Cervicogenic headache(CGH)
What You Need to Know About Cervicogenic Headache
The cervicogenic headache is a secondary headache and is usually a musculoskeletal dysfunction-first three cervical segments of the spine are most often involved. The pain usually starts at the base of the skull or at the back of the head and goes towards the anterior side, sometimes even reaching up to the forehead. Many patients describe pain traveling from the neck to one or more areas of the face or scalp.
Cervicogenic Headache vs Migraine: How to Differentiate?
One of the major diagnostic difficulties in headaches is to decide whether it is cervicogenic headache or not, more so with neck migraine. In fact, studies have shown that this cannot be decided properly in over half of the cases (Hall, 2007). Both CGH and migraines do cause neck pain and headache and that makes them very easy to confuse.
A headache accompanied by visual auras is a classic migraine condition. Such auras consist of visual disturbances like flickering lights, spots, or zigzag lines, which may be accompanied by neurological signs such as numbness or pins and needles. Usually, such signs and symptoms are fleeting and reversible, going on for less than an hour (Kirchman, 2006). On the other hand, CGH is a headache without an aura and is usually associated with physical neck dysfunction.
How Physiotherapy Helps in Managing Cervicogenic Headache
In managing cervicogenic headache, physiotherapy is one of the best methods. The physiotherapist will undertake a careful assessment investigating whether your symptoms correspond with CGH, including an examination of restricted movements, muscular imbalances, and dysfunctions of the upper cervical joints.
Manual Therapy
Manual therapies like joint mobilizations and massage are highly effective for pain relief. Mobilizing the cervical spine will reduce pressure on the joints and may reduce nerve irritation. These techniques are much more powerful if combined with postural correction exercises so that the neck and upper back muscles learn how to maintain proper alignment.
Exercises
A personalized set of exercises will be introduced for restoring normal movement and posture. General exercises include:
- Strengthening the deep neck flexor muscles
- Exercises to stretch the thoracic spine
- Cranio-cervical flexion (CCF) training
- Reseating of scapular muscles and
- Postural correction exercises for awareness and to lessen stress on the cervical spine.
These movements, when consistently practiced, can help to make the body better at supporting the head and neck and result in the resolution of symptoms such as headache at base of skull and forehead.
Role of Posture and Lifestyle
Poor posture is the leading cause of most neck pain and headaches. The most common posture includes some degree of forward head posture and rounded shoulder position. Long hours of sitting, standing, and working on devices tend to add strain on the neck muscles and joints hence, headache symptoms are triggered or aggravated.
Postural correction exercises help solve these root causes. They train the body in posture maintenance, muscle engagement, and avoiding stress-painful positions. This alleviates any current symptom and keeps them from recurring.
Cervicogenic Headache and Sleeping: Is Your Sleeping Posture a Cause?
Many cervicogenic headache sufferers complain that their symptoms worsen after waking. This may be due to making cervicogenic headache sleeping posture mistakes such as too-high a pillow or neck-gargling position. Neutral neck alignment should be maintained during sleep. Back support pillows and ergonomic pillows help reduce overnight strain and minimize morning headaches.
When To Seek Help
If you have headache back of head, stiffness, persistent neck pain and headaches, then it is time to seek a physiotherapist. Timely identification and treatment of CGH can prevent its chronic nature and lead to an enhanced quality of life.
Frequently Asked Questions
How to treat cervicogenic headache (CGH)?
The key to treating CGH is to address the neck dysfunction that triggers headache. Physiotherapy focuses on restoring normal movement and posture so the nerves and joints in your upper neck stop sending pain signals to your head.
Treatment usually includes:
- Manual therapy to release tight neck and shoulder joints
- Posture retraining for long-hour desk users
- Deep neck flexor and shoulder-blade strengthening
- Ergonomic correction of your workstation
- Gentle stretching and home exercises
With consistent physiotherapy, most people feel noticeable relief in 4–6 weeks, and long-term headaches often stop completely when posture and muscle balance improve.
What not to do with cervicogenic headaches?
Avoid anything that increases stress on your neck joints and upper spine:
- Don’t sit for hours without breaks take micro-breaks every 30–45 minutes.
- Don’t crack or stretch your own neck aggressively.
- Avoid heavy upper-body lifting or high-impact exercise until pain subsides.
Don’t sleep on too many pillows or in awkward positions that push your head forward.
Instead, focus on posture awareness, gentle mobility, and getting a proper physiotherapy assessment before resuming intense workouts.
What can be mistaken for cervicogenic headaches?
Several conditions mimic CGH symptoms:
- Migraine – Throbbing pain, nausea, and sensitivity to light
- Tension-type headaches – Dull, tight band around the head
- Occipital neuralgia – Sharp, shooting pain at the skull base
- Jaw (TMJ) dysfunction or eye strain can also cause referred pain
A trained physiotherapist can differentiate CGH by assessing neck movement, muscle tension, and trigger points. Accurate diagnosis is crucial treating the wrong cause wastes time and keeps pain recurring.
What exercises help with cervicogenic headaches?
Exercises that strengthen and stabilize your neck and shoulder muscles are most effective:
- Chin tucks:Strengthen deep neck stabilizers and correct posture
- Scapular retraction:Improves shoulder-blade control and reduces upper-neck load
- Neck rotations and side bends:Restore mobility
- Upper trapezius and levator scapulae stretches:Relieve tension at the base of the skull
Do these gently, 1–2 times daily. Pair them with posture correction and ergonomic adjustments for lasting relief. Always consult your physiotherapist before starting.
What are the trigger points for cervicogenic headaches?
Trigger points often form in these areas:
- Upper trapezius (shoulder to neck)
- Levator scapulae (side of the neck to shoulder blade)
- Suboccipital muscles (base of skull)
- Sternocleidomastoid (SCM) (front and side of the neck)
When tight or inflamed, these muscles refer pain upward usually behind one eye, around the temple, or at the base of the skull. Physiotherapy, dry needling, and trigger-point release can deactivate these areas and reduce referred pain quickly.
What is the root cause of cervicogenic headaches?
The main cause is poor neck posture and joint dysfunction in the upper cervical spine (C1–C3). This often results from:
- Long hours at a computer or mobile device
- Whiplash or neck injury
- Weak deep neck muscles
- Chronic muscle tension and stress
These factors cause irritation of the nerves and joints that send pain signals to the head. Correcting posture, strengthening weak muscles, and restoring joint mobility resolves the root problem not just the symptom.
Can massage help cervicogenic headaches?
Yes — when done correctly, targeted massage therapy can relieve tension in tight neck and shoulder muscles, improve blood flow, and reduce headache intensity. However, massage alone offers temporary relief.
For long-term recovery, combine massage with:
- Physiotherapy for muscle re-education
- Postural correction and ergonomic setup
- Strengthening exercises to keep the pain from returning
A physiotherapist can combine manual therapy, trigger-point release, and stretching to give lasting results rather than short-term comfort.
