accidentally damaging important structures. If you are not comfortable performing this technique yourself, seek guidance from a professional.

How to Prevent These Headaches

Prevention is always the best medicine. By preventing shoulder stiffness and misalignment of my neck, I get far fewer of these headaches.

  1. For instance, I have found that when I sleep with my head flopped to the right, I'm sure to wake up "in trouble." So, I have a few methods to prevent this:
    • I prop my pillow up slightly on both sides, usually just using towels underneath.
    • If I've been getting mild headaches that I know are caused by misalignment, I wear my cervical collar to bed. It's not the most comfortable thing, but it is way better than the severe headaches that can develop.
    • I have several different pillows that work well depending on my needs. Sometimes, I need something firmer; other times, I need something soft.
  2. I also try to spend 15 minutes a day on my Real-Ease Neck and Shoulder Relaxer. I have prevented imminent cervicogenic headaches by doing this—even in the middle of the night when I wake up feeling one starting up.
  3. Because I have Ehlers-Danlos syndrome, I get regular treatment from an osteopath who does low-impact manual therapy. Most of you won't have the chronic problems that I have and may only need a few treatments.
  4. Work on your posture and ergonomics. Be sure that when you work at your computer, for instance, you have good ergonomics. Customize the keyboard and monitor heights and angles to your needs. Sit up straight Our teachers and parents were right. It might temporarily feel uncomfortable to remain in good posture, but your effort will be worth it.
  5. Get up regularly and move around. We used to spend more time standing and walking than we do now. If you are at work, walk over to your coworker's desks instead of calling or emailing them. Drink water: refilling and going to the restroom will get you away from your computer. Take a walk around your house, inside or out. Get up and look out the window.
  6. Many wearable fitness devices (like a Fitbit) encourage 250 steps per hour. This corresponds to the simple advice my physical therapist gave me to be more mobile. If you are goal or numbers oriented, these devices can be great motivational tools.
  7. Stay away from your smartphone. The position or posture you're in when using your smartphone tenses the muscles around your neck and aggravates the spine. This was hard for me at first, but the headaches reminded me not to play those addictive games for so long!

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


MaryBeth Walz (author) from Maine on September 03, 2019:

Mohammad, I hope this information helps you get some relief!

Mohammad Rafeeque on September 02, 2019:

Very informative article.i have often pain n stiffness in my neck .in morning when I woke up . gradually pain reffer to skull n forehead .one sided .

MaryBeth Walz (author) from Maine on August 05, 2019:


I'm so glad the info helped! I hope you can work toward relief. I've read this is be becomming more common with the constant use of smart phones.

I wish you good health!

Merrilltokar on August 04, 2019:

This article was so helpful. I have had similar pain for 3 years now. MRI and other tests show no problem but I have daily fluctuating pain that starts in right side of my neck and gives me pain in my head and eye. Have been mis diagnosed with migraine and my doctor acts like I am crazy. Did PT for a short period and am going to start religiously doing the exercises to strengthen my neck and build better posture. Also going to buy the neck rest you talked about in this article. I hope that this pain will eventually go away. Thank you again for the wonderful article. Better insight then I have received from any MD.

MaryBeth Walz (author) from Maine on May 07, 2019:

Hi Heather,

I use a CALDERA - Releaf Neck Rest. It's definitely not perfect, but it keeps my jaw from dislocating and my neck going completely out. Hope that helps!

Heather Cutrer on May 02, 2019:

What cervical collar do you ecommend? I deal with hyoermobility and sleeping is not something I look forward to due to fear of getting in the wrong position while I am sleeping and waking up with a migraine

MaryBeth Walz (author) from Maine on June 30, 2018:

Petro, I'm glad you found this article helpful. Waking up without a migraine is a much better way to start your day. And I'm all too familiar with that look from practioners and family. Just keep in mind what my understanding doc said to me: we don't know what we don't know! Best of luck.

Petro on June 29, 2018:

Hi Mary-Beth,

Thanks for this article. For the last 4 years, I am waking up with pounding headace at the back of my neck. Hàve to take tablets. Tow of them, every morning of my life. Now, I have a liver-count which is not good, actually alerting me.

I am definately going to give this a try. Did not ever think of that collar.

I always telling my dr that ai’m feeling better when I went to the chiro, for 2 max 3 days. So it hàs to be my neck. Numerous x-rays, Brain MRI’s, etc, and no answers. I always walk out there with the comment, ‘mam, there is nothing wrong. Here’s another prescription, maybe that will help.

I am so fed-up feeling like this. I am almost afraid of going to bed at night. Because I knòw I will have another one when I wake, sometimes at 2h, sometimes at 4, somethimes at 6. But believe me, èvery morning. In the past 6 months, there was maybe 4/5 nights which went well. I actually write is my diary on those mornings, -halleluja. I send all my close friends messages, telling them ‘no headace this morning!!

I am definately going to get that pillow and the collar. Thanx a lot for your article. Only people who have frequent headaces, understand headaces.... other’s think ‘she only wants attention’

Amanda on July 19, 2017:

Hello I just read your article and am quite intrigued. I slept on my neck wrong about a week ago and ever since have had extreme pain when turning my head and the back of my head goes numb along with my jaw and ear. I've suffered every night with awful headaches that make it unbearable to turn my head in any direction. I figured I had irritated nerves when I slept on my neck wrong but the funny thing is that I've felt a bone hard lump on the right back side of my neck that I had assumed was normal after being made to feel like a hypochondriac about it. After reading your article I'm quite sure that it's part of my spine that's crooked. I'm still quite sore from sleeping wrong but now I'm wondering if I should get this checked. Thank you for the wonderful article.

Lynne Price on July 04, 2017:

Fire the doctor who wants to put you on antidepressants. Lexapro is not the answer. How unethical.

On the bright side, I bought a Tempur-pedic neck pain pillow and it's working great. If you buy one, be sure to buy a protective cover and also use a pillowcase (the smell is awful, actually smells toxic).

MJ Dace on February 12, 2017:

I've been experiencing this pain for 12 h


sadiq on May 01, 2016:

i exactly have the same problem..

MaryBeth Walz (author) from Maine on September 02, 2014:

Thanks Steve! For lots of folks this will be very useful. For people with EDS like me, our nerves do not give us the "that's far enough" signal when we stretch and so hyper-extending way beyond the healthy spot is normal for us. There is no way for our body to know how far is too far - until we've done it. So, stretching for me is almost forbidden. But regular stretching for most people is very healthy and a helpful way to stay out of this situation. Problem is, most people wake up with this, having relaxed their muscles while sleeping, and cricked their neck, leaving tight muscles trying desperately to keep the joint from moving any more. For me, it takes 1-2 days of rest to let the muscles un-knot themselves so the pain is back to a manageable level.

Steve on September 02, 2014:

"Cat-back" stretch!!! Do it!! On hands and knees, head down and curl your back up and hold. Then head up and arch your back. Instant relief. Simple reminder to stretch more.

MaryBeth Walz (author) from Maine on July 15, 2014:

Sharon Smiles,

I'm so glad to help!

MaryBeth Walz (author) from Maine on April 10, 2014:

Moon Daisy - I suffered two days at a time, twice a month for years. I still get them but far less often now that I get regular osteopathic treatment and understand the signs! I hope you can get some help and glad I could help you a bit!!

Moon Daisy from London on April 10, 2014:

Yes, this sounds exactly like me, even the bit about your head flopping to the right. When I wake up with one of these it's invariably after I've slept on my right side!

The right of my neck is pretty hypermobile, so sleeping on my left doesn't seem to cause this problem, but when I'm on my right side, the (compensating?) rigid muscle on the left of my neck seems to pull something out of alignment. If that makes sense! And then of course the horrible throbbing pains start, and all the other associated neurological problems. Arrrrgh!!! So horrible!

I've known for years that it's tied in with my EDS, but I didn't know the name for this type of headache, or that it actually had a name! So thank you for this very useful hub. And for the suggestions you've included.

MaryBeth Walz (author) from Maine on February 16, 2014:

Sam, I am unfamiliar with any professionals in your area. I recommend speaking with osteopaths in your area - be sure they do Osteopathic Manipulation Technique and aren't just a family practice or specialist D.O., physical therapist familiar with this kind of headache and who does manual therapy, or a chiropractor who specializes in headaches. Remember, if you've had these for a long time, the mechanisms that have created the conditions for the cervical imbalance will take time and work on your part with your professional to correct. Several months/visits on your part will be required. Feel free to print out the above article from JOAO.ORG and take it to your doctor. Good luck!

Sam on February 15, 2014:

3-4 years of suffering from these... Off and on. Never knew about these headaches and I can't seem to get rid of mine. I remember a chiropractor fixing it but only for a week or so. Just since the other day did I find out about this and now I know this is exactly the cause. :( still nothing seems to work. My head is heavy and I have extreme facial pressure sometimes. It's very hard to think. If you could recommend anyone in sarasota, florida to help that would be awesome. Thank you and good article.

CraftytotheCore on September 15, 2013:

You wouldn't believe what I went through about 9 months ago when I encountered a first hemiplegic migraine with paralysis!

A nurse at the hospital where I stayed paralyzed for 8 days told me that it's not possible for the cervical spine to be associated with headaches.

This was after having an x-ray days before the paralysis which showed I have bone fusion and protruding bones in my cervical spine. Later on at physical therapy they claim I was born like that. Yet, never had a problem before from it.

I have since suffered frequently from migraines. I control them by taking allieve every day, exercising, and taking vitamins. I learned my magnesium levels were low so I take a supplement.

On humid days, I suffer the worst. I suffer terribly and it's hard to walk straight without looking hunched over from the neck issues.

MaryBeth Walz (author) from Maine on August 14, 2013:

Thank you Rajan Jolly, Coolh and Shyron E. Shenko. Shyron, so sorry you are suffering. I admit that when I have these headaches, I have no desire to go to the ER as I'm not sure they have the ability to truly treat them. I may be wrong, but I also know the ride there and the waiting would be worse (for me) than lying in bed. Good luck getting a solution for yours!

Shyron E Shenko from Texas on August 11, 2013:

I have severe migraines, I spent yesterday in the ER with one from hell.

The doctors don't know what is causing mine. Just know they are bad.

will read you article again when I am feeling better.

Voted up and shared.

Rajan Singh Jolly from From Mumbai, presently in Jalandhar, INDIA. on August 11, 2013:

I had absolutely no idea of cervicogenic headaches so this was very informative. Sharing this as well as voted up and useful.

MaryBeth Walz (author) from Maine on November 16, 2012:

Thanks innerspin! Sometimes if I'm bad, I actually sleep with a cervical collar (soft, found at drug stores) which prevents my head from flopping over to the side when I'm on my back. Glad the article helped!

Kim Kennedy from uk on November 16, 2012:

This was interesting, as I tend to sleep on my belly and often wake with a crick in my neck and a pounding headache. If caught early, I can change position and the headache wears off. Maybe it's time to go back to the chiropractor. Thanks for the hub.

MaryBeth Walz (author) from Maine on March 06, 2012:

Thank you Docmo!

Mohan Kumar from UK on March 05, 2012:

Excellent hub on cervicogenic headaches. It is good that you have clarified for people this cause of headache that is often ignored. Informative, well written and illustrated. Voted up and useful!

MaryBeth Walz (author) from Maine on March 05, 2012:

Thank you Marpi - I hope it helps! Headaches are awful - no matter what kind it is!

Marpi on March 05, 2012:

Very interesting read. I suffer from headaches quite often (I work a lot on my computer) so every info regarding this subject is very useful.