Health Corner

What are the symptoms of cervicogenic headache?
Cervicogenic headaches typically present as unilateral or sometimes bilateral pain, often more pronounced on one side. The pain is usually described as tension-like, pressure, or dull ache, and is accompanied by neck pain and stiffness. The pain often starts at the suboccipital area (base of the skull) and radiates to the temporal (above the ear), frontal (forehead), or periorbital (around the eyes) regions, and sometimes may extend to the same side’s arm. The symptoms often worsen with neck rotation, tilting, or maintaining the same posture for prolonged periods.

Unlike migraines, the pain is usually not pulsating and usually lacks nausea, vomiting, photophobia, phonophobia, or visual aura.

What causes the symptoms?
The nerves from the upper cervical spine segments (C1 to C3) converge with sensory nerves from areas around the back of the head, temples, forehead, eye sockets, and temporomandibular joint in the trigeminal spinal nucleus before entering the brain. If joints, discs, muscles, fasciae, or other soft tissues around the upper cervical spine cause irritation or pain, the brain can misinterpret this as pain originating from the head or face regions—similar to how heart pain may radiate to the chest, arm, neck, or jaw due to nerve convergence.

How is cervicogenic headache diagnosed?
Diagnosis includes evaluating headache characteristics, onset, and medical history along with clinical assessments:

• Posture assessment: Looking for forward head posture or rounded shoulders (see Upper Crossed Syndrome).

• Neck movement assessment: Reduced rotation on one side is common, as the C1 and C2 vertebrae account for over half of neck rotation.

• Muscle and soft tissue examination: Tightness or tenderness in suboccipital or paraspinal muscles, with trigger points referring pain to the head or arm.

• Cervical joint examination: Assessment of facet joint mobility and restrictions, treated with mobilization or manipulation to restore normal movement.

• Muscle strength testing: Weak deep neck flexors and back muscles worsen posture and increase joint and muscle strain.

• Imaging: X-rays, CT, or MRI may be necessary to exclude other conditions.

How is cervicogenic headache treated?

• Physical therapy modalities: Includes transcutaneous electrical nerve stimulation (TENS), cryotherapy to reduce inflammation and swelling, low-level laser therapy to relieve pain and enhance circulation, ultrasound therapy to relax tissues and reduce inflammation.

• Manual therapy: Mobilization or manipulation to free restricted joints and relax tight muscles.

• Soft tissue release: To loosen adhered fascia and muscles and relieve trigger points.

• Rehabilitation exercises:

  • Stretching tight, shortened muscles.

  • Strengthening muscle coordination, control, strength, and endurance.

  • Posture correction to improve awareness and reduce poor postural habits.

When to seek immediate medical attention?
Sudden severe headaches, worsening headaches over time, associated fever, neck stiffness, skin rash, head trauma, or visual changes require urgent medical evaluation.

Hong Kong Registered Physiotherapist
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