As a Physical Therapist who treats headaches (and has suffered from them), I understand how debilitating they can be. Within several different types of headaches, cervicogenic headaches stand out in the realm of physical therapy due to their unique correlation to the vertebrae, intervertebral discs and soft tissue structures of the cervical spine. In this blog post, we will explore the ideas and concepts specific to understanding cervicogenic headaches: exploring their causes, symptoms, and treatment.
What are Cervicogenic Headaches?
Cervicogenic headaches originate from structures within the cervical spine causing referral (pain not located at the source) symptoms presenting within the head region. Essentially, cervicogenic headache sources are located within the cervical region and can be associated to a wide variety of tissues or injury. Symptoms consistent with cervicogenic headaches are most commonly unilateral but can be bilateral and tend to be chronic in nature due to various causes listed later in this post. It is believed that most cervicogenic headaches originate from structures innervated by the cervical spinal nerves at levels 1-3 (just below the skull). Patient demographics appear to be neutral from male to female comparisons and effect patients aged between 30 and 44 years of age. Additionally, many patients don't seek formalized treatment well into their late 40's, allowing for the condition to become chronic in nature.
Causes of Cervicogenic Headaches
The source of cervicogenic headaches stems from dysfunction or reduced stress tolerance of the cervical spine and its surrounding structures specific to cervical levels 1-3. Some typical factors that present with cervicogenic headaches include, but are not limited to the following:
Neck Injuries: Motor vehicle accidents or patterns of whiplash (football collision), multiple variations of falls (slips, trips and tumbles), or sports injuries specific to excessive force production without adequate strength or structural integrity (first time downhill mountain bikers crashing) can lead to cervicogenic headaches.
Poor Posture: Incorrect sitting alignment or long duration sitting (gamers), ergonomics that lack correct structure and or tools such as correct seat height, improper monitor height etc.
Cervical Abnormalities: Variations of arthritis, vertebral and or structural abnormalities, fractures, tumors etc. Abnormalities will be addressed by your health care provider and may require advanced imaging or specific testing.
Muscle Imbalances: Muscular weakness, muscular stiffness, lack of stability or mobility that is joint specific etc.
Symptoms of Cervicogenic Headaches
Cervicogenic headaches often present as pain in the head region due to a referral from dysfunctional tissues in the cervical spine, specifically affecting one side. Common symptoms include, but are not limited to:
Unilateral Head Pain: Cervicogenic headaches are one sided in nature and may affect regions of the forehead, temple, or eye. Everyone is different and will present differently based on source of referring symptoms.
Neck Pain and Stiffness: Cervical pain and stiffness are one of the most common symptoms associated with cervicogenic headaches. These symptoms may not be present, but imbalances may still be leading to referral-based symptoms presenting as headaches.
Mechanical dysfunction: If abnormalities are present dysfunctional movement patterns and limitations will present with reduce range of motion, incorrect movement patterns or excessive compensation from other surrounding structures. Overall, these limitations lead to increased stressed placed on the structures of the cervical spine.
Activity dependent pain or symptomatic response: Activity based pattern or specific postural positions may elicit cervicogenic headache symptoms causing confusion regarding the true source of symptoms.
Diagnosis of Cervicogenic Headaches
Cervicogenic headaches are complicated in nature and require a team approach including primary care providers, neurological providers and physical therapists for accurate diagnosis. All providers will take into account the patients' history, symptomatic response to various stresses and evaluation of structural integrity with source-based testing. Additionally, specific providers may order and use specific imaging to rule out other possible diagnosis that may present in a similar matter. Moral of the story, create a team of highly qualified health care professionals and stick to a plan of care that focuses on team collaboration.
Treatment Options
Cervicogenic headaches once diagnosed can be treated with a multitude of tools. Here is a short list of the most common interventions that will target treating symptoms:
Physical Therapy: Focused diagnosis on source-based symptom producing tissues such as muscle, nerve or joint. Once diagnose specific treatment focusing on restoration of muscle balance via stretching, strengthening or movement pattern correction can occur. Additional education and training will occur once symptoms are stabilized allowing for long term effects to be maintained with proper use of a home exercise program and activity modification if needed.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants may offer temporary relief for acute episodes. Medications/drug-based prescriptions should be discussed with your medical providers who possess a scope of practice that is appropriate.
Heat and Ice Therapy: Superficial in nature both heat and ice may have an effect on short term symptoms of pain but are not long lasting and will not correct the underlying mechanical issue.
Posture Correction/Activity modification: A component of physical therapy, posture can have a major impact on cervicogenic headaches. Patients may need to alter workstations, home computer set ups, car and or living room set ups to correct alignment to reduce stresses placed on the cervical spine. Additionally, patients may need to modify specific activities to correct cervical alignment. Each patient may have different movements that need to be corrected or modified putting increased importance on having a thorough evaluation with a team of medical providers.
Dry Needling/Trigger Point Injections/Nerve Blocks: Dry Needling targets musculature and neural structures. Trigger point injections target musculature that is producing referral symptoms presenting as headache like symptoms. Nerve blocks target specific nerve roots that may be producing cervicogenic headache symptoms. As with heat and ice, these techniques are short lived and do not correct the underlying issues that are producing the symptoms. They should be combined with movement and imbalance correction.
Conclusion
Cervicogenic headaches can be corrected with proper diagnosis, effective and evidence-based treatments and appropriate lifestyle modifications. The most important part of the process is an accurate diagnosis, which will require skilled providers who treat/specialize in headaches or the cervical spine. You do not need to live in pain! Reach out to your local providers and begin your journey to return to the activities you love.
The contents of this blog are intended to be educational and or informational only. They are not substitute for licensed professional health care. Please seek out specific individualized medical treatment within your area.
References:
Al Khalili Y, Ly N, Murphy PB. Cervicogenic Headache. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507862/
Robinson, J. Cervicogenic Headaches. [Updated 2023, March 16]. In: WebMD [Internet]. https://www.webmd.com/migraines-headaches/cervicogenic-headache-facts_
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