Cervicogenic Headache

What is a Cervicogenic Headache ?
Cervicogenic headaches are a specific type of headache where the underlying cause is related to dysfunction of structures of the upper neck (cervical spine), which refer pain into the face and head. It is estimated that between 15-20% of all chronic or recurrent headaches are cervicogenic in nature. Neural signals from the upper three cervical vertebrae converge in an area of the brain, called the cervical-trigeminal nucleus, that also receives signals from the head and face. Due to these overlapping neural connections, the brain finds it difficult to localise the source of pain, and therefore neck pain can present as a headache. There is evidence to suggest that cervicogenic headaches respond well to physiotherapy treatment.

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What are the symptoms of a Cervicogenic Headache ?
Cervicogenic headaches may feel as if they start at the base of the skull or upper neck and can spread to the front of the head as the headache worsens. Characteristically, these headaches are unilateral (on one side), non-throbbing, of mild to moderate intensity and typically do not change sides during an episode. These types of headaches are not to be confused with tension-type headaches or migraines, which present in a different pattern. Cervicogenic headaches can be triggered or aggravated by sustained neck postures or certain neck movements.

How is a diagnosis made?
The diagnosis of a cervicogenic headache is made after a thorough assessment by your physiotherapist. It is important to differentiate a cervicogenic headache from other types such as migraines and tension-type headaches, as the treatment for each one will differ. Assessment will also be able to rule out the possibility of more serious pathology. A cervicogenic headache will often present with a restriction in the neck range of motion, tenderness of the upper neck joints that also reproduces the headache, and impairment of certain muscles within the neck. Medical imaging is often not required for the diagnosis of a cervicogenic headache, however one may be requested to rule out further causes of the symptoms.

What Treatment is available ?
Treatment of a cervicogenic headache consists of manual therapy directed to the upper neck joints and appropriate rehabilitation of muscle dysfunction through specific exercises.

Physiotherapy research has shown that patients with cervicogenic headaches can be successfully rehabilitated with the above approach. While there is limited evidence to support posture being a primary cause of headache, poor posture may be a factor in recurrent headaches. In this situation, postural exercises may be incorporated into treatment.