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Cervicogenic headaches

Cervicogenic headaches

8th May 2017

Cervicogenic headache (CGH) is a syndrome characterised by chronic hemicranial pain that is referred to the head from either bony structures or soft tissues of the neck. As the diagnosis of CGH is still relatively new, its particular etiology remains unclear. Bogduk 1 has proposed that the pathophysiology of CGH results from a convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus, including input from:

  • Upper cervical facets
  • Upper cervical muscles
  • C2-3 intervertebral disc
  • Vertebral and internal carotid arteries
  • Dura mater of the upper spinal cord
  • Posterior cranial fossa

Diagnostic Criteria

  • Unilateral head or face pain; the pain may occasional be bilateral
  • Pain localised to the occipital, frontal, temporal or orbital regions
  • Moderate to severe pain intensity
  • Pain is generally deep and non-throbbing
  • Intermittent attacks of pain lasting hours to days
  • Head pain is triggered by neck movement, sustained or awkward neck postures; digital pressure to the suboccipital, C2, C3 or C4 regions or over the greater occipital nerve; valsalva, cough or sneeze might also trigger pain
  • Muscular trigger points found in suboccipital, cervical and shoulder musculature
  • Restrictive active and passive neck range of motion
  • Associated signs and symptoms can be similar to typical migraine: nausea, vomiting, photophobia, ipsilateral blurred vision
  • Normal imaging

Approximately 47% of the global population suffers from a headache,2 and 15-20% of those headaches are cervicogenic.3 Recently, CGHs were estimated to affect 2.2% of the population. 4 Females seem more predisposed to CGHs affecting 4 times as many women as men.


As CGH is related to cervical joint dysfunction, most studies on CGH treatment have focused on joint mobilisation and manipulation. Several studies of varied research designs have shown that Spinal Manipulative Therapy (SMT) is effective for CGH,5,6 particularly those focused on treatment of the upper cervical segments. Systematic reviews of randomized control trials using manual therapy in CGH patients suggest better outcomes compared to no treatment.7 In addition, patients with neck pain with or without headache have more short-term relief when manual therapy is combined with exercise as compared to exercise alone.8

Patients with CGHs often have tightness of the SCM, upper trapezius, scalenes, suboccipitals, pectoralis minor, and pectoralis major.9 The post-isometric relaxation (PIR) technique [or Muscle Energy Technique (MET)] is useful in helping reduce tightness and trigger point pain.10

The Osteopaths at Canterbury Health Hub use a combination of SMT and MET in the treatment of cervicogenic headaches. Corrective exercises and postural advice is also administered.

1. Bogduk N., Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep, 2001. 5(4): p. 382–6 [PubMed]
2. Stovner L., et al. , The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia, 2007. 27(3): p. 193–210 [PubMed]
3. Haldeman S., Dagenais S., Cervicogenic headaches: a critical review. Spine J, 2001. 1(1): p. 31–46 [PubMed]
4. Antonaci F., Sjaastad O., Cervicogenic headache: a real headache. Curr Neurol Neurosci Rep, 2011. 11(2): p. 149–55 [PubMed]
5. Haas M., et al. , Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J, 2010. 10(2): p. 117–28 [PMC free article] [PubMed]
6.. Jull G., et al. , A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976), 2002. 27(17): p. 1835–43; discussion 1843. [PubMed]
7. D’sylva J., et al. , Manual therapy with or without physical medicine modalities for neck pain: a systematic review. Man Ther, 2010. 15(5): p. 415–33 [PubMed]
8. Miller J., et al. , Manual therapy and exercise for neck pain: A systematic review. Man Ther, 2010 [PubMed]
9. Jull G., et al. , Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia, 1999. 19(3): p. 179–85 [PubMed]
10. Lewit K., Simons D.G., Myofascial pain: relief by post-isometric relaxation. Arch Phys Med Rehabil, 1984. 65(8): p. 452–6 [PubMed]
This article is for information purposes only. Please consult your Osteopath or primary healthcare professional for further information.