Headaches & Migraines
Many headaches don’t begin in the head. When the source is the neck or its nerves, targeted treatment can change everything.
Headaches & Migraines is a symptom. The source is the answer.
Headache is among the most common and most misdiagnosed complaints in medicine. Patients spend years labeled as “migraine” — cycling through medications with limited benefit — when the actual pain generator sits in the upper cervical spine or in a specific irritated nerve.
The anatomy explains why. The nerves of the upper neck converge with the trigeminal system that carries sensation from the face and head. A problem in the C1-C3 segments can be perceived, entirely convincingly, as a headache behind the eye.
That doesn’t mean migraine isn’t real — it is, and it deserves proper treatment. It means that a substantial number of chronic headaches have an identifiable, treatable structural source. Our job is to determine which kind you have before treating you as though you have the other.
The scale of the problem is easy to underestimate. Headache is among the leading causes of disability worldwide, and chronic headache in particular erodes work, sleep, relationships, and the ordinary texture of daily life. Patients frequently arrive here having tried a decade of medications, having been told that their imaging is normal, and having quietly concluded that this is simply how life will be.
It often isn’t. The critical insight is that a headache which has never responded to headache treatment may not be a primary headache disorder at all. When the pain generator is a facet joint, an occipital nerve, or an upper cervical segment, no amount of migraine medication will reach it — and no scan will reveal it. Only a careful examination and a precisely placed diagnostic block will.
Years of failed migraine treatment sometimes means the diagnosis was never migraine.
What can cause headaches & migraines
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Cervicogenic & Structural Causes
Cervicogenic Headache
Headache originating in the cervical spine. Upper cervical joints and nerves share pathways with structures in the skull, so a neck problem presents convincingly as a headache. Often one-sided, often worsened by neck movement or sustained posture.
Atlantoaxial & Atlanto-occipital Joint Pain
The uppermost cervical joints refer pain to the skull base, behind the ear, and over the head. Arthritis or injury here is a frequent and frequently missed headache source.
Cervical Facet Arthropathy
Upper cervical facet joints, particularly C2-C3, commonly refer pain into the head. The third occipital nerve crossing this joint is a well-recognized headache generator.
Post-Traumatic & Whiplash Headache
Headache following a motor vehicle collision or head injury, often driven by injured cervical facet joints, ligaments, or nerves rather than by the brain itself.
Nerve-Related Causes
Occipital Neuralgia
Irritation of the greater or lesser occipital nerves produces sharp, shooting, electric pain from the skull base upward over the back of the head, sometimes behind the eye. It is routinely mistaken for migraine.
Third Occipital Neuralgia
Pain arising from the third occipital nerve as it crosses the C2-C3 facet joint — a specific, identifiable, and highly treatable source of upper neck pain and headache.
Trigeminal Neuralgia
Sudden, severe, electric facial pain in the distribution of the trigeminal nerve, often triggered by light touch, chewing, or wind. A distinct condition requiring specific treatment.
Sympathetically-Mediated Headache
In some patients, headache is amplified by sympathetic nervous system activity. Dr. Joshi is a published co-architect of the landmark theory connecting the stellate ganglion block to sympathetically-mediated conditions.
Primary Headache Disorders & Amplifiers
Migraine
A genuine neurologic disorder with throbbing, often one-sided pain, light and sound sensitivity, nausea, and sometimes aura. Migraine can coexist with a cervicogenic source — treating the neck can reduce migraine frequency in patients who have both.
Tension-Type Headache
Bilateral, pressing, band-like head pain, frequently associated with myofascial trigger points and sustained postural load in the cervical and shoulder musculature.
Cluster Headache
Severe, strictly one-sided pain around the eye with autonomic features such as tearing or nasal congestion, occurring in clusters. Distinguishing it from other causes is essential.
Central Sensitization & Medication-Overuse Headache
Chronic headache can be perpetuated by an amplified nervous system, and paradoxically by the frequent use of acute headache medications. Both require a strategy other than more medication.
Contributing & Perpetuating Factors
Forward-Head Posture & Ergonomic Load
Sustained screen work and forward-head posture place continuous load on the upper cervical extensors and facet joints — the very structures that refer pain into the head. Correcting the mechanics is often part of resolving the headache.
Sleep Disruption & Non-Restorative Sleep
Poor sleep lowers pain thresholds and amplifies headache frequency, while headache disrupts sleep. The cycle must be broken from both directions, and treating only one side rarely succeeds.
Temporomandibular Disorder
Dysfunction of the jaw joint and its musculature refers pain to the temple, ear, and head, and frequently coexists with cervicogenic headache and bruxism.
Medication-Overuse Headache
Frequent use of acute headache medications can paradoxically perpetuate chronic headache. Recognizing this pattern changes the treatment strategy entirely — more medication is precisely the wrong answer.
When a headache is an emergency
Seek immediate care — call 911 or go to an emergency room — for: a sudden, severe “worst headache of my life”; headache with fever and neck stiffness; headache after significant head trauma; headache with weakness, numbness, vision loss, confusion, or difficulty speaking; or a new headache pattern with seizure. These can signal hemorrhage, meningitis, or stroke. This page is educational and is not a substitute for evaluation.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Headache character, location, triggers, associated symptoms, and a careful cervical spine and neurologic examination. Most of the diagnosis is made here — which is why our visits are longer than the industry norm.
02 — Correlated imaging when indicated
Imaging is used to rule out serious pathology and to assess the cervical spine — never as a stand-alone answer to what is causing your headache.
03 — Virtual MSK Movement Assessment
Objective measurement of cervical range, control, and compensation patterns — data that often reveals the mechanical contributor behind a “migraine” that never responded to migraine treatment.
04 — Diagnostic nerve blocks
The definitive test. Anesthetizing the occipital nerves, the third occipital nerve, or specific cervical medial branches — and observing whether your headache resolves — confirms the source with precision no scan can provide.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Occipital Nerve Blocks
Targeted blocks of the greater and lesser occipital nerves both confirm occipital neuralgia and provide meaningful relief from headache originating in the neck.
Third Occipital Nerve Blocks & Ablation
For headache arising from the C2-C3 facet joint, precise blocks confirm the diagnosis and radiofrequency ablation can deliver durable relief.
Dr. Joshi developed and performs a single-needle lateral approach to cervical medial branch blocks and radiofrequency ablation, using smaller-gauge needles and a longer-duration, lower-temperature, tissue-sparing lesion — precision instead of destruction.
Cervical Medial Branch Blocks & Radiofrequency Ablation
When upper cervical facet joints are the headache source, diagnostic blocks confirm it and ablation can provide relief lasting many months to years.
Sphenopalatine Ganglion Blocks
For certain headache and facial pain syndromes, blocking this nerve cluster can reduce headache frequency and intensity.
Stellate Ganglion Blocks
For sympathetically-mediated headache and facial pain. Dr. Joshi is a published co-architect of the landmark unifying theory linking the stellate ganglion block to sympathetically-mediated conditions including CRPS, hot flashes, and PTSD.
Trigger Point Injections
For the myofascial component of tension-type and cervicogenic headache — treated alongside the underlying joint or nerve problem, not instead of it.
Ketamine Infusion Therapy
For chronic headache driven by central sensitization, ketamine infusions can reduce the nervous system’s amplified pain response. We built America’s first surgery-center-based outpatient ketamine program.
Rehabilitation & Postural Correction
Sustained forward-head posture loads the exact structures that generate cervicogenic headache. Correcting the mechanics is part of resolving the headache.
Cervical Epidural Steroid Injections
When headache is driven by upper cervical disc pathology or nerve root irritation, a carefully selected epidural approach can reduce the inflammation feeding the pain.
National Pain Centers does not perform cervical or thoracic transforaminal epidural steroid injections. Although some practices offer them, the transforaminal approach in the neck carries a risk of catastrophic injury we do not consider acceptable. We use safer approaches to achieve the same goal. Declining a procedure we could easily bill for is exactly the kind of decision that defines how we practice.
Treating the Coexisting Cervical Source
Many patients carry both a primary headache disorder and a treatable cervical pain generator. Resolving the cervical source frequently reduces migraine frequency and severity — because the neck was functioning as a persistent trigger all along.
Sleep, Posture & Whole-Person Care
Our multi-disciplinary team addresses the sleep disruption, postural load, and metabolic factors that perpetuate chronic headache. Interventional relief that isn’t paired with correcting the drivers invites the headache back.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Headaches & Migraines, answered
Clues include one-sided pain that starts at the skull base, headache provoked by neck movement or sustained posture, restricted neck motion, and limited response to migraine medications. The definitive test is a diagnostic nerve block: if anesthetizing a specific cervical nerve resolves your headache, we’ve found the source.
Yes, and it’s common. Treating the cervical source often reduces migraine frequency and severity in patients who have both — because the neck problem was acting as a persistent trigger.
No. Occipital neuralgia is sharp, shooting, electric pain following the occipital nerves from the skull base over the back of the head. It is frequently misdiagnosed as migraine for years. A diagnostic occipital nerve block distinguishes them quickly.
No. Opioids are a poor treatment for headache and can worsen it through medication-overuse headache and increased pain sensitivity. Dr. Joshi has never prescribed OxyContin or oxycodone in over three decades of practice.
It is an injection near a cluster of sympathetic nerves in the neck, used for sympathetically-mediated pain conditions. Dr. Joshi is a published co-author and co-architect of the landmark 2009 unifying theory connecting this block to CRPS, hot flashes, and PTSD — a foundational contribution to the field.
For appropriately selected patients whose diagnostic blocks confirmed the source, relief commonly lasts many months and often longer. Nerves regenerate over time and the procedure can be repeated. Individual results vary.
No. Patients regularly discover, after decades of failed migraine treatment, that a cervical facet joint or occipital nerve was generating their headaches the entire time. A diagnostic block answers the question definitively, and it can be done at any point.
Both. They exclude serious pathology, which matters. But they cannot show facet-mediated pain or nerve irritation, which are among the most common treatable headache sources. A normal scan does not mean nothing is wrong — it means the answer lies elsewhere.
Yes. Both are distinct conditions requiring specific approaches, including targeted nerve blocks and, for selected patients, sphenopalatine ganglion blocks. Accurate diagnosis determines everything, because these conditions do not respond to treatments aimed at other headache types.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.