What Every Physiotherapist Must Know About Cervicogenic Headaches by Bahram Jam
This 2016 systematic review included 10 RCTs and basically concluded that mobilizations or manipulations of the cervical spine may be beneficial for those who suffer from cervical headaches.
“The single most important factor which determines the potential effectiveness of Physical Therapy treatment for headaches, is accurately diagnosing if the patient actually suffers from cervical headaches….because we cannot treat headaches related to MSG, monthly cycle, meningitis, high blood pressure, migraine, tension, etc. ” B. Jam
It has been shown that cervical headaches can be differentiated from migraine or tension headaches with 100% sensitivity, if 7 criteria are present. The top 3 important/sensitive signs for cervical headaches include:
- Unilateral headache with side consistency: e.g. If a patient reports one day my headache is on the right side and the next day it is on the left, headaches are less likely of cervical origin. (A patient with a sore right knee due to OA or MCL sprain will not suddenly have their pain switch into the left knee!)
- Headaches precipitated and aggravated by certain neck postures e.g. Prolong reading, looking down, keyboarding, turning to look behind, looking up to the top shelf of a cupboard, etc.
Restricted range of motion in the neck:e.g. C0-C1 and/or C1-C2 and/or C2-3 are commonly involved with cervical headaches, hence rotation is the most obvious movement that is restricted and may be painful.
Here is a 2010 study that every PT who manages individuals with cervicogenic headache must know.
180 women with chronic cervical pain and cervical headaches were randomly assigned to 3 groups.
- Group 1 (Strength Training Group): Prescribed isometric, dynamic and stretching neck exercises
- Group 2 (Endurance Training Group): Prescribed dynamic muscle and stretching neck exercises
- Group 3 (Control Group): Prescribed neck stretching exercises only
After 1 year…
- Group 1 (Strength Training Group): Headache decreased by 69%
- Group 2 (Endurance Training Group): Headache decreased by 58%
- Group 3 (Control Group): Headache decreased by 37%
Study Conclusion: After 1 year of exercising, combined stretching with muscle endurance or strength training was significantly more valuable than stretching alone.
Personal Comment: If I suffered from cervical headaches, I would immediately start a deep cervical flexor training protocol, progress to superficial cervical training and progress to scapular and upper limb strengthening. Sadly the pharmaceutical approach to temporarily helping headaches is far more advertised and far more popular approach.
To view a sample Cervical Training 6-week protocol, join my online course 'Cervical Headaches.'
- Garcia JD et al Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. 2016 Mar 21;7:40.
- Vincent MB, Luna RA 1999 cerviogenic headache: a comparison with migraine and tension type headache. Cephalgia 19 (25);11-16
- Ylinen J, Nikander R, Nyknen M, Kautiainen H, Hkkinen A. Effect of neck exercises on cervicogenic headache: a randomized controlled trial. J Rehabil Med. 2010 Apr;42(4):344-9.
Dr Bahram Jam, MPhty, BScPT, Cred. MDT, FCAM
He is a physiotherapist and founder of the Advanced Physical Therapy Education Institute (APTEI). He's taught 1000+ continuing education courses to healthcare professionals across Canada & internationally.
He has instructed over one thousand post-graduate orthopaedic and pain science courses and has been a guest presenter at several physiotherapy and medical conferences across Canada and internationally.
His primary clinical approach is to identify relevant functional impairments and determine the best self-management strategy to maximize patient independence.