PT Treatment of Cervicogenic Headaches

Navigating the Path to Relief: Physical Therapy for Cervicogenic Headache Treatment

Cervicogenic Headaches- Causes and treatments 


What is a cervicogenic headache? 

A cervicogenic headache is a headache that originates from structures in the neck. It is known as a secondary headache because it is a symptom of an underlying problem such as a neck issue or injury.  These headaches usually accompany a reduced range of motion (ROM) of the neck and may be confused with a migraine, tension headache, or other primary headache syndromes.  

Diagnostic criteria must include all of the following points: 

  1. The source of the pain must be in the neck and perceived in the head or face.
  2. Evidence that the pain can be attributed to the neck.
    • It must have one of the following: demonstration of clinical signs that implicate a source of pain in the neck or abolition of a headache following diagnostic blockade of a cervical structure or its nerve supply using a placebo or other adequate controls.
  3. Pain resolves within three months after successful treatment of the causative disorder or lesion. 


What causes a cervicogenic headache? 

A cervicogenic headache is caused by referred pain arising from irritation of cervical (neck) structures innervated by spinal nerves C1, C2, and C3. Therefore, any structure innervated by the C1–C3 spinal nerves could be the source of a cervicogenic headache. These nerves can radiate pain to the back of the head, behind the ear, and the upper shoulder. 


Nerves of the neck






Image illustrating nerves of the neck and shoulder.


Because cervicogenic headaches arise from problems in the neck, different conditions can trigger this type of pain. These include degenerative conditions like osteoarthritis,  disc issues in the neck, or a whiplash injury. An injury to the neck from falling or playing sports can also trigger these headaches. They may also occur due to your posture while sitting or standing.  Falling asleep in an awkward position can also cause these types of headaches.  A compressed or pinched nerve in or near the neck is another cause of cervicogenic headaches. 


Cervicogenic headache treatment

Physical therapy is considered the first line of treatment.  Your doctor of physical therapy will ask questions about your symptoms, assess your range of motion, joint mobility, posture, and strength. They will then come up with a treatment plan that will help eliminate the underlying cause of the headache. Our doctors of physical therapy provide evidence-based treatments that are backed by science. 


Physical therapy treatment for cervicogenic headaches may include: 

  • Massage
  • Dry needling 
  • Joint mobilizations of the neck and upper back
  • Posture education and retraining
  • Strengthening exercises


Most cervicogenic headaches respond very well to physical therapy treatments. In more severe cases, further medical management may be needed. 

Other treatment options include: interventional therapy (injections, ablations, nerve blocks, etc.) which will differ depending on the cause of the headache. 


Do I need imaging (x-ray or MRI?)

Imaging of the cervical spine is not sensitive enough for diagnosing a cervicogenic headache. Recent studies show no specific radiologic abnormalities associated with cervicogenic headaches, meaning that your imaging may be normal even if you have headaches. MRIs or CTs can be ordered to help rule out some possible causes such as Chiari malformations, nerve root pathology, or identify spinal cord pathology (e.g., asymmetric facet arthropathy or rheumatoid changes around the atlantoaxial joint) but cannot point directly to a cervicogenic headache.  Surgery is performed only as a last resort


If left untreated, cervicogenic headaches can become severe and debilitating. If you have a recurrent headache that doesn’t respond to medication, see a doctor. The outlook for cervicogenic headaches varies and depends on the underlying neck condition. However, it is possible to alleviate pain and resume an active lifestyle with physical therapy treatment. 


Our doctors of physical therapy can help screen for the cause of your headache and help you determine if further medical intervention is needed. 


Take charge of your health today! Request an appointment with one of our skilled Doctors of Physical Therapy to start feeling better now.

More questions? Give us a call at (479) 442-7473.


Carrie Lynch









Written by Carrie Lynch, PT, DPT



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