Cervicogenic headaches (CGH) are a distinct type of head pain originating from bony or soft tissue structures in the upper cervical spine (C1 to C3). This discomfort is known as “referred pain” because the source is in the neck, but the pain is felt in the head. Unlike primary headaches such as migraines, CGH is classified as a secondary headache, meaning it is a symptom of an underlying physical issue like an injury, arthritis, or functional problem in the neck. Effective management requires addressing the underlying neck dysfunction.
Identifying Cervicogenic Headaches
A key feature of CGH is that the pain often begins in the neck or the back of the head and then radiates forward to the side of the head, the temple, or the area around the eye. The pain is typically non-throbbing, moderate in severity, and remains on one side of the head, a characteristic known as side-locked pain. Symptoms are frequently provoked or worsened by specific neck movements, sustained awkward postures, or pressure applied to tender spots in the upper neck region.
People experiencing CGH often have a noticeably reduced range of motion and stiffness in their neck. While CGH can sometimes mimic migraines by causing light or sound sensitivity, these symptoms are generally less common and less severe than in a true migraine. Confirming the neck as the source of the pain requires a differential diagnosis by a healthcare professional to rule out other potential causes.
Acute Pain Relief and Self-Care
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce inflammation originating from the cervical spine structures, thereby lessening the headache pain. These medications provide temporary symptomatic relief during an acute episode.
Applying a heat pack to the stiff muscles in the neck and upper shoulders can promote blood flow and muscle relaxation, which helps ease the pain. Alternatively, applying an ice pack to the base of the skull or tender spots in the neck provides a numbing effect and reduces local inflammation. Gentle, non-straining stretches can also be cautiously performed, such as the chin tuck exercise. This exercise involves slowly pulling the chin straight back to align the head over the spine, activating the deep neck flexor muscles without aggressively rotating the neck.
Physical Therapy and Postural Correction
Physical therapy is the primary long-term approach for resolving cervicogenic headaches, as it directly targets biomechanical dysfunction in the neck and upper back. A physical therapist often employs manual therapy techniques, utilizing skilled, specific hands-on procedures like joint mobilization to restore normal movement in the upper cervical spine. This passive treatment is usually paired with a tailored exercise program designed to create lasting structural changes.
A central focus of the exercise regimen is strengthening the deep neck flexor muscles, which are small muscles located at the front of the neck responsible for stabilizing the head. Exercises like the chin tuck, performed with low-load resistance, help re-educate these deep stabilizers to hold the head in a neutral position. Strengthening the muscles that control the shoulder blades, known as scapular stabilization exercises, is also crucial since poor upper back strength and posture directly influence strain on the neck.
Correcting daily posture and making ergonomic adjustments are equally important for preventing the recurrence of CGH. Maintaining a neutral spine position throughout the day, especially while sitting at a desk, reduces strain on the upper cervical joints and surrounding soft tissues. The computer monitor should be positioned so the top of the screen is at eye level, ensuring the head does not tilt forward into a “forward head posture.” Individuals should also evaluate their sleeping posture, using only enough pillows to keep the neck aligned with the rest of the spine when lying on their back or side.
Specialized Medical Procedures
When conservative measures like physical therapy and self-care do not provide sufficient relief, specialized medical procedures may be considered. These interventions are typically administered by a pain specialist and are reserved for cases where the specific joint or nerve causing the pain has been identified. One common approach involves injecting a local anesthetic, often combined with a steroid, near a suspected pain-generating structure in the neck, such as a cervical facet joint.
These diagnostic nerve blocks are highly specific: if the injection successfully abolishes the headache pain, it confirms that the targeted structure is the source of the CGH. Another targeted procedure is a greater occipital nerve block, which can temporarily relieve pain that radiates across the back of the head and up to the front. For chronic pain, a more definitive procedure called radiofrequency ablation may be used, which involves using heat energy to temporarily deactivate the sensory nerves transmitting pain signals from the irritated joint.