Cervicogenic headache, their causes, symptoms and management

 Cervicogenic Headache: Causes, Symptoms, and Physiotherapy Management

Introduction

Headaches are one of the most common health complaints worldwide, but not all headaches originate in the brain. Some are actually caused by issues in the neck—these are known as cervicogenic headaches. As physical therapists, we frequently encounter patients who describe pain starting in the neck and spreading to the head or behind the eyes.

Understanding cervicogenic headache (CGH) is essential because it often mimics other headache types, such as tension or migraine, leading to misdiagnosis and ineffective treatment. This article explores its causes, symptoms, and the physiotherapy approaches that help manage it effectively.

What is Cervicogenic Headache?

A cervicogenic headache is a secondary headache that originates from disorders of the cervical spine (neck) or the surrounding soft tissues. In simpler terms, the headache pain is referred from the neck to the head.

Unlike migraine, which is neurological, or tension headache, which is muscular, cervicogenic headache is mechanical—it’s caused by poor posture, joint dysfunction, or neck injuries.

Anatomy Behind Cervicogenic Headache

The upper cervical spine—especially the C1, C2, and C3 vertebrae—plays a vital role. Nerves from these segments connect with the trigeminal nerve, which transmits sensation from the head and face. When these cervical nerves are irritated or compressed, the pain radiates to the head, resulting in a cervicogenic headache.

cervicogenic headache


Causes of Cervicogenic Headache

Common causes include:

  • Poor posture (e.g., prolonged screen use or forward head posture)

  • Cervical spondylosis or degenerative changes in the neck joints

  • Whiplash injuries or trauma to the neck

  • Muscle imbalance or tension in upper trapezius and suboccipital muscles

  • Facet joint dysfunction in the upper cervical spine

Symptoms

Cervicogenic headache symptoms can overlap with migraine or tension headaches but have some distinct features:

  • Pain starts in the neck or occipital region and radiates to the forehead, temples, or eyes

  • Unilateral (one-sided) headache

  • Stiffness or reduced neck movement

  • Pain aggravated by neck movements or prolonged postures

  • Tenderness in upper neck muscles

Some patients also report blurred vision, dizziness, or shoulder pain, depending on nerve involvement.

Diagnosis

Diagnosis is usually clinical, based on symptoms and physical examination.
Tests may include:

  • Cervical range of motion assessment

  • Palpation of neck joints and muscles

  • Diagnostic nerve blocks (to confirm pain source)

  • Imaging (X-ray, MRI)—to rule out structural issues

A physiotherapist or physician determines the diagnosis by ruling out other primary headache types.

 Special/Clinical Tests for Cervicogenic Headache

Here are several tests commonly used when evaluating someone for cervicogenic headache:

Test Name What It Evaluates Notes / Diagnostic Value
Cervical Flexion-Rotation Test (CFRT) Assesses upper cervical (C1-C2) segment mobility by measuring how much rotation is possible when the neck is flexed. This test shows high reliability and strong diagnostic accuracy for cervicogenic headache. (PubMed)
Spurling’s Test Applies compression while the head is extended/rotated to provoke symptoms; assesses whether nerve roots in the neck are irritated. Useful for ruling in cervical contribution to symptoms (though more for radicular components).
Upper Cervical Joint Palpation/Manual Examination The clinician palpates facet joints and assesses joint movement and pain provocation by pressure on upper cervical joints. Manual examination of the cervical spine aids diagnosis of CGH. (PMC)
Range of Motion/Movement Limitation Tests Comparing neck flexion, extension, and rotation, restricted movement in the upper cervical spine is a clue. According to the StatPearls summary, reduced cervical motion is part of the evaluation. (NCBI)

Physiotherapy Management of Cervicogenic Headache (Phase-Wise Approach)

Cervicogenic headache (CGH) management depends on the stage of the condition—acute, subacute, or chronic. Each phase requires a different therapeutic focus to reduce pain, restore movement, and prevent recurrence.

🔹 1. Acute Phase (Pain Relief and Protection Phase)

Goal:

  • Decrease pain and muscle spasm

  • Protect irritated cervical structures

  • Reduce nerve compression and inflammation

Treatment Techniques:

  1. Pain-Relieving Modalities

    • Transcutaneous Electrical Nerve Stimulation (TENS) for pain control

    • Ultrasound therapy to decrease muscle spasm and inflammation

    • Moist heat or cold packs, depending on muscle tension

  2. Gentle Manual Therapy

    • Soft tissue mobilization for suboccipital muscles and upper trapezius

    • Gentle passive traction (manual or mechanical)—under therapist supervision

  3. Postural Education

    • Correct sitting posture (ears over shoulders)

    • Avoid prolonged forward-head position (especially during mobile/computer use)

  4. Patient Education

    • Explain the nature of CGH and importance of posture

    • Encourage ergonomic setup at work or study place

Precautions:
Avoid aggressive mobilization or stretching during acute pain—it can worsen irritation.

🔹 2. Subacute Phase (Mobility Restoration Phase)

Goal:

  • Restore cervical spine mobility and flexibility

  • Strengthen stabilizing muscles

  • Gradually reintroduce normal activity

Treatment Techniques:

  1. Manual Therapy and Joint Mobilization

    • C1-C2 segment mobilization (low-amplitude techniques)

    • Soft tissue release for tight cervical muscles

  2. Stretching Exercises

    • Upper trapezius stretch

    • Levator scapulae stretch

    • Suboccipital stretch

  3. Deep Cervical Flexor Strengthening

    • Chin tuck exercise:

      • Sit or lie supine, gently retract the chin (making a double chin).

      • Hold for 5 seconds, relax, and repeat 10×.

    • Progress by adding gentle resistance with a hand or towel.

  4. Scapular and Upper Back Strengthening

    • Mid-trapezius and rhomboid strengthening to improve posture.

  5. Proprioceptive and Movement Control Training

    • Use laser pointer or mirror feedback for head repositioning accuracy.

🔹 3. Chronic Phase (Functional Restoration and Maintenance Phase)

Goal:

  • Prevent recurrence

  • Improve endurance, coordination, and posture

  • Enhance patient’s ability to return to normal work/life activities

Treatment Techniques:

  1. Advanced Strengthening

    • Progressive resistance training for neck and scapular stabilizers

    • Include isometric and dynamic neck exercises

  2. Postural & Ergonomic Training

    • Teach self-correction techniques during daily tasks

    • Encourage stretching breaks every 30–45 minutes at desk jobs

  3. Manual Therapy Maintenance

    • Periodic cervical mobilizations to maintain joint alignment and tissue flexibility

  4. Functional Re-education

    • Integrate neck control with upper-limb tasks and eye-head coordination

    • Practice safe lifting and sleeping postures

  5. Home Exercise Program

    • Daily stretching, chin tucks, and strengthening for at least 10–15 minutes

    • Encourage long-term adherence to posture correction habits

Expected Outcomes

With proper physiotherapy:

  • Pain and headache intensity reduce within 2–4 weeks

  • Cervical range of motion improves

  • Muscle endurance and posture gradually normalize

  • Recurrence risk decreases significantly with continued home exercise

Home Exercise Example

  • Sit upright and gently pull your chin backward (like making a double chin).

  • Hold for 5 seconds, relax, and repeat 10 times.

  • Perform 2–3 sets daily to strengthen deep neck flexors and correct forward head posture.

Prevention Tips

  • Maintain proper sitting posture while studying or using a computer.

  • Take breaks every 30–45 minutes to stretch your neck.

  • Use a pillow that supports the natural curve of your neck.

  • Avoid carrying heavy bags on one shoulder.

Prognosis

With proper physiotherapy intervention and postural training, most patients experience significant reduction in pain and improvement in neck mobility within a few weeks. Early management leads to faster recovery and prevents chronic pain.

Conclusion

Cervicogenic headache is a common but often overlooked cause of chronic head and neck pain. Physiotherapy plays a central role in diagnosis and management by addressing the underlying cervical dysfunction. Through manual therapy, posture correction, and tailored exercises, patients can achieve lasting relief and a better quality of life.

Disclaimer

This article is for educational purposes only and does not replace professional medical advice. Always consult a qualified physiotherapist or healthcare provider for personalized assessment and treatment.

PubMed / Evidence References

  1. Rubio-Ochoa J, Benítez-Martínez J, Lluch E, Santacruz-Zaragozá S, Gómez-Contreras P, Cook CE. Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review. Man Ther. 2016. PMID: 26423982. PubMed

  2. Anthony Demont, et al. Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies. Musculoskelet Sci Pract. 2022. PubMed

  3. G. Jull. Cervicogenic headache. Musculoskelet Sci Pract. 2023.

Comments

Post a Comment

Popular posts from this blog

What is osteogenesis imperfecta?

Image
What is Osteogenesis Imperfecta? | Causes, Types, Symptoms & Treatment Osteogenesis Imperfecta (OI) , also known as “brittle bone disease,” is a rare genetic disorder characterized by fragile bones that break easily , often with little or no trauma. It affects the production of collagen , a key protein that provides strength and structure to bones and connective tissues.  What is Osteogenesis Imperfecta? Osteogenesis Imperfecta is a hereditary connective tissue disorder . It primarily affects the bones but may also involve the teeth, skin, ligaments, and eyes . The condition is caused by mutations in genes—mostly COL1A1 or COL1A2 —that control the production of type I collagen . As a result, bones become brittle, leading to frequent fractures and skeletal deformities.  Types of Osteogenesis Imperfecta  There are at least eight recognized types of OI, varying from mild to severe. Here's a simplified breakdown: Type Description Severity Type I Most...
Read more

What is a dpt program?

Image
Introduction And if you’ve ever been intrigued by the way the human body can move and heal — and have a desire to work in a field that intersects science, caring, and impact — then a Doctor of Physical Therapy (DPT) program could be your calling. Whether you’re a high school student in the process of investigating health careers, a college graduate considering applying to DPT programs, or just curious about physical therapy education, learn more about what the DPT program is and what it covers as well as how it paves the way for a licensed practice. 🧠 What is a DPT Program? The Doctor of Physical Therapy (DPT) program is a professional doctorate that provides the level of education required for students to take the licensing examination to become PTs. It’s the entry-level degree for anyone who wants to be able to practice as a PT in most countries, this one included.  This degree focuses on: Movement science Patient rehabilitation Injury prevention Manual therapy Neuromuscular and...
Read more

what is brain encephalitis?

Image
Brain Encephalitis: Causes, Symptoms, Diagnosis & Treatment Encephalitis is a serious and potentially life-threatening medical condition characterized by inflammation of the brain . It is often caused by a viral infection   but may also occur due to autoimmune reactions , bacteria, or other pathogens. If not treated promptly, encephalitis can lead to severe neurological complications .  What is Brain Encephalitis? Encephalitis is the inflammation of brain tissue. The inflammation causes the brain to swell, which can interfere with normal brain function and lead to a wide range of neurological symptoms. It can be classified as: Primary encephalitis : Direct viral infection of the brain. Secondary encephalitis : An immune response following an infection elsewhere in the body. Causes of Encephalitis 1. Viral Infections (Most Common Cause) Herpes Simplex Virus (most common and severe) Enteroviruses Varicella-zoster virus (chickenpox) Measles, mump...
Read more