Cervicogenic headache (CH) refers, perhaps unsurprisingly, to headaches stemming from some cervical cause. While the diagnosis may sound straightforward, it is actually a surprisingly challenging subject even for experienced professionals. Diagnosis can be difficult due to the condition's relative rarity and its association with many other fairly common symptoms, such as neck pain. However, distinguishing CH from other headache types is crucial, as approximately 10-20% of chronic headaches are believed to be cervicogenic in origin. Cervicogenic headaches are typically diagnosed in a clinical setting, with further investigations rarely required. Occasionally, nerve blocks may be attempted, which in some cases confirm the pain source originating from cervical structures and may also serve as a treatment. However, nerve blocks are typically reserved for the most severe and persistent cases. Generally, the condition is managed conservatively, focusing on rehabilitation. Diagnosis is based on criteria established by the International Headache Society (IHS) and the Cervicogenic Headache International Study Group (CHISG) (1,2,3)
Symptoms
At present, it is believed that the condition arises from some cervical origin. This means that some anatomical structure, such as muscles in the neck area (usually structures innervated by C1-C3 spinal nerves), when irritated, causes headache as if radiating pain. However, the exact cause is not known. (1,2,3) Below are the typical symptoms of cervicogenic headache:
Pain is only on one side of the head
Pain begins or is provoked by movement of the neck or in a specific neck position
Range of motion in the neck is often limited
Shoulder and arm on the same side may also be painful
Pain is provoked when structures in the neck (e.g., muscle mass) are palpated by hand
Neck pain
Treatment
Treatment of cervicogenic headache typically begins with rehabilitative exercises, such as strength training, which may be supplemented with manual therapy, such as massage. The combination therapy mentioned above appears to be effective for many in managing pain. However, currently in the field of science, there is no specific exercise regimen that is superior to another, which is why rehabilitation must be individualized for each client.
In more severe cases, radiofrequency therapy may also be attempted, although there is not compelling evidence for its efficacy and it carries its own risks. Some patients experience good results from so-called nerve blocks, where a specific nerve or nerves are numbed by a physician. In some cases, cervicogenic headache may be associated with myelopathy (narrowing of the cervical spine canal) or radiculopathy, such as a herniated disc. In such cases, surgical treatment may be the outcome, which seems to provide relief for headache symptoms in many cases as well. (1,2,3,4,5)
What kind of exercises can I do for my neck and how much?
The training volume is always determined by the individual's starting level. However, here are some tips on what to aim for during the first month. If you have never trained your neck before, it is advisable to start with lower volumes to avoid excessive strain on the neck. You can find neck exercises on Flexus' Instagram, you can view them here.
Weeks 1-2
Exercises 2-3 times per week, with at least one rest day between sessions, rest periods between sets 1.5-2 minutes
Lateral raises with dumbbells or resistance bands, 3 sets of 10 reps
Neck flexion in side lying position, 3 sets of 10 reps
Neck extension in supine position, 3 sets of 10 reps
Weeks 2-4 (load can be increased, for example with added weights)
Lateral raises with dumbbells or resistance bands, 4 sets of 7 reps
Neck flexion in side lying position, 4 sets of 7 reps
Neck extension in supine position, 4 sets of 7 reps"
Can headache be caused by the neck?
Yes, it can, although it is much rarer than tension-type headache.
How do you know if the headache is cervicogenic?
Can cervicogenic headache be treated?
Do you need help? At Flexus, we handle musculoskeletal disorders with years of experience, care, and compassion. It is especially important to us that our clients feel seen and that they get value for their money. We make your everyday life easier. Book your appointment with us here.
Joonas Virtanen
Osteopath, sports massage therapist & physique coach
Ilari Keckman
Osteopath, sports massage therapist & educator
References
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