Cervicogenic headache

Headaches can happen for lots of reasons. It can be hard to know what kind of pain you have and what’s the reason behind it. There are so many types of headaches that we don’t know about. So let’s have a look at this-

But if it is related to a problem in your neck then there is a good chance that it is a cervicogenic headache.

What is a Cervicogenic Headache?

Cervicogenic headache is a type of pain that develops from the specific point of the neck and the back of the head and it radiates toward the front of the head. People may get confuse cervicogenic headaches with migraine and tension headaches because both of them can cause neck pain. 



Cervicogenic headache is a type of pain that develops from the specific point of the neck and the back of the head and it radiates toward the front of the head. People may get confused cervicogenic headache with migraine and tension headache because both of them can cause neck pain. 



In the neck, there are seven cervical vertebrae which connect to each other. If there is any problem such as neck injuries, infections and high blood pressure can cause cervicogenic headache. Cervicogenic headache is also known as secondary headaches. 




In this article we will discuss some symptoms, causes and treatment of cervicogenic headache. So that you can easily identify which type of headache you have.


When does cervicogenic headache get serious? 


In some cases, CGH can be caused by some underlying condition such as tumor, fracture, hemorrhage or arteriovenous malformation (i.e. abnormal connection between arteries and veins) in the head and neck region.In such cases, some of the following symptoms may also be present-


. A change in the type of headache pain, i.e. severe headache which is intolerable

. Nausea and vomiting

. Confusion and disorientation

. Headache may be triggered by coughing and valsalva maneuver. 

. Neck stiffness and swelling

. Numbness in the arms 





CGH symptoms are always side-locked, i.e. occurs at only one side of the head or neck. 


  1. Dull, moderate or severe intensity pain: The pain in CGH is most commonly as dull and non-throbbing pain and it gets moderate to severe intensity in the head and neck region. 

  2. Reduced flexibility of neck: The pain starts at the back of the neck and head which may lead to some neck stiffness and reduced range of motion.

  3. Pain in multiple areas: The pain may extend from the back of the head to the following scalp, forehead, area around the eye, temple, and area surrounding the ear.

  4. Blurred vision in one eye: The affected eye may have blurring vision.

  5. Pain beneath the neck: Pain in the arm, shoulder or between the shoulder blades is also common.   


Causes of cervicogenic headache: 


The causes of cervicogenic headache are based on involvement of several anatomical structures in the upper cervical region that are sensitive to pain.



1. Facet joint: 

. There are two small facet joints at the back of each spinal level which allows restricted movement between adjacent vertebrae.

. The upper cervical facet joint C1-C3 are most commonly involved in CGH pain and lower cervical facet joint C4-C7 are less involved in CGH pain.

. The facet joints are more prone to injury due to weight bearing function they perform while supporting the head. 

. About 70% of cases are reported to occur due to traumatic injuries to the cervical facet joint.  


2. The atlanto-occipital joint: This joint connects the lower part of occipital bone with the first cervical vertebra called atlas. The spinal cord passes from the skull and down into the cervical spine.


3. Intervertebral disc: It acts as a shock absorber between vertebral bones, helps facilitate neck movements and space for nerves and joints to function.


4. Neck muscles: Overuse or misuse of neck muscles can result in muscle fatigue or weakness leading to CGH.


5. Cranial nerves: Compression and irritation of cervical spinal nerves can result in CGH.


6. Whiplash injury commonly associated with rear-end car accident.


7. Herniated disc in which outer layer(annulus fibrosus) tears and inner(nucleus pulposus) jelly-like material leaks inflammatory proteins.


8. Cancer and benign tumors in the cervical region may compress or pinch the cervical spinal nerve causing pain.


Risk factors of CGH: 


1. Occupational hazards: Hair stylists, carpenters, drivers and other occupations may be at higher risk for CGH due to their head posture while working.

2. Strenuous activities: CGH is the most common type of headache in weight-lifting sportsmen.

3. Forward head posture: Holding the head out in a  forward position while working on a computer on a continual basis and other activities may eventually lead to CGH.

4. Sex: Women are more prone to get CGH than men.




1. Patient history: 

The doctor asks some question when the current symptoms started, how you feel,

– Type and nature of pain

– Onset of pain characteristic and other symptoms

– Reduced flexibility of neck

– Evidence of trauma or injuries to the cervical region.


2. Physical examination:

– The doctor observes and palpates the neck checking for tenderness, swelling and other abnormalities. 


– The doctor may also perform examinations on the arms and hands to check any deficit in strength, sensation or reflex. 


3. Cervical flexion rotation test: 


– It is used to evaluate the severity of CGH

– As the name of the test suggests it involves the patient lying down and then bending the neck forward then rotating the head gently from left to right. 

– If pain or resistance is experienced then it indicates limited rotation of cervical spine. 





4. Diagnostic nerve block: 


Diagnostic nerve block injections are used to test the exact source of pain in the cervical spine.


5. Medical imaging: 


Diagnostic imaging such as x-ray,CT scan and MRI may support the diagnosis but are not only used to confirm the diagnosis of CGH. Cervical disc bulging can be seen in these images but may not always indicate the cause of CGH.


6. Differential diagnosis:


Pain triggered due to abnormal neckhead movement or application of external pressure over the cervical region.  


Treatment of cervicogenic headache: 


1. Manual therapy:


Manual therapy involves joint mobilisation, manipulation, massage and physical therapy  for CGH. Spinal manipulative therapy may relieve pain by relieving pressure in joints and improve nerve function. Before manual therapy it is necessary to rule out any medical condition or neck injuries in order to reduce the risk for serious complications.   


Transcutaneous electrical nerve stimulation(TENS): TENS electrotherapy involves the use of a device that produces low-voltage electrical current to stimulate nerves and treat pain. This device consists of small sticky electrode pads that are placed over the area of pain and electrical current is passed through the electrodes. This device stimulates the sensory nerves, creating a tingling sensation in the area, thereby reducing the feeling of pain. 


Instrument assisted soft tissue mobilization:  This technique involves an assessment into the deep layers of tissue in the cervical region to identify restrictions within tissues. This is done by using a handheld instrument and gently rubbing the affected area using massage technique. Restrictions in tissues may be formed due to development of fibrous muscle tissue, scar tissue, chronic inflammation or degeneration. Once the restrictions are identified then they are mobilized by gently stretching or pulling with the help of instruments that use traction force.



  1. Tricyclic antidepressant 

  2.  Anti-epileptic drug

  3.  Analgesics 

  4.  Muscle relaxants

  5.  Botulinum toxin 


Mind-body therapy: 


  1. Cognitive behavioral therapy: It teaches strategies for positive thinking and problem solving.

  2. Biofeedback: It aims to train the mind and body to become more aware of physiological responses that may be causing pain and how to manage them.


Therapeutic exercise: 


Neck pain resulting form muscle imbalance, forward head posture and rounded shoulders may be treated with therapeutic exercise. These exercise focus on strengthening and stretching the neck and its supporting muscles. 


1. Neck stretches 


2. Neck strengthening

Trigger point exercise for neck pain: 

A post isometric relaxation technique may be used to help relieve muscle tightness and trigger point pain in tense and shortened neck muscles. 

1. Foam roller

2. Racquetball



Nikita Sharma

Hope you have enjoyed reading this blog and gained good knowledge regarding the topic. Here, I am Nikita Sharma I am a student of physiotherapy and I love to write blogs related with Physiotherapy.

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