What is a
Cervicogenic Headache?

The term “cervicogenic headache” refers to a chronic headache that is perceived as pain in one or multiple cranial regions and/or face, but actually originates from the upper cervical spine (neck). Generally speaking, this type of headache occurs as a result of either a neck disorder or lesion of the cervical spine.

According to The International Headache Society (IHS), this type of headache is recognized as an inferior (secondary) headache that is suspected to derive as a result of another illness, physical matter, or nociception (the response of the body’s nervous system when it feels threatened) in the cervical spine region.

Epidemiology
When it comes to chronic headaches, cervicogenic headaches account for about 14-18% of them all. However, a recent study shows a prevalence rate of 2.2%. Because of these varying numbers, knowing how to differentiate between cervicogenic headaches and other types of headaches (such as migraines) is imperative.
Cervicogenic Headache Symptoms

Oftentimes, a cervicogenic headache is not an easy diagnosis. It normally presents as a persistent dull ache, with the pain usually centralized to the rear of the head, but sometimes the pain is behind the eyes or temples, and least commonly, on the top of the head, forehead, or ear regions.

Other cervicogenic headache symptoms include:

  • Unilateral “ram’s horn” or unilateral dominant headache
  • Cervical pain or tenderness of the muscles
  • Aggravation or inflammation caused by movement of the neck or due to poor posture
  • Difficulty turning the neck
  • Tenderness to the cervical spine joints (upper 3)
  • General symptoms associated with dysfunction or pain to the neck
  • Conclusive evidence (clinical, laboratory, and/or imaging) of a lesion or disorder located within the cervical spine or soft tissues of the neck that is either known to be, or has valid reason to be considered as, a valid reason for the headache
  • Majority of patients experience elevated tightness and trigger spots in upper trapezius, levator scapulae, scales and suboccipital extensors, more so than in patients suffering from migraines
  • Weakening of the deep neck flexors
  • Superficial flexors will exhibit levels of elevated activity
Cervicogenic Headache Symptoms

Cervicogenic headaches are known to originate in the upper cervical spine region, so obvious cervicogenic headache causes include a lesion or disorder of the neck, illness, or some other injury (as in whiplash). Generally, they are caused by activities that put excessive stress on the upper joints of cervical spine or neck, such as:

  • Poor posture or long-term slouching
  • Heavy lifting or carrying
  • Excessive bending and/or twisting of the neck
  • Prolonged computer use and other activities that require the arms to be held out in front of the body
  • A result of whiplash
Contributing Factors of Cervicogenic Headache

Many factors can contribute and help lead to the development of cervicogenic headaches. Those that can be corrected should be done so to avoid this occurrence.

  • Poor posture
  • Imbalances within the muscles
  • Stiffness in the upper back and neck
  • Weakness or tightness within the muscles
  • Previous Trauma to the neck, as in whiplash
  • Dissatisfactory desk setup
  • Poor pillow or sleeping positions
  • Inactive lifestyle
  • Excessive stress
  • Dehydration
  • Lifestyle activities promoting excessive bending forward or shoulders forward
Diagnosis
Clinical examination is imperative for cervicogenic headache to be properly diagnosed. Usually, a comprehensive and objective examination by a physiotherapist is enough to diagnose a cervicogenic headache, but in some cases, additional investigative tools, such as an MRI, X-Ray, or CT scan may be necessary to reach an accurate diagnosis before any cervicogenic headache treatment can begin.
Cervicogenic Headache Treatment Options

An eclectic approach is taken when it comes to cervicogenic headache treatment options.

Most commonly, cervicogenic headache treatment involves one or more of the following:

  • Physical therapy, including “manual therapy”.
  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-Acquired in Adolescence or Adulthood.
  • Cervicogenic headache exercises, including strengthening moves that work the deep neck flexors and upper quarter muscles.
  • Thoracic manipulation and related exercises.
  • (SNAG) – C1-C2 Self-sustained Natural Apophyseal Glide.

There are also educational tools that can be provided to help the patient with cervicogenic headache treatment:

  • Educating the patient on craniocervical spine flexor muscles.
  • Co-contraction of the neck flexors and extensors.
  • Retraining the strength of the superficial and deep flexor synergy.
  • Retraining of the scapular muscles.
  • Proper posture methods.
  • Sensorimotor training to include progressive exercises.
Our Treatment

At NYDNR, we take a comprehensive and sensible approach to treating cervicogenic headaches. We take the time that is necessary to validate a proper functional and structural diagnosis in order to determine the best course of treatment.

All of our PT’s are trained in a minimum of 2 different fields, including extensive manual therapy, sports-related injuries, orthopedic, and neurological rehabilitation. Many years of experience have taught us that we can provide successful results with maximum success by integrating a mixture of treatment styles into our protocols.

To ensure our patients receive appropriate care targeted towards the origin of the issue rather than the symptoms, we entrust our patients with only the most technologically advanced equipment and techniques. Because of this technology, we can confidently deliver a functional movement diagnosis from both a biomechanical as well as a neuromuscular standpoint.

The many unique and leading-edge approaches (both manual and neurological) include:

Testimonial

Headaches and Migraines

There are many different types of headaches, however the most common ones are: Tension headache, Cervicogenic headache, Cluster headache and Migraine.

We will only talk about Cervicogenic headache since other types of headaches heave been extensively described in the literature and are more familiar to the general public. Even though, cervical component is found in most types of headaches, Cervicogenic headache is the only one that could be managed by a chiropractor or a physical therapist without the use of drugs. Cervicogenic headache is second most common after Tension headache and the most common headache in children and adolescents. Unfortunately the majority of cases are missed or mismanaged due to general lack of functional diagnostic skills by primary care physicians. This leads to unnecessary suffering and overuse of pain medications and degeneration of cervical spine. Cervicogenic headache is a pain arising from dysfunction of the cervical spine. This dysfunction involves: soft tissue and muscle hypertonicity in the neck muscles, faulty posture in the thoracic and cervical spine, faulty breathing patterns, TMJ dysfunction, abnormal motor control in the locomotor apparatus all of which result in irritation of upper cervical joints. Cervicogenic pain syndrome is also known as: vertebrogenic headache, cranio-cervical syndrome. It has a direct relationship with mandibulo-cranial syndrome AKA TMJ pain syndrome. See TMJ section.

Features of Cervicogenic headache:

  • One-sided pain without a shift to another area
  • Reduced range of motion of the neck
  • Provocation of the pain by neck movement, sub occipital pressure and feeling of patient that the head or neck is in awkward position
  • Associated neck and shoulder pain
  • Pain usually radiates to front of the head, especially to the fore head and behind the eyes
  • Pain is of mild or moderate intensity
  • Pain is always fluctuating
  • Nausea, vomiting, dizziness, blurring of the eyes, and photophobia are rarely present and if present are usually mild.

The best treatment approach is a functional one. This approach addresses dysfunction at its roots. Let alone without treatment Cervicogenic dysfunction will eventually lead to: spinal degeneration, difficulty chewing or swallowing, difficulty breathing and will affect the rest of the spine through alteration of posture. All this can be prevented if proper and timely diagnosis is established and functional treatment is undertaken.

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130 west 42 street, suite 1055 New York, NY 10036

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