Cervicogenic Headache

by Jennifer Ironside

The following outline discusses the most common clinically relevant information pertaining to cervicogenic headaches. Their description, diagnosis and management will be discussed with links to appropriate resources.


'Cervicogenic headache' is a term used to define headaches that arise from musculoskeletal dysfunctions in the cervical spine.1,2 More specifically, dysfunction is thought to lie within the joints, discs, ligaments, muscles, and/or dura of C0-C3. Typically these types of headaches are unilateral, often beginning at the neck or base of the skull and spreading into the oculo-fronto-temporal area.

Myofascial Referral Patterns

Referral Patterns After Noxious Stimuli3


Referred pain pattern after noxious stimuli with percentages of patients who reported pain in area.3


Theory of Convergence

Convergence of Cervical and Trigeminal Sensory Afferents

Although this theory of convergence is still the most widely accepted explanation for cervicogenic headaches, it has not been demonstrated in humans. All of the studies that support this theory have been conducted on animals.3

Diagnostic Criteria

In 1988 the International Headache Society (IHS) published diagnostic criteria for headaches, including cervicogenic headache. In 2004 the IHS published a revised classification of headaches. Cervicogenic headache is considered a secondary headache and falls under the ICD-10 code of G44.841, with the key component being pain in the head or face that can be attributed from the neck dysfunction.

In 1998 the Cervicogenic Headache International Study Group (CHISG) published its own set of criteria that is more widely utilized in clinical practice than the IHS classification.

Diagnostic Criteria for Cervicogenic Headache

Distinguishing between Headache Types

Manual Diagnosis

The criteria put forward by the CHISG requires a diagnostic nerve block of the suspected cervical level for a diagnosis of cervicogenic headache to be given. For many patients it is not possible to receive this procedure. A manual examination of the upper cervical spine is a key tool many practitioners use to diagnosis cervicogenic headache.

General Examination for Cervical Spine1,4 with a focus on cervicogenic headache.

Patient History


  • Women are 4 times more likely to suffer from cervicogenic headache
  • Cluster headaches more commonly seen in males


  • Individuals with managerial and professional occupations seem to be more afflicted by cervicogenic headache


  • Disc problems
  • Degenerative joint changes

Family History

  • No family tendency seen with cervicogenic headache

Time-line of Cervicogenic Headache

  • Spontaneous, traumatic, or unknown start?
  • Progression

Specific Sites of Pain

Where does it start?
Sjaastad et. al.5 found that 90% of patients suffering from migraines report the pain starting in the forehead or temporal region where as 73% of cervicogenic headache patients report pain beginning at the neck and moving into the head

  • Does it seem to move?
  • Does it move in a predictable pattern?

Unilateral or Bilateral Symptoms?* Tension headaches are typically bilateral while cervicogenic headache are unilateral

  • Does it switch sides?
  • Migraines can switch sides, but cervicogenic headaches stay unilateral.

Constant or Intermittent

  • What makes it better or worse?
  • Is posture a component?
  • Cervicogenic headaches are more likely to be triggered by a specific position than migraines.

Any other symptoms besides pain?

  • Dizziness
  • Nausea
  • Vomiting
  • Blurred vision
  • Photophobia
  • Phonophobia

Postural Abnormalities

  • Forward head
  • Rotation
  • Any asymmetry

Special Tests if Applicable

  • Vertebral Artery insufficiency testing
  • Upper cervical spine stability testing
  • Cervical Spine ROM testing
  • Gross movements
  • Flexion
  • Extension
  • Side Flexion
  • Rotation

Upper Cervical

  • Protraction
  • Retraction
  • Quadrants


  • Soft tissue
  • Spinous processes
  • Transverse processes
  • Articular pillar
  • Facet joints

Based on the findings from the examination a practitioner should be able to determine the source of a patient’s pain. If the patient is presenting with all of the criteria described earlier and a specific structure in the neck seems to be the cause then it is likely they are suffering from cervicogenic headaches.

Types of Management1,2,3

Physical Therapy for Cervicogenic Headaches

When a physical therapist sees a patient suffering from cervicogenic headaches there are several tools that can be utilized to help relieve their symptoms. Mobilization and/or manipulation of the spine can help to ease pain and promote movement. Massage can be useful for relaxation and release of trigger points that may be referring pain to the head. Depending on the patient posture, postural reeducation may be another area for treatment focus. Proper alignment of the cervical spine can help to reduce strain on ligaments and muscles. Educating a patient on relaxation techniques, stretching, and the possible triggers for their headaches will help them to become independent in symptom management.

Web Based Resources

Recent Related Research

  1. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache.
  2. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: A pilot randomized controlled trial.
  3. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache
  4. Headache subsequent to whiplash.
  5. Influential variables associated with outcomes in patients with cervicogenic headache.
  6. Orthopaedic manual physical therapy including thrust manipulation and exercise in the management of a patient with cervicogenic headache: A case report.
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