Cervicogenic Headaches

Characteristics of Cervicogenic Headaches

According to the International Headache Society there are over 230 different classifications of headaches all with different presentations and symptom sets. As physiotherapists, there is one group of headaches that stand out above all the rest for us to influence and change, the Cervicogenic Headache. The Cervicogenic headache characteristics are quite distinct and easy to identify and once assessed, we can definitively determine whether or not musculoskeletal treatment is going to be successful.  

The determining characteristics of cervicogenic headaches are:
1.    Location of the headache is not symmetrical i.e. unilateral headache or alternating headache swapping sides
2.   Always has associated neck pain or stiffness at some point during the presentation
3.   The headache comes on after long periods of sitting (i.e. associated with posture)
4.   The headache started (or escalated) after a trauma?
5.   The Headache is failing to respond to medication like it used to

If your patient has all or some of these symptoms, they need to have their upper cervical spine examined to determine if it is a primary cause of their headache. Our assessment techniques quickly and accurately determine whether the neck is involved and whether our treatment will help. If the patient currently has a headache during assessment, our strategy is to actively reduce (if not clear) the headache in that clinical session and then educate them how to minimise the risk of return. We can assess the neck when the patient has a headache or is totally pain free.
If the patient doesn’t currently have a headache, we can still assess the upper cervical spine and isolate the individual joints to try to reproduce the headache symptoms. This can sound scary for a patient but if we can provoke a response from a cervical segment, we can accurately determine that this structure is the cause of their headache, then educate the patient and treat the section to remove the dysfunction and reduce the headache. Nobody leaves our clinic with a headache if they come in symptom free.

Reducing or temporarily reproducing the patient’s symptoms, determines whether the upper cervical spine is a cause of their headache and we can then set the goal over 3 sessions to reduce their headache symptoms. If treatment is unable to reproduce or reduce their symptoms, their headache is not cervicogenic in origin and we refer them back, or if there is no change by three treatments, we refer them back for further investigation. 


Author: Nigel Smith