Cervicogenic headache and migraines treatment

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.

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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.

Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury
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Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

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 causes

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


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.

Cervicogenic Headache Physical Therapy 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.

Migraine Headache Specialist NYC​

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

Clinical Case Studies

Ultrasound Guided Dry Needling for Vertigo Treatment in Patient with Skull Trauma

Our patient is a 30 year-old male with head trauma, suffering from persistent vertigo and neck pain. Prior attempts to resolve his condition had been unsuccessful, primarily due to misdiagnosis and ineffective treatments. Apparently the musculoskeletal component of vertigo had been overlooked.

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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.

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018)At: Paris, France
Conference: 14th European Headache Federation CongressAt: Berlin, Germany (virtual congress), June 29 – July 02, 2020
Conference: EFIC Congress 2019 - Pain in Europe XIAt: Valencia, Spain

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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