Friday, March 17, 2023

How To Treat Cervicogenic Headache

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Dont Try Neck Exercises Without An Experts Help

How to treat cervicogenic HEADACHES

If you strained your neck, its tempting to try and do some stretching or exercises yourself. But DIY treatment may not be helpful and could make it worse.

The neck is very complex, Dr. Estemalik says. Thats why physical therapy is key to treating this type of headache. Your physical therapist can identify which muscles are involved. They can guide you through exercises to strengthen the core muscles that need it. They also help you avoid overusing certain muscles that could cause more pain.

Without expert guidance, you could further strain your neck or work on the wrong areas.

How Cervicogenic Headache Differs From Migraine

Because the symptoms are similar, it can be tricky to determine the cause of chronic headaches. It’s even possible for one person to have more than one headache disorder.

Ashina, S., Bendtsen, L, Lyngbert, AC, et al. Prevalence of neck pain in migraine and tension-type headache: A population study. Cephalgia, May 22, 2014, Volume: 35 issue: 3, page: 211-219.

The main difference between Migraine and CGH is that CGH is attributed to nerve, bone, and muscle disorders within the neck.

Those with CGH often experience a reduced range of motion in the neck and are less likely to report symptoms of nausea, vomiting, and sensitivity to light and sound when compared to those with Migraine. Additionally, those with CGH do not respond to treatment with triptans, ergotamine, or indomethacin.

Chiropractic Treatment For Cervicogenic Headaches

Chiropractic care is generally considered a safe and effective therapy for cervicogenic headaches. There is even evidence to suggest that chiropractic adjustments are more effective for treating this kind of headache than standard medical care. At least one study has shown that patients who receive chiropractic care for their cervicogenic headaches saw their pain and disability lessen to a greater degree than others who received standard care. The pain relief from chiropractic care also appears to last for longer than that from standard care. Researchers found that patients who received the therapy were still reporting that they had fewer cervicogenic headaches and that their headaches were shorter and less intense months after they were treated. The patients in the study who received chiropractic care also reported a higher level of satisfaction with their course of treatment compared to those who got the standard medical care.

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Enhancing Healthcare Team Outcomes

The management of cervicogenic headache is an interprofessional. There are several types of treatments and healthcare workers including nurse practitioners need to be aware of them. Physical therapy is considered the first line of treatment. Manipulative therapy and therapeutic exercise regimen are effective in treating a cervicogenic headache. Another option for treatment of a cervicogenic headache is interventional treatment, which will differ depending on the cause of a headache. There is some evidence that cervical epidural steroid injection has some benefits in treating pain in a cervicogenic headache. Steroids can work in this setting due to the theory that the pain continues sensitizing the cervical nerve roots and initiates a pain-producing loop involving nerve root and microvascular inflammation as well as mechanically-induced micro-injury. Unfortunately, cervicogenic headaches tend to recur and can significantly affect the quality of life. Thus, some patients may also benefit from simultaneous cognitive behavior therapy.

What Level Of Experience Do The Surgeons Have In Performing Nerve Decompression Surgery

Cervicogenic Headache

Dr. Matthew Kaufman of The Institute for Advanced Reconstruction is a Peripheral Nerve Surgeon who is double board-certified in Plastic & Reconstructive Surgery and Otolaryngology-Head & Neck Surgery. He has a tremendous amount of experience and success in performing nerve decompression surgery for cervicogenic headache and other types of headache conditions. He has been performing nerve decompression surgery for headaches since 2007.

Our team of surgical specialists and staff welcomes your inquiry regarding treatment options for cervicogenic headache or other debilitating headache conditions.

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Summary Of Management Techniques For Cervicogenic Headaches

Weve talked about quite a bit here!

Lets summarize the key points for properly managing a cervicogenic headache:

  • Consult with your medical doctor for an official diagnosis
  • If pain is severe enough, you may require a nerve block
  • Physical therapy for a full musculoskeletal evaluation and treatment plan. This will include a postural assessment, ergonomic assessment, provision of exercises, and manual therapy.
  • Pillow and mattress support at home

If youre experiencing recurrent and/or severe headaches and believe you may have a cervicogenic headache, reach out to your doctor right away. Remember, if you notice any red flag symptoms that were listed above, contact 911 immediately.

Help is available to get your pain under control!

Seek Professional Care For Cervicogenic Headaches

People suspected of having cervicogenic headache should be carefully assessed by their doctor to exclude other primary or secondary causes of headaches.

Nerve blocks are used both for diagnostic and treatment purposes. If numbing the cervical structures abolishes the headache, that can confirm the diagnosis of cervicogenic headache and also provide relief from the pain.

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Cervicogenic Headaches A Pain In The Neck

If you stick your neck out for someone, the saying suggests, then youve taken some risk.

In this technology-driven age, were literally sticking our necks out at the risk of causing very real headache pain. An article in Mens Journal used the term the desk workers malady, while a BBC story called it text neck.

The problem is that were craning our heads forward over our screens, according to the BBC, and its creating intense pressure on the front and backs of our necks.

That pressure can cause pain that manifests as a headache. This pain actually isnt in the head but rather is referred from the neck.

The technical term for this is cervicogenic headache, or CGH, which by one estimate accounts for 15 to 20 percent of all headache disorders. The Journal of Manual and Manipulative Therapy noted:

Although the prevalence of CGH is considerably lower than tension-type headache and migraine, patients with CGH have a substantial quality-of-life burden, comparable to patients with migraine and tension-type headache.

The first part of cervicogenic refers to the cervical spine, comprising seven bones more commonly known as the neck genic means that the headache is generated in this area, particularly the upper three bones. In other words, what feels like a dull, achy pain in the head really has its roots in the neck.

Common causes of CGH can be chronic: poor posture, as noted above, or arthritis.

Research Abstract Managing Cervicogenic Headaches With Conservative Treatment

Cervicogenic Headache Treatment (Just Do THIS!!)


Cervicogenic headaches are chronic or recurring in nature and have been found to arise from musculoskeletal dysfunction of the cervical spine . The lifetime prevalence of headaches in adults may be as high as 20 to 30 percent.

Conservative treatment, such as physical therapy, often is recommended as a first line of headache management. Treatment may include manual therapy, exercise or a multimodal approach.

The purpose of this study was to assess the short- and long-term effectiveness of manual therapy and a low-load exercise program, used alone or in combination and compared with a control group that received no treatment.


Participants ranging in age from 18 to 60 were included in the study if they experienced a headache that was unilateral or unilateral dominant and associated with neck pain. These symptoms needed to be aggravated by neck postures or movements and present for at least one week over a period of two months to 10 years.

The subjects were randomly assigned to one of four groups: a control group that received no treatment a group that received manual manipulative therapy a group that received therapeutic exercise using low-load endurance exercises to the cervicoscapular region and a group that received both manual therapy and therapeutic exercise.



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Cervicogenic Headache Vs Migraine

A cervicogenic headache is a headache caused by nerve irritation in the spine of the neck . A cervicogenic headache is often confused with a migraine as pain from a migraine may radiate down into the neck. However, the key difference is that a cervicogenic headache is caused by an issue in the cervical region of the spine, whereas a migraine can be caused by a number of other issues.

How To Prevent Or Manage The Pain

A successful diagnosis pinpoints possible causes of headaches. For instance, the doctor can tell whether a bad posture while working is straining the neck muscles and advise better sitting and sleeping postures. Through the imaging tests, nerve and muscle degeneration may be detected and the appropriate cause of action recommended. These may include relaxation techniques such as meditation, exercise, and yoga. Relaxation increases blood flow to the muscles and nerves, which escalates the healing process.

Cold and hot treatments on the specific pain areas may help manage the pain and promote blood flow. Wrap ice cubes with a towel, then place on the neck as you gently massage the area for 20 minutes, then replace with a hot wrap for another 20 minutes. Repeat the process several times daily. Professional massage may also help, especially after a long day at work. When the pain results from degeneration of neck and spinal cord muscles, apart from taking pain medication, exercise, and a healthy lifestyle may help stop or slow down the process. Also, drink more water, eat more fruits and vegetables, and avoid unhealthy habits such as smoking and excessive alcohol consumption. Excessive alcohol consumption numbs or destroys spinal nerves which speed up the degeneration process. Osteoarthritis and muscle degeneration may not be preventable, but the pain is manageable through physical therapy and pain medication.

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The Basics Of Cervicogenic Headaches

Cervicogenic headache is referred pain perceived in the head from a source in the neck. Cervicogenic headache is a secondary headache, which means that it is caused by another illness or physical issue. In the case of cervicogenic headache, the cause is a disorder of the cervical spine and its component bone, disc, and/or soft tissue elements. Numerous pain-sensitive structures exist in the cervical and occipital regions. The junction of the skull and cervical vertebrae have regions that are pain generating, including the lining of the cervical spine, the joints, ligaments, cervical nerve roots, and vertebral arteries passing through the cervical vertebral bodies.

Cutting Edge/emerging And Unique Concepts And Practice

Cervicogenic Headache

In order to identify true cases of cervicogenic headache, diagnostic blocks should be performed. The anatomical areas that are often blocked using local anesthetic include:

  • The atlanto-axial joint
  • 3rd occipital nerve at the zygapophyseal joint joint of C2-C3
  • Medial branch block of the C3 and C4 dorsal rami.13,22,23
  • The C2 dorsal root ganglion may be blocked in isolation24

If diagnostic blocks are effective, long term options such as a radiofrequency ablation can be attempted, including at the level of C2. 24-27

Greater occipital nerve blocks or pulsed ablations may be a poor treatment for headaches that are truly cervicogenic in origin due to the distal innervation to occipital regions and the scalp makes that will not modulate the true etiology of pain. The ICHD-3 criteria separate cervicogenic headache from occipital neuralgia11. Other new techniques involve using biological agents such as infliximab, a monoclonal anti-body against TNF-. This has been shown to lower cervicogenic pain scores as well as decrease analgesic use28. A longer observation period and more trials need to be done to extrapolate these data to non-inflammatory cervicogenic headache.

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What Is A Cervicogenic Headache

A cervicogenic headache can be a very debilitating condition for many people. The pain associated with a cervicogenic headache usually starts in the neck or base of the skull and radiates to the side of the head, forehead, behind the eye, and sometimes even into the shoulder blade and arm. Have you ever experienced these symptoms? The good news is, its preventable!

How Are Cervicogenic Headaches Treated

It is important to try to determine exactly which structures in the neck are causing the headaches. Once this has been done, an appropriate treatment may be prescribed.

Initially, cervicogenic headaches are treated with pain medications and physiotherapy. Avoidance of aggravating activities is important.

Constant cervicogenic headaches arising from the facet joints may respond to percutaneous radiofrequency denervation . A facet joint block with local anaesthetic is usually performed first to confirm the diagnosis.

C2 radiofrequency pulse ganglionotomy is another technique which may benefit some patients, particularly if C2 nerve root compression is thought to be involved in the production of the headaches.

Cervicogenic headaches secondary to cervical disc prolapse or nerve root compression often improve with microsurgical discectomy and fusion.

Peripheral nerve stimulation of the greater and lesser occipital nerves is an effective technique in patients with cervicogenic headaches . It appears that around 70% of patients who are resistant to other conventional therapies may benefit from this fairly low-risk surgical technique.

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How Can I Tell If I Have Cervicogenic Headache How Is This Different Than A Migraine Headache

A cervicogenic headache usually has the following qualities:

  • One sided symptoms that dont shift from side to side
  • Symptoms are brought on by neck motion, awkward neck positions or posture, or from pressure on the back of the head
  • Movement of the arm and shoulder on the same side may cause a headache
  • There may be a loss of range of motion of the neck
  • Pain is usually moderate , usually non-throbbing
  • Pain will usually start in the neck and go up
  • into the head and around the ear
  • Cervicogenic headache affects men and women equally and is often triggered by a trauma to the head or neck

Migraine usually has the following qualities:

Women are 3 times more likely to suffer from migraine

Usually symptoms are on one side, but can shift to the other side

Pain is described as throbbing or pulsating with moderate to severe quality

Pain is usually located around the eye, face, forehead, and sometimes the top or side of the head, but not associated with neck pain

Associated symptoms of light, sound, or movement sensitivity visual changes and nausea or vomiting often accompany migraines

Dont Let Cgh Keep You Sidelined

What can help a Cervicogenic headache?

The fact that cervicogenic headaches can be painful and cause a great deal of discomfort, people dont have to feel helpless in thinking nothing can be done. Once diagnosed, sufferers of CGH can get the help they need from a licensed physiotherapist who has the knowledge and expertise in devising a method of treatment that is unique for your recovery.

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What To Do For Your Cervicogenic Headache

The neck can be a difficult area to self-treat. I often encourage people to seek out the help of a medical professional with neck injuries because of how complicated diagnosis can be. With that said, there are some basic stretches you can do to help prevent and get rid of cervicogenic headaches. The stretch shown below is meant to target your suboccipital muscles. Be sure to follow it up with some self massage techniques. I suggest lying with the base of your skull on a foam roller, tucking your chin, and gently rotating side to side.

Now, keep in mind that headaches can be an emergency. There are so many different types of headaches and cervicogenic headaches can be very similar to some of the other types. I always encourage people to seek medical opinion when dealing with headaches or neck pain because there are so many sensitive structures in that area. If you have any questions, please feel free to reach out to me.

As always, please share this post if you found it interesting!

Treatment Options For Cervicogenic Headaches

At Nura, we treat chronic whiplash pain with medications, physical therapy, nerve blocks and sometimes nerve ablation procedures.

The first interventional procedure may be a simple cervical epidural steroid injection if we believe an injury to an intervertebral disc is contributing to pain.

If epidural steroid is not helpful, we may target cervical facet joints with steroid injections, or we may recommend a diagnostic procedure called medial branch block. The medial branch nerves provide sensory innervation to the facet joints and can be easily blocked for diagnostic purpose.

If medial branch blocks relieve pain for the duration of the injected local anesthetic, this identifies the facet joint as a pain generator. The interventional pain specialist can then target the painful facet joint with a nerve ablation procedure called radiofrequency ablation , which may provide a year of more of pain relief.

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Epidemiology Including Risk Factors And Primary Prevention

Prevalence is estimated to be up to 4.1% in the general population, and as high as 17.5% among patients with severe headaches. The prevalence is as high as 53% in patients with headache after whiplash. In a study of patients with other cervical spine disorders requiring surgery, a 21.4% prevalence was noted4. The mean age of patients has been documented as 42.9 years it is four times more prevalent in women. 2,3

Primary And Secondary Headaches

Cervicogenic Headache

A primary headache has no known underlying cause, such as migraines, cluster headaches, and tension headaches. Secondary headache results from another condition leading to pain, which may be due to infection, vascular disease, or trauma.

Having only occipital neuralgia is rare, and the condition is often discovered whenseeking medical help for migraines. Occipital nerve pain may be diagnosed with migraines involving the occipital nerve.

Causes of occipital neuralgia include:

  • Pinched nerve in the neck
  • Prior surgery to the scalp or skull
  • Tight muscles that entrap the nerve
  • Infection or diseases such as gout or diabetes

Occipital neuralgia is diagnosed with a physical exam, imaging studies such as magnetic resonance imaging , X-ray, or CT scan, and an occipital nerve block.

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What Is Cervicogenic Headache Look For These Symptoms

Headache is one of the most commonly experienced heath issues that bother a lot of people on a daily basis. It can be triggered by many factors including lack of sleep, fatigue, hunger, and weather changes among others. However, if you are witnessing recurrent headache that arise from the neck, then there can be other factors behind it.

Cervicogenic headache is the type of headache whose source lies in the neck and which causes pain up to the head. Such headaches are usually steady and result in a dully feeling for a person. Sometimes the headache can get severe where intensity of the pain increases.

Cervicogenic headache initially emerges as an intermittent pain but can later progress to result in continuous pain.

Symptoms of cervicogenic headache

The symptoms of cervicogenic headache can be a lot like migraine which makes it difficult to distinguish between the two. Here, the main difference is that while migraine pain is rooted in the brain, the source of cervicogenic headache pain lies in the neck or cervical spine or the base of the skull region.

Below are some of the symptoms that a person having cervicogenic headache can witness.



Cervicogenic headaches can be treated through various ways that include medication and physical therapy. In some cases, surgery or injection can also be used to treat the problem.

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