Headaches & Migraines Treatment

Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director

Headaches and migraines that begin in the neck

Chronic headaches and migraines affect millions of people and can be profoundly disabling. While many types of headaches originate in the head itself, a significant number — particularly cervicogenic headaches and tension-type headaches — have their source in the neck, upper back, or occipital nerves. At IPC, our specialists evaluate headache and migraine patients to determine whether interventional pain procedures can provide relief. Treatment options include occipital nerve blocks for occipital neuralgia and cervicogenic headaches, cervical facet joint injections and radiofrequency ablation for headaches originating from neck arthritis, trigger point injections for tension headaches, and coordination with neurologists for comprehensive migraine management.

Symptoms of headaches and migraines

Headache types differ in ways that matter for treatment, so the details of the pattern are worth noting before an appointment.

• Migraine: moderate to severe, often one-sided and throbbing,[1] worsened by routine activity, and commonly accompanied by nausea and sensitivity to light and sound. Some people experience visual or sensory warning symptoms beforehand.
• Cervicogenic headache: pain starting in the neck or the back of the head and spreading forward, often one-sided, provoked by neck movement or sustained posture, and frequently accompanied by neck stiffness and tenderness.
• Occipital neuralgia: sharp, shooting or electric pain from the base of the skull over the back of the head, sometimes with tenderness or altered sensation of the scalp.
• Tension-type headache: a bilateral pressing or tightening band, usually mild to moderate and not aggravated by routine activity.

Keeping a simple record of frequency, duration, triggers and how often you take acute medication is genuinely useful at a first appointment.

When to see a pain specialist about headaches

Consider an evaluation when headaches occur several times a month or more, when they are costing you work or family time, when acute medication is not reliably working, or when you are taking acute medication on more than about two days a week — frequent use can itself begin driving a rebound pattern that needs a different approach.

Interventional options are particularly relevant when the headache appears to originate in the neck or the occipital nerves, which is more common than most patients expect. Occipital nerve blocks, cervical facet and medial branch procedures, and radiofrequency ablation all target that source directly, and a diagnostic block is often the clearest way to confirm it.

Some headaches need emergency assessment rather than an appointment: a headache that reaches maximum intensity within seconds, a first or worst-ever headache, headache with fever and a stiff neck, headache with new weakness, numbness, confusion or vision loss, a new headache after a head injury, a headache that is consistently worse when lying down or that wakes you, or a new headache starting after age 50.

Treatment options for headaches and migraines

Headaches that originate in the neck respond to different treatment than those that do not, and the options below are aimed at the cervical and occipital sources. A block that gives short-lived relief also tells us whether ablation is worth considering.

References

Clinical sources for this page.

1. Migraine Headache. StatPearls [Internet], National Library of Medicine; updated July 5, 2024. Back to first citation ↑