Cervicogenic Headache

What is it?

Cervicogenic headache is a headache that originates from the neck and is one of the most common types of headache. Up to 20% of regular headache sufferers fulfil the cervicogenic headache criteria. Other common headaches include migraines, tension headaches and sinus headaches.

Cervicogenic headache is due to a disorder in the neck which is associated with movement changes in the top 3 vertebra of the neck. The pain associated with this condition is an example of referred pain (i.e. pain arising from a distant source – in this case the neck). This occurs because the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears. As a result, pain arising from structures of the upper neck may refer pain to any of these regions causing a cervicogenic headache.

Although cervicogenic headache can occur at any age, it is commonly seen in people between the ages of 20 and 60. It is twice as common in females as males.

What Causes it?

Cervicogenic headache can occur acutely due to loss of movement in the neck or be more continuous due to prolonged load on the neck. There are typically postural causes such as excessive and prolonged slouching when sitting or the opposite, which involves an overcorrected posture. Altered posture can influence how much load is placed on the neck. Too much load over time can lead to pain. Cervicogenic headache is also very common following trauma such as a car accident. Physiotherapist’s are highly skilled in assessing potential contributing factors to cervicogenic headache.

Possible causes of cervicogenic headache include

              Trauma to the neck (such as whiplash)

              Poor neck support whilst sleeping

              Incorrect work postures and poor ergonomics (such as sustaining a poor posture whilst sitting at a computer); and

          Over use of the muscles related to neck function

How do we Diagnose a Cervicogenic Headache?

Diagnosis is based on the subjective features of a headache and a thorough physical examination. Physiotherapist’s are highly skilled in assessing subjective features of cervicogenic headache and correlating this with physical findings such as posture and neck mobility. This is usually sufficient to diagnose cervicogenic headache. Radiology is of limited benefit as common findings on X-Ray overlap with those seen in healthy individuals.

The current diagnostic criteria from the international headach study group include:

  • Pain on one side of the head that does not shift sides
  • Pain that normally begins in the neck or back of the head
  • Moderate intensity of pain without stabbing or lancinating pain
  • Pain has a mechanical cause (ie. is aggravated by prolonged postures and/or movement)
  • Restricted neck mobility
  • Tightness or overactivity in the muscles of the cervical spine

Does Physiotherapy Help?

There is normally a good response to Physiotherapy treatment for cervicogenic headache. Acute headaches normally respond rapidly to treatment. More chronic and continuous headaches may have a slower response to treatment as it may take times to alter poor posture and movement patterns.

What will a Physiotherapist Do?

Physiotherapy treatment for this condition can help resolve the headache and focus on contributing factors to help manage the potential for reoccurrence. Treatment and management can include:

  • joint mobilization
  • joint manipulation
  • soft tissue massage
  • dry needling
  • postural advice, re-education and taping
  • education
  • ergonomic and activity advice
  • exercises to improve neck mobility and control

As not all headaches are cervicogenic, your physiotherapist will look for signs of a more serious headache. If this is the case, or you are not responding to physiotherapy as expected, your physiotherapist will refer you on to an appropriate medical profes