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Cervicogenic Headache


In the current fast pace society, there is an increasing trend of people suffering from headache. Two common reasons given by victims of headache are:

  1. Mental stress from the type of lifestyle they have or want to pursue

  2. Nature of work that requires an individual to be in a prolonged static position working on devices such as computers and smart phones

It is common that people have the tendency to term their headaches as “migraine”.  However, there are many different forms of headache. It is useful to identify the possible types of headache you might be suffering from. This allows an individual to seek appropriate management, reducing the period of suffering. Cervicogenic headache is in fact one of the common type of headaches. It can be treated with physiotherapy, whereas the main treatment for migraine is medication.


Cervicogenic Headache Versus Migraine

Migraine is a neurovascular disorder with signs inclusive of mostly unilateral throbbing head pain lasting 4-72 hours and a group of neurological symptoms including increased sensitivity to light, sound and smell, nausea, and a variety of autonomic, cognitive, emotional and motor disturbances. Triggers of a migraine attack are frequently associated with a wide variety of internal and external triggers such as stress, hormonal fluctuations, sleep disturbances, skipping meals or sensory overload.

Cervicogenic headache is pain referred from a source in the neck presenting in the head. It is caused by another illness or physical issue usually due to a neck disorder or lesion. In the upper neck area there is a region called the trigeminocervical nucleus which interacts with the sensory fibers from the upper cervical neck. This allows pain referral between the neck, face and head, explaining why when there is a headache the source of pain may be in the neck instead.


Signs and Symptoms of Cervicogenic Headache

Altered neck posture, restricted cervical range of motion, upper cervical joint dysfunction assessed by manual examination are common signs of people with cervicogenic headache. The headache can be reproduced or triggered by active and/or passive neck positioning and/or movement, or by pressure application to the affected regions. Trigger points are usually found in the suboccipital, cervical, and shoulder musculature, which can cause headache when manually or physically stimulated.



Physiotherapy Treatment for Cervicogenic Headache

There is a variety of treatments including nerve blocks, physiotherapy and exercise, Botox injections, and medications. Treatment for cervicogenic headache should target the neck as it is the cause of the pain and varies from patient to patient. Physical therapy treatment chosen is dependent on the results of the clinical assessments performed on the patient. Physiotherapy and an ongoing exercise regimen often produce the best outcomes with low recurrence rate. However, it is still crucial to have medications or anesthetic injections for temporarily pain reduction, facilitating greater participation in physiotherapy allowing more permanent benefits.


Physiotherapy treatment involves three main components:

Pain relieving treatments

Manual therapy can be done, such as low-velocity cervical joint mobilization techniques (in which the cervical segment is moved passively with rhythmical movements). and high-velocity cervical manipulation techniques. Such approach encourages the body to modulate the pain level. Soft tissue release is another essential tool to help relieve tight connective tissues or muscle knots that can be irritating the nerves causing headache. Physiotherapy modalities such as electrical therapy, ultrasound therapy, heat or cryotherapy are also commonly used to complement the hands on techniques in pain relieving and facilitate the body recovery

Reconditioning of muscular imbalances

Reconditioning of muscular imbalance includes low load endurance exercises to train muscle control of the cervicoscapular region. The first stage consists of specific exercises to address the impairment in neck flexor synergy found in cervicogenic headache and other neck pain disorders. Neck flexors have an important supporting function for the cervical region. Shoulder blade muscles, particularly the lower trapezius and serratus anterior, are also trained for a better postural control. Subsequently, co-contraction of the neck flexors and extensors is performed to increase the general strength at the cervical region. Muscle stretching exercises are also taught as necessary to optimize the loading at the cervicoscapular region.


Postural and ergonomic correction

Postural correction of the daily activities is crucial to optimize loading on the spine and overlaying muscles preventing unnecessary fatigue or stress on the supporting muscles. Use of mirror for visual feedback and tactile feedback such as tape application may be used to aid with posture correction. Rearrangement of layouts and work process advices are given to minimize undue strain obtained from prolonged posture especially people who have deskbound jobs.



Physiotherapy can help to identify the root of cerviogenic headache and develop an individualized treatment plan. A holistic treatment progamme providing symptomatic relief, reconditioning of the human body and minimizing the potential stressors ensure successful outcomes and prevent future recurrences.


Suggested Readings

Biondi, D. M. (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association, 105, 16S-22S.

Gilmore, B., & Michael, M. (2011). Treatment of acute migraine headache. Am Fam Physician, 83(3), 271-280.

Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., Richardson, C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 27(17), 1835-1843.

Noseda, R., & Burstein, R. (2013). Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. PAIN®, 154, S44-S53.

Zito, G., Jull, G., & Story, I. (2006). Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Manual therapy, 11(2), 118-129.

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