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cervicogenic headaches

Cervicogenic Headaches: It’s Not All in Your Head.

by Molly Runquist, DPT, COMT, Emory Competent, AIB-VRCLeave a Comment

There are many different types of headaches. In fact, the International Classification of Headaches has more than 180 pages! However, there is one type of headache that affects more than just your head and can be helped by a physical therapist: cervicogenic headaches.

Cervicogenic headaches are headaches that come from the cervical region of your spine- otherwise known as your neck. These headaches are typically caused by musculoskeletal issues, which is why your physical therapist is the ideal professional to evaluate and treat this type of headache.

So how do you know if you have a cervicogenic headache?

Cervicogenic headaches often present with what is considered a “rams horn” distribution. For example, pain may begin in the base of your skull and can come up and around your head to your forehead and behind your eye (taking the shape of a ram’s horns). It is more often felt on one side vs. throughout the head. Per the International Classification of Headaches, to be diagnosed with cervicogenic headaches, a patient must have clinic and/or imaging evidence of a contributing factor within the cervical spine, as well as at least two of the following criteria:

  1. Headache developed in forehead in relation to the onset of the neck issues
  2. Headache significantly improves or resolves with improvement of the issue in the neck
  3. Movement of the neck may be decreased and headache may be made worse with movements within the neck
  4. Headache is resolved following a diagnostic block of a cervical structure or nerve supply1

Simply, if you are having headaches anywhere along the distribution above, please contact a physical therapist to be evaluated.

How do you treat a cervicogenic headache?

The treatments for cervicogenic headaches may vary and will be individualized to your specific symptoms. Musculoskeletal issues in the neck can be addressed with manual or hands-on treatment. This can improve how the joints move in your neck, decreasing tightness or tone in the surrounding muscles. Additionally, hands-on treatment can improve how your neurological system communicates between these structures and your brain, which can also decrease tightness in the muscles and improve your head and neck position in your posture. There are studies that demonstrate improvement of symptoms of people with cervicogenic headaches related to mobilization or even manipulation (hands-on treatment to the joints of the neck), especially in the upper levels of the neck when compared to no treatment at all. Overall, this provides your therapist with an opportunity to change your symptoms in the short term, but also offer a less painful window for exercises that will better support your posture and neck to improve longer term independent management of your headaches to meet your goals.2

Other exercises will address your posture because sustained postures can contribute to cervicogenic headaches. The most important thing to remember is you should never stay in one position or place for too long. Keep moving! For example, sitting at your desk leaning forward toward your screen allows for muscles in your neck to get tight and muscles in your upper back to weaken – contributing to your headaches. Retraining exercises directed by your physical therapist will often involve stretches for tight muscles, as well as exercises that strengthen and re-educate weakened muscles to better support your posture and movement throughout the day. There can even be exercises that may utilize a laser and target to better educate how you hold your head and neck within your posture.3

What can you do right now?

Keep moving! In other words, don’t sit in one position for too long. You can even set a timer to get up and move around for 2-3 minutes every hour. Stretch your neck or work on becoming more aware of your posture.

Cervicogenic headaches can be improved with conservative care. This is a great opportunity for a free assessment with a physical therapist at Athletico to allow for evaluation of your symptoms, answer any and all of your questions, and if required help direct care to your primary care provider or a neurologist depending on your symptoms.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

1. The International Classification of Headache Disorders 3rd edition. (2019, June 22). Retrieved from
2. Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.
3. Armstrong, B., Mcnair, P., & Taylor, D. (2008). Head and Neck Position Sense. Sports Medicine, 38(2), 101–117. doi: 10.2165/00007256-200838020-00002

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Molly is a physical therapist passionate about educating others in physical therapy. Her favorite Vestibular Rehabilitation topics involve helping diagnose, treat, and improve the quality of life of those with dizziness. She has undergone extensive training from several groups specializing in treating vestibular conditions. She also develops courses within Athletico to improve other clinicians' and new graduates' ability to efficiently and effectively assist this population. Molly is excited to share her trials, success, and tricks with people looking to learn more about what physical therapy offers to improve their lives and make everybody better with Athletico.

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