Understanding Neck-Related (Cervicogenic) Headaches: Causes, Symptoms, and Effective Treatments
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on September 4, 2024
Neck-related headaches, or cervicogenic headaches, originate from issues in the cervical spine or surrounding muscles and structures. These headaches are often characterized by pain that starts in the neck and spreads to the head, typically affecting one side. The pain can range from mild to severe and is frequently accompanied by stiffness or tenderness in the neck and shoulders.
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Cervicogenic headaches are quite common, affecting an estimated 15-20% of people with chronic headaches. They can significantly impact daily life and work, causing reduced productivity, impaired concentration, and diminished quality of life. Individuals may experience difficulty in performing routine tasks, leading to work absenteeism and increased healthcare utilization.
This article will provide an in-depth look at cervicogenic headaches, covering their definition, prevalence, impact on daily life and work, and a comprehensive overview of their management and treatment options.
Definition of neck-related (Cervicogenic) headaches
Cervicogenic headaches
Cervicogenic headaches are a type of headache that originates from the cervical spine or neck region. The term "cervicogenic" is derived from "cervical," referring to the neck, and "genic," meaning originating from. These headaches are thought to arise from dysfunction or irritation in the cervical spine or its surrounding structures, which can refer pain to the head.
Anatomical basis
The connection between the neck and head is complex. The cervical spine has numerous structures, including vertebrae, discs, ligaments, and muscles, which can interact with the trigeminal nerve system, responsible for facial sensation. Pain originating in the neck can be referred to the head due to this overlap in nerve pathways.
Differentiation from other headaches types
Cervicogenic headaches are distinct from other types of headaches such as migraines and tension headaches. Unlike migraines, which are often accompanied by nausea, sensitivity to light, and visual disturbances, cervicogenic headaches typically involve pain that starts in the neck and radiates to the head. They are different from tension headaches, which are generally bilateral and associated with muscle tension.
Common misconceptions
A common misconception is that cervicogenic headaches are merely tension headaches or migraines. However, while they share some symptoms, cervicogenic headaches have a specific origin in the cervical spine and are often associated with neck pain and stiffness. Additionally, some may believe that cervicogenic headaches are not as severe as migraines, but they can significantly impact daily functioning and quality of life.
Causes of cervicogenic headaches
Neck joint dysfunction or irritation. Dysfunction or irritation of the cervical joints can lead to cervicogenic headaches. This can result from conditions like cervical facet joint arthritis or inflammation, which can affect the surrounding nerve structures and refer pain to the head.
Muscle tension or trigger points. Tension in neck muscles or the presence of trigger points can contribute to cervicogenic headaches. These trigger points, or localized areas of muscle spasm, can cause referred pain to the head.
Poor posture. Poor posture, such as prolonged sitting with a forward head posture, can strain the cervical spine and muscles, leading to headaches. This strain can irritate neck structures and contribute to pain referred to the head.
Traumatic neck injuries. Injuries such as whiplash can disrupt the normal function of the cervical spine and its associated structures, leading to cervicogenic headaches. These injuries can cause inflammation and muscle spasm that contribute to headache symptoms.
Degenerative conditions. Degenerative changes, such as cervical osteoarthritis or disc herniation, can affect the cervical spine's structures and lead to cervicogenic headaches. These conditions often involve wear-and-tear changes that impact the spine's function.
Occupational factors. Certain occupational factors, such as jobs that require prolonged computer use or manual labor, can contribute to cervicogenic headaches. These activities can exacerbate poor posture and muscle tension, leading to headaches.
Signs and symptoms of cervicogenic headaches
Characteristic pain patterns
Cervicogenic headaches typically present as one-sided pain that originates in the neck and radiates to the head. The pain often starts in the cervical region and can spread to the forehead, eye, or temple.
Pain description
The pain associated with cervicogenic headaches is usually described as dull, aching, and persistent. It can occasionally be sharp, especially when triggered by specific neck movements or postures.
Associated neck symptoms
Common neck symptoms include stiffness, reduced range of motion, and tenderness in the neck muscles. These symptoms are often present alongside the headache.
Potential accompanying symptoms
In some cases, cervicogenic headaches may be accompanied by nausea, dizziness, or visual disturbances. These symptoms are less common but can occur if the headache is severe or if there is significant nerve involvement.
Triggers
Triggers for cervicogenic headaches can include poor posture, neck strain, or specific movements that aggravate the neck. Identifying and managing these triggers can help alleviate the headaches.
Differentiating features
Cervicogenic headaches differ from tension headaches and migraines in their pain pattern and associated symptoms. Unlike tension headaches, which are often bilateral and associated with muscle tension, cervicogenic headaches usually start in the neck and are often unilateral. They also differ from migraines, which can involve severe, throbbing pain and other systemic symptoms.
Diagnosis of cervicogenic headaches
Detailed medical history taking
The diagnosis of cervicogenic headaches begins with a comprehensive medical history. This includes asking about the onset, duration, and nature of the headaches, as well as any associated symptoms and possible triggers. A detailed history helps differentiate cervicogenic headaches from other types of headaches and identify potential contributing factors such as previous neck injuries or chronic neck pain.
Physical examination techniques
Range of motion tests. Range of motion tests assess the flexibility and movement of the cervical spine. Limited range of motion, especially when coupled with headache symptoms, can suggest a cervicogenic origin. Testing involves having the patient move their neck in various directions (e.g., flexion, extension, rotation) to evaluate pain and restriction.
Palpation of neck structures. Palpation involves gently pressing on specific neck muscles and joints to identify tenderness, muscle tightness, or abnormalities. This can help pinpoint areas of pain and discomfort that may be contributing to the headache.
Provocation tests. Provocation tests involve manipulating the neck or applying pressure to certain areas to see if these actions trigger or worsen the headache. Common tests include cervical spine mobility tests and assessments of cervical facet joints to identify pain responses indicative of cervicogenic headaches.
Imaging studies (X-rays, MRI). Imaging studies such as X-rays or MRI may be necessary if the physical examination suggests structural abnormalities or if there is a need to rule out other conditions. X-rays can reveal changes in cervical spine alignment or degenerative changes, while MRI provides detailed images of soft tissues, including discs and ligaments. However, imaging is generally used to confirm findings rather than for initial diagnosis.
Diagnostic nerve blocks. Diagnostic nerve blocks involve injecting an anesthetic into specific cervical nerves or joints. This procedure helps confirm whether the nerves or joints are the source of pain. Relief from headache symptoms following a nerve block can support the diagnosis of cervicogenic headache..
International classification criteria for cervicogenic headaches. The International Headache Society provides criteria for diagnosing cervicogenic headaches. These criteria include evidence of a cervical spine disorder and a specific pattern of headache symptoms, including pain that starts in the neck and radiates to the head, with no better explanation for the headache.
Prevention strategies for cervicogenic headaches
Posture improvement techniques
Proper sitting and standing postures. Maintaining correct posture is crucial in preventing cervicogenic headaches. Proper sitting involves keeping the back straight, shoulders relaxed, and the head aligned with the spine. Ergonomic adjustments, such as using a chair with adequate lumbar support and positioning the computer screen at eye level, can also help.
Ergonomic adjustments at work and home. Ergonomic adjustments at work and home include arranging workspaces to promote proper posture and reduce strain. This can involve using an adjustable desk, ensuring that work surfaces are at a comfortable height, and taking regular breaks to stretch and move.
Neck-strengthening exercises
Specific exercises to improve neck muscle strength and endurance. Engaging in neck-strengthening exercises can help support the cervical spine and reduce the risk of headaches. Exercises may include isometric neck exercises, chin tucks, and gentle stretching. These exercises enhance muscle strength and endurance, improving neck stability and reducing pain.
Stress management techniques
Relaxation exercises. Practicing relaxation exercises, such as deep breathing or progressive muscle relaxation, can help reduce stress, which is a known trigger for headaches. These techniques promote muscle relaxation and alleviate tension in the neck and shoulders.
Mindfulness and meditation practices. Mindfulness and meditation can reduce overall stress and improve mental well-being. These practices help individuals manage stress more effectively and may reduce the frequency and severity of cervicogenic headaches.
Lifestyle modifications to reduce headache frequency. Adopting a healthy lifestyle can contribute to reducing headache frequency. This includes regular physical activity, maintaining a balanced diet, staying hydrated, and ensuring adequate sleep. Making these changes can help mitigate factors that exacerbate cervicogenic headaches.
Conservative approaches
Rest and activity modification. Resting and modifying activities that exacerbate headaches can help alleviate symptoms. Avoiding activities that strain the neck and allowing time for recovery are fundamental in managing cervicogenic headaches.
Application of ice or heat. Applying ice can reduce inflammation and numb pain, while heat can help relax tense muscles and improve blood flow. Alternating between ice and heat can be effective in managing acute pain and muscle tension.
Gentle neck stretches and exercises. Performing gentle neck stretches and exercises can improve flexibility and reduce muscle tension. Exercises such as neck tilts and rotations, along with gentle stretching, can help alleviate headache symptoms and improve neck function
Medications
Over-the-counter pain relievers. Non-prescription pain relievers like ibuprofen or acetaminophen can help manage pain and reduce inflammation associated with cervicogenic headaches. These medications can be effective for mild to moderate symptoms.
Prescription medications (when necessary). For more severe cases, a healthcare provider may prescribe medications such as muscle relaxants, anti-inflammatory drugs, or even antidepressants. These medications can help manage pain and associated symptoms when over-the-counter options are insufficient.
Manual therapy techniques
Cervical mobilisation and manipulation. Manual therapy techniques such as cervical mobilisations can improve neck mobility and reduce pain. These techniques involve gently moving or adjusting the cervical spine to relieve pressure and restore normal function.
Soft tissue techniques. Soft tissue techniques, including massage and myofascial release, target the muscles and connective tissues around the neck. These methods can help reduce muscle tension and pain associated with cervicogenic headaches.
Nerve blocks and injections
Types of injections used. Nerve blocks and injections, such as occipital nerve blocks or cervical facet joint injections, can provide temporary relief from cervicogenic headaches. These procedures involve injecting anesthetic or steroid medication into specific areas to reduce pain.
When they’re considered and their effectiveness. Injections are typically considered when other treatments have not been effective. They can offer significant pain relief and are often used in conjunction with other therapies for more comprehensive management.
Lifestyle modifications
Dietary considerations. A balanced diet can help support overall health and reduce headache frequency. Staying hydrated and avoiding potential dietary triggers, such as excessive caffeine or alcohol, can be beneficial.
Sleep hygiene improvements. Improving sleep hygiene, such as maintaining a regular sleep schedule and ensuring a comfortable sleep environment, can help reduce headache frequency and improve overall well-being.
Stress reduction strategies. Incorporating stress reduction techniques, such as relaxation exercises and mindfulness, can help manage stress-related triggers for cervicogenic headaches. These strategies promote relaxation and reduce muscle tension.
Physiotherapy's effectiveness for cervicogenic headaches
Overview of physiotherapy approach
Physiotherapy is a key component in managing cervicogenic headaches. It involves a range of treatments aimed at improving neck function, reducing pain, and preventing recurrence. Physiotherapists use a combination of manual therapy, exercises, and education to address the underlying causes of cervicogenic headaches.
Benefits of physiotherapy
Pain reduction. Physiotherapy can significantly reduce pain through techniques such as manual therapy and therapeutic exercises. By addressing muscle tension and joint dysfunction, physiotherapy helps alleviate headache symptoms.
Improved neck function. Physiotherapy improves neck function by enhancing mobility, strength, and endurance. This helps reduce the frequency and severity of headaches and supports overall neck health.
Long-term management strategies. Physiotherapy provides strategies for long-term management, including posture correction, ergonomic adjustments, and exercises to maintain neck health and prevent future headaches.
Specific techniques used
Manual therapy (joint mobilisation, soft tissue work). Manual therapy techniques such as joint mobilisation and soft tissue work are used to address musculoskeletal issues in the neck. These techniques help relieve pain and improve neck mobility.
Therapeutic exercises and stretches. Therapeutic exercises and stretches focus on strengthening neck muscles and improving flexibility. These exercises are tailored to each individual’s needs and contribute to overall neck health.
Postural retraining. Postural retraining involves teaching individuals how to maintain proper posture to reduce strain on the neck. This includes guidance on ergonomics and techniques to prevent poor posture habits.
Pain modulation techniques (e.g., TENS). Transcutaneous electrical nerve stimulation (TENS) and other pain modulation techniques can help manage pain by altering pain signals and providing relief.
Expected outcomes and recovery timeline. Patients typically experience significant improvements within a few weeks of starting physiotherapy. Recovery timelines vary based on individual factors, but consistent treatment often leads to sustained relief and improved neck function.
Research supporting physiotherapy for cervicogenic headaches. Studies have shown that physiotherapy is effective in managing cervicogenic headaches. Research indicates that manual therapy, exercise, and education lead to reduced pain and improved function. For example, a study by Martelletti & van Suijlekom (2004) demonstrated that physiotherapy significantly reduced headache frequency and severity in patients with cervicogenic headaches.
Red flags and warning signs
Severe or sudden onset headaches. Headaches that occur suddenly and are extremely severe could indicate a serious condition, such as a migraine, intracranial hemorrhage, or other emergencies. Immediate medical evaluation is necessary to rule out life-threatening issues.
Headaches accompanied by fever, vision changes, or neurological symptoms. If headaches are accompanied by symptoms such as fever, vision changes, or neurological signs (e.g., weakness, numbness, difficulty speaking), this may indicate underlying systemic or neurological conditions. Prompt medical attention is crucial.
Headaches following head or neck trauma. Headaches that follow head or neck trauma, such as a car accident or a fall, may be indicative of a more serious injury, including concussion or cervical spine injury. Seeking medical help is important to assess and manage potential complications.
Importance of proper diagnosis and treatment
Proper diagnosis is essential for effective treatment. Identifying the exact cause of headaches ensures that the most appropriate and targeted treatment strategies are employed. Misdiagnosis or delayed treatment can lead to worsening symptoms and prolonged suffering.
How to choose the right healthcare provider
When seeking treatment, choose a healthcare provider with experience in managing cervicogenic headaches. Look for providers who specialize in headache disorders or musculoskeletal issues. For physiotherapy, ensure the physiotherapist is licensed and has experience in treating cervicogenic headaches.
What to expect during your first physiotherapy visit
During your first physiotherapy visit, the physiotherapist will conduct a thorough assessment, including a review of your medical history and a physical examination. They will evaluate your neck function, posture, and pain patterns. Based on this assessment, they will develop a personalized treatment plan that may include manual therapy, exercises, and education on posture and ergonomics.
Conclusion
Recap key points about cervicogenic headaches
Cervicogenic headaches originate from neck structures and can significantly impact daily life and work. They are often characterized by pain that starts in the neck and radiates to the head. Effective management involves a combination of conservative treatments, medications, manual therapy, and lifestyle modifications.
Emphasise the importance of proper diagnosis and targeted treatment
Proper diagnosis and targeted treatment are crucial for effectively managing cervicogenic headaches. Early and accurate diagnosis helps ensure that the treatment plan addresses the underlying causes and provides relief. Proactive management, including adopting preventive strategies such as improving posture, engaging in regular exercise, and managing stress, can help reduce the frequency and severity of cervicogenic headaches. Incorporating these strategies into daily life can lead to long-term benefits.
Physiotherapy plays a key role in managing cervicogenic headaches by addressing neck dysfunction, improving posture, and providing pain relief through various techniques. A tailored physiotherapy approach can lead to significant improvements in symptoms and overall neck health. If you are experiencing symptoms of cervicogenic headaches, consulting a physiotherapist can provide you with a comprehensive evaluation and a personalized treatment plan. Take proactive steps to address your symptoms and improve your quality of life by seeking professional help.
References:
Haldeman, S., & Dagenais, S. (2001). Cervicogenic headaches: a critical review. The spine journal, 1(1), 31-46.16
Biondi, D. M. (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. Journal of Osteopathic Medicine, 105(s4), 16-22.
Bogduk, N., & Govind, J. (2009). Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. The Lancet Neurology, 8(10), 959-968.
Martelletti, P., & van Suijlekom, H. (2004). Cervicogenic headache: practical approaches to therapy. CNS drugs, 18, 793-805.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.