What to expect from a neurology consult for cervicogenic vs tension headaches

[Edward.T]

I've been experiencing persistent, dull headaches for several weeks that seem to originate at the base of my skull and are worse in the afternoon. I've seen my primary care doctor, who ruled out sinus issues, and I'm now being referred for a headache differential diagnosis. I'm trying to understand what to expect from a neurology consultation and what specific tests or questions might help distinguish between tension-type headaches, cervicogenic issues, or something else, as the treatment paths seem very different.

[JohnR]

That sounds frustrating. In a neurology consult for persistent headaches, you’ll start with a detailed history and a focused neuro exam of the brain and neck to help distinguish tension-type, cervicogenic, migraines, or other causes.

[Steven_R]

Tests you might see: brain MRI to rule out structural issues; MRI of the neck if neck pain is prominent; CT if something acute is suspected; sometimes blood tests. Often imaging is used to rule out dangerous conditions rather than to confirm a headache type.

[Logan39]

How they differentiate: tension-type headaches are usually bilateral, pressure-like, and not worsened by exercise; cervicogenic headaches are linked to neck pain and may worsen with neck movement or poor posture; migraines are often unilateral with throbbing pain, nausea, or light/sound sensitivity. A headache diary helps a lot.

[AndrewJ]

Prep for the visit: bring a 1–2 week headache diary (days, duration, location, intensity, triggers, meds), a list of all meds and supplements, sleep/stress patterns, and any imaging you’ve had. Note red flags (sudden worst headache, weakness, speech changes, fever).

[Ryan4]

Possible plan after the eval: tension-type -> stress management, posture, physical therapy, OTC meds; cervicogenic -> neck-focused physical therapy and posture work; migraine -> acute meds (NSAIDs/triptans) and possibly preventive therapy; you may get a referral to a headache specialist or PT.

[Jeffrey_B]

Bring questions: Do I need imaging now? How confident are you in the likely diagnoses? What non-drug options exist (PT, CBT, sleep)? How will progress be tracked, and when should I return? Are there red flags that would require urgent care?