Cervicogenic Headaches

What is a Cervicogenic headache?
A cervicogenic headache is a chronic headache that is characterised by pain that develops in the neck, although a person feels the pain in one or more regions of the head and face. Cervicogenic headaches are secondary headaches, which means they are caused by an underlying condition, such as neck injuries, infections, or severe high blood pressure.

What causes Cervicogenic Headaches?
Cervicogenic headaches are thought to be referred pain arising from irritation caused by cervical (neck) structures supplied by spinal nerves C1, C2, and C3. Therefore, any structure supplied by the C1–C3 spinal nerves could be the source for a cervicogenic headache. This could include the joints, disc, ligaments, and surrounding musculature.
It is believed that the facet joints (see my blog on facet capsular irritation), especially those of C2/C3, are the most common sources of cervicogenic headache pain, which would correlate in patients with a history of whiplash.
Other incidents of neck trauma, strain, or chronic spasm of the scalp, neck, or shoulder muscles can also increase the sensitivity of the area so you feel pain from stimuli that doesn’t normally cause pain. This is known as allodynia.

Clinical Presentation/characteristics
The main symptoms of a cervicogenic headache are a combination of pain localised in the neck and occiput (base of the skull), which can spread to other areas in the head, such as forehead, orbital region, temples, vertex, or ears, usually unilateral (one-sided).
Range of movement in the neck is reduced, and pain is relieved with anaesthetic blockades.
Pain is exacerbated by neck movement or sustained posture.
Compared to migraine headache, cervicogenic headache patients tend to have increased tightness and trigger points in upper trapezius, levator scapulae, scalenes and suboccipital muscles.

Potential findings of examination
When compared with other headache patients, these patients have an abnormal muscle tenderness on the painful side.
It affects males and females equally and onset tends to be in the early 30s.
There is weakness in the deep neck flexors, and the sternocleidomastoid, scalenes, levator scapulae, pectoralis major and minor, and short sub-occipital extensors are implicated.
Tenderness of the upper 3 cervical spine joints.

Prevention and treatment for Cervicogenic headaches?
Manipulative therapy and therapeutic exercise regimen are effective in treating a cervicogenic headache. Compression, stretching, or transverse friction massage as well as pressure release over the sternocleidomastoid muscle trigger point.
Re-education of Posture - Strengthening exercises including deep neck flexors and upper trapezius muscles, improving mobility and stability of cervical spine (neck).