Cervicogenic Headaches: The Best Exercises for Relief [Video]

Woman with cervicogenic headache

The relentless pounding…the intense throbbing…headaches are the worst! Unfortunately, they’re also very common. In fact, they’re the most common reason people use over-the-counter pain medication. Headaches also account for 18 million doctor visits in the US, 156 million work days missed – an estimated $25 billion in productivity losses – every year1.

Do you get headaches? What Kind – migraines, tension-type, cluster? Maybe you’re like many of the patients I see and get headaches stemming from the neck region – these are called Cervicogenic Headaches. The good news with this type of headache is that there are steps you can take to alleviate the pain – even without taking medication.

Let’s take a look at what Cervicogenic Headaches are, what causes them, how they differ from other headaches, and – most importantly – how you can alleviate and prevent them from recurring…

What is a Cervicogenic Headache?

There are a ton of different types of headaches – over 150 according to WebMD.

To make things more confusing, the symptoms of Cervicogenic Headaches can mimic symptoms of tension-type headaches, migraines, cluster headaches, and others2.

So how do you know if your headache is a Cervicogenic Headache?

A Cervicogenic Headache is pain referred to the head from the cervical spine or muscles in the neck region3.

Typically with this type of headache, you’ll feel pain in the neck and on one side of the head – usually behind the eye, the forehead and temple.

Cervicogenic Headaches can present with:

  • Pain made worse by neck movement4,5
  • Pain from sustained awkward head positions
  • Pain from external pressure on the upper part of the neck or lower part of the skull
  • Restricted range of motion in the neck
  • Neck pain on the same side as the headache, sometimes referring to the shoulder6

A few quick facts about Cervicogenic Headaches:

  • Affect people with an average age of 43 years7
  • Affect women 4x more often than men8
  • Affect up to 2.5% of the general population9
  • Affect 53% of people after whiplash injuries from car accidents10
  • Duration of symptoms is usually a few hours to a couple of weeks11

What Causes Cervicogenic Headaches?

Oftentimes, Cervicogenic Headaches come on after a head or neck injury, but they can also happen without any trauma at all12.

The million-dollar question is: what structures are actually causing these headaches?

It has been proposed that the pain is likely referred from one or more muscles, nerves, joints, or vascular structures in the neck13.

In recent studies using pain blocks, researchers found that the C2–3 facet joints of the spine (joints on between vertebrae on either side) are the most common source of pain in people following a trauma. However, these same studies found that, for the participants without trauma, none of them had these joints as a source of pain14,15,16,17.

Unfortunately, MRI studies haven’t been much help in this area. When comparing people with Cervicogenic Headaches to those without, there were no differences in cervical spine structures and an equal amount of disc bulging present.

What does this mean? For people with headaches, 45% had disc bulges on their MRIs and for people without headaches, 45% had disc bulges on their MRIs (this shows you how common disc bulges are – even in people without pain!)18,19,20.

We do know that people with Cervicogenic Headaches tend to have restricted or reduced neck range of motion21. This makes sense, especially after trauma with facet joints being a main source of pain – stiffness in these joints can refer pain to the head.

Refer pain to the head? Yes…

We also know that there are nerve fibers (trigeminal nerve, spinal accessory nerve, cervical nerve roots) that converge in the upper part of the neck that refer pain to the head and face. Pain signals from the upper neck region can send sensory signals through these nerves, which present as a headache22,23.

Trigger points are a potential source of pain that can send these sensory signals. A trigger point is a hyper-irritable spot in a taut band of muscle24. When compressed, stretched, or stressed, trigger points can refer pain to other body regions in predictable patterns25. In particular, trigger points in the Upper Trapezius, Sternocleidomastoid, and Sub-occipital muscles can refer these sensory signals to the head and face26,27.

How do these trigger points get so hyper-irritable?

A forward-head posture can cause hyperextension of the upper part of the neck. This position is usually associated with shortening or stiffening of muscles like the Upper Trapezius, Sternocleidomastoid, and Sub-occipitals28 – the same muscles in which trigger points refer pain to the head…hmmm….

Treatment Options for Cervicogenic Headaches

Typically, when people get headaches, they reach for the pills, even to the point of becoming dependent on them.

However, studies show that medications alone are often ineffective and provide only mild relief for Cervicogenic Headaches29,30.

A couple of other treatment options have been shown to be of some benefit. Although I’m not recommending them as a first-step, I should mention them here:

  • Trigger point injections with a local anesthetic may provide temporary pain relief and relaxation of local muscle spasms31.
  • For pain stemming from the C2–3 facet joint, corticosteroid injections have been shown to benefit some patients32. However, a placebo effect hasn’t been ruled out.

When it comes to less invasive treatment options for Cervicogenic Headaches, manual therapy and exercise prove to be the most beneficial33

Manual therapy can include joint mobilizations and soft tissue work from a Physical Therapist.

Although both modes of treatment are beneficial, the largest and most recent study shows that the combination of both manual therapy and exercise are no more effective than either intervention alone34.

With exercise alone, this study showed 76% of patients achieved >50% decrease in headaches and 35% achieved complete relief at 7 weeks35.

Therefore, in my book, exercise is the best, most cost-effective, least invasive way to go for the treatment of Cervicogenic Headaches.

What are the best exercises to do?

Exercises For Cervicogenic Headaches

Re-education of muscle control with low-load exercises for the neck and scapular (shoulder blade) region are most effective36,37,38   

  1. Chin Tucks With Resistance

 

2. Wall Angels For Scapular Strengthening

 

  • Practice twice daily to increase the endurance capacity of the muscles.

Equally as important is to incorporate this training into improving your posture, especially in the sitting position:

  • maintain a neutral lumbar spine
  • keep the shoulders gently retracted back
  • maintain a slight chin tuck while elongating the neck to facilitate the deep neck flexor muscles39
For more tips and exercises to improve a forward head position and overall posture, get my free eBook, Why You Have Bad Posture and How To Make It Better.

Question: What triggers your headaches? What have you found that helps? You can leave a comment by clicking here.

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