Cervicogenic Headaches: Causes, Signs & Treatment Options

According to Deloitte Australia, 85% of adults over the age of 18 experienced at least one headache in the past year.[1] Several research papers note that anywhere between 0.17%-17.8% chronic headache (>3 months) cases are cervicogenic or caused by upper cervical spine abnormalities.[2][3][4]

There are several reasons why the number of people diagnosed with cervicogenic headaches (CGH) vary significantly. One key reason is that there are hundreds of different causes of headaches, ranging from migraines to traumatic injury and infection.[5] Additionally, no single medical test or examination can determine these diagnoses. A thorough physical and medical questioning assessment is currently the most reliable way to determine cervicogenic headaches.

What is a Cervicogenic Headache?

Cervicogenic headaches describe the painful sensations around the head which arise from the upper cervical spine (high part of the neck). Abnormalities to several structures in the upper neck can cause headaches, including the C1-C3 joints, blood vessels, muscles and nerves.

What are the symptoms of a cervicogenic headache?

Cervicogenic headaches are a specific type of headache with unique symptoms. These include neck stiffness, dizziness, blurred vision, sensitivity to light, nausea and potential vomiting. The pain from cervicogenic headaches is usually felt at the back of the skull.

Common symptoms of cervicogenic headaches

• Pain at the back of the head

• Reduced range of motion of the neck

• Pain on one side of the head

• Pain and stiffness of the neck

• Pain around the eyes

• Head pain that is triggered by neck movements

• Sensitivity to light or noise

• Nausea

• Blurred vision

• Pain on the right side the neck

• Pain on the left side the neck

• Pain at the front of the neck (Sternocleidomastoid pain)

What causes a cervicogenic headache?

Cervicogenic headaches have many causes, all of which relate to the neck (cervical spine). These causes include neck injuries, arthritis, inflammation and other medical conditions.

Common causes of cervicogenic headaches

• Osteoarthritis

• Fracture

• Disc bulge

• Whiplash injury

• High impact collision sports

• Falling down

• Bad posture

• Sitting or standing for a prolonged time

• Nerve impingement

Some jobs require you to maintain prolonged positions, which are not ideal for your body. Jobs, where you tend to sit or stand for a long time may cause you to unknowingly move your chin forward (protraction). This position puts a lot of stress on your neck and may trigger cervicogenic headaches.

How is a cervicogenic headache diagnosed?

There are several options available when it comes to diagnosing your headaches as cervicogenic in nature. One of the more common ways to get a diagnosis is to be assessed by a physiotherapist.

Through years of intensive clinical experience, physiotherapists can effectively diagnose referred pain such as cervicogenic headaches. The process of physiotherapy assessment is simple yet comprehensive.

Like visiting a GP, your assessment will start with your physiotherapist asking you vital questions about your health. This is referred to as a consultation and will last for about 30 to 60 minutes. You should take this time to discuss relevant issues relating to your headaches.

It is best to tell the physiotherapist your symptoms and give a detailed list of your activities before the onset of your pain.

Be sure to include other health concerns such as rash, fever, vomiting, and recent or past head trauma. This is a crucial step to screen for red flags and provide you with an accurate diagnosis.

After establishing the background of your condition, your physiotherapist will perform specific physical tests to determine the best possible cause of your pain and rule out other conditions.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on your condition.

From here, your physiotherapist will give you the details of your treatment program; this will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Timeline for recovery.

How is a cervicogenic headache treated?

Cervicogenic headaches can be distressful and may affect the quality of your life. Medications can provide temporary relief, but specific issues in your neck region such as posture, muscle spasm, and muscle imbalance can only be addressed by physical intervention.

There are several options when it comes to treating cervicogenic headaches. One of the more common options referred to by Australian GPs is physiotherapy.

A cervicogenic headache is an injury that physiotherapists come across regularly, and the process of treating it is straightforward. Following an initial consultation, the physio will be in the best position to determine your treatment plan.

A combination of manual therapy, stretching, and specific movement exercises will be given to you by your physiotherapist. Physiotherapists are experts in dealing with pain and musculoskeletal conditions.

Depending on the severity of your cervicogenic headache, a physiotherapist may provide you with a combination of the following types of treatments:

• Therapeutic Exercises - Utilising exercises specific to treating cervicogenic headaches.

• Manual Therapy - Hands-on therapy to relieve muscle spasms and tension in the neck.

• Stretching Exercises - Stretching will help lengthen muscles and increase range of motion

• Joint Mobilisation / Manipulation - Specific joint mobilisations are used to reduce stiffness in the neck and shoulders.

• Myofascial Release - A specific massage-like technique used by physiotherapists.

• Dry Needling - A technique used to help alleviate pain and reduce muscle tension through needles.

• Heat Therapy - Used to reduce tension and pain in acute situations.

• Traction Treatments - Specific to neck pain, traction can relieve tension at the base of the skull.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.

Next Step - Creating a treatment plan made for you

Following your initial appointment, your physiotherapist will craft a tailored treatment plan that will highlight the course of action required, including what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.

Self-care for cervicogenic headaches

Whilst a physiotherapist is the number one choice for professional help when it comes to cervicogenic headaches, there are things you can do yourself to help speed up your recovery.

If you think you have a cervicogenic headache, here are the best things you can do.

Things to do:

• Hot Compress or Hot Shower

Heat will promote blood flow towards the area. This will also relieve stiffness and facilitate natural relaxation of the tensed muscles around your head and neck. Be careful not to apply too much heat as it may cause burns.

• Gentle Stretching

Stretching of your neck muscles can help relieve the tension. Your physiotherapist will provide you with effective stretching techniques for the neck.

• Relaxation / Massage

Gentle massage on your neck and upper back can help relieve tension in the area and decrease pain.

• Practice Good Posture

Maintaining a good posture will decrease the stress and pressure on your neck muscles and spine. It will also promote overall spinal health, which will prevent injuries.

Things to avoid:

• Avoid Activities that worsen the pain

Take rest and let the symptoms subside. If you are working on a computer, be sure to take frequent rest in between and observe proper posture. Keep your head aligned with your torso.

Do I need a specialist or surgery?

Headaches can be a complex condition and can be caused by something more serious. Get emergency medical care if the headache comes on suddenly and you are starting to feel dizzy. Headaches following a head trauma should be seen immediately by a physician.

Diagnostic imaging may be done such as X-ray, CT scan, or MRI to rule out brain damage, fracture, and other severe medical conditions. You may also get a blood test to make sure the problem is not a disease that causes pain.

In rare cases, surgery is required to relieve cervicogenic headaches due to nerve compression.

If your GP determines that your headache is of musculoskeletal origin, they may coordinate with your physiotherapist to provide you with proper treatment.

What is the recovery time / prognosis for a cervicogenic headache?

Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of your headaches.

Most cases of cervicogenic headaches will resolve within 1 hour or up to a few weeks, depending on the severity. Physiotherapy can effectively treat musculoskeletal causes of cervicogenic headaches.

You may immediately feel signs of relief during your physiotherapy treatment. Generally, you will be asked to continue with your program to strengthen your muscles and correct your posture, preventing future headaches.

Important factors in recovery include:

• Sticking to your rehabilitation program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Can cervicogenic headaches be prevented?

Guaranteeing prevention can be impossible; however, you can decrease the risk of cervicogenic headaches through some of these techniques.

• Manage your screen usage: Computers and mobile devices tend to hook us in a position that puts our head in a forward position which causes strain and stress on the cervical spine and structures around it. Limiting your screen time or frequent short breaks will help decrease the chance of having a cervicogenic headache.

• Chin tucks: Proper control of your cervical muscles is needed to prevent strain and injury in the neck region effectively. Doing chin tucks can activate the deep neck muscles and promote greater strength and stability of your neck region. Your physiotherapist will teach you exercises and movements that would help you build strength on your neck muscles and the shoulders and upper back.

• Don’t sleep on high pillows: Sleeping on high pillows may cause excessive pressure on the base of the skull and the muscles around it. This of course is more of a personal preference, and really only you can determine the right pillow height for you.

• Use a neck brace: In severe cases, your health care practitioner may advise you to wear a neck brace to prevent excessive neck movement and allow your injury to heal. This strategy is only rarely used and more likely with a motor vehicle-related injury or the case of other trauma.

Outlook and the main takeaways

The pain you are suffering from is ultimately your body sending you a message asking you to do something about it. If there is anything to take away from this article it is that you need to listen to these messages. Get your cervicogenic headaches assessed by a qualified physiotherapist and start feeling better soon!

Anatomy of the cervical region

The cervical spine consists of seven vertebrae, eight cervical nerves, muscles, and ligaments.

The first two vertebrae have unique shapes and functions. They form the upper cervical spine. Each pair of cervical nerves passes through each segment of your cervical vertebra.

Cervical nerves also provide sensation to different parts of the head, neck, and arms.

Any of the above structures may be affected in cervicogenic headaches, causing radiating pain to the head.

• Fractures or trauma on the upper cervical spine

• Cervical nerve impingement

• Muscle spasm/tightness

• Sprain / strain