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Cervicogenic Headache

Cervicogenic headaches (CGH) are associated with musculoskeletal dysfunction arising from the neck. They account for 15- 20% of all headaches and are characterized by muscle imbalance (weakness and tightness) and poor posture.

Causes

  • CGH are classically a consequence of poor sustained posture like sitting at a desk for long periods or sleeping on your tummy at night. Patients classically display a forward head position with chin poke and rounded shoulders and usually present with decreased strength and endurance in the deep neck flexors and increased tension in the posterior neck muscles.

  • Classic muscular imbalances seen are; tightness in the pectoral muscles, levator scapula, upper trapezius and sub occipitals and weakness in the opposing muscles of the rhomboids, lower traps and deep neck flexors showing this upper cross syndrome pattern. CGH are common post whiplash or concussion, in hairdressers, carpenters, truck drivers and office workers.

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Signs & Symptoms

  • Unilateral pain radiating from the back of the head

  • Evidence of cervical dysfunction, usually restricted range of motion

  • Pain provocation with sustained awkward head postures + Pain reproduction with trigger point over the upper cervical or occipital region

  • Moderate - severe intensity but non- throbbing

  • Normal imaging results

Differential Diagnosis

Other headaches such as Tension Type Headache and Migraines need to be ruled out as physiotherapy will not be as effective for these primary headaches


It's very important to recognize red flag symptoms of headache that require further medical evaluation, which include:

  • Headaches that are getting worse over time

  • Severe sudden onset of severe headache

  • Headaches associated with high fever, stiff neck, or rash

  • Headache associated with neurological signs or changes in consciousness

  • Onset of headache after head injury

  • Problems with vision or profound dizziness


PROmotion Assessment and Outcomes Measures

When correctly diagnosed physiotherapy can be very effective in treating CGH. Treatment can consist of;

 

  • Postural correction and work place set up 

  • Manual techniques to help with joint restriction and muscular tightness 

  • Importantly exercises to help strengthen the neck and correct muscle imbalances. 


It's important to work through a progressive strength and endurance program ranging from all different positions, lying on your back, standing, on hands and knees or lying on your tummy. Looking at the whole body is important and your Physio at PROmotion can guide you to correct any other issues found in the assessment.

How to Manage

When correctly diagnosed physiotherapy can be very effective in treating CGH. Treatment can consist of;

 

  • Postural correction and work place set up 

  • Manual techniques to help with joint restriction and muscular tightness 

  • Importantly exercises to help strengthen the neck and correct muscle imbalances. 


It's important to work through a progressive strength and endurance program ranging from all different positions, lying on your back, standing, on hands and knees or lying on your tummy. Looking at the whole body is important and your Physio at PROmotion can guide you to correct any other issues found in the assessment.

References

  1. Uthaikhup, S., Assapun, J., Watcharasakslip, K., Jull, G. (2017). Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction. The spine Journal. (Vol 17). Elsvier.

  2. Sjaastad, O. Fredriksen, T.A., Pfaffenrath, V. (1998). Cervicogenic headache: diagnostic criteria. Headache (Vol 38). Wiley.

  3. Rubio-Ochoa, J., Benitez-Martinez, J., Lluch, E., Santacruz-Zaragoza, S., Gomez-Contreras, P., Cook, E .C. (2016). Physical examination tests for screening and diagnosis of cervicogenic headache: Manual Therapy (Vol 21). Elsvier.

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