Cervicogenic headaches are a form of secondary headache resulting from dysfunction in the cervical spine—typically, the upper most part of the cervical spine (atlanto-occipital joint) and upper three cervical segments (C1-3). Dominant symptoms and signs include unilateral head and upper neck pain, limited neck motion, and increased symptoms with certain neck and head positions. It’s estimated that cervicogenic headaches affect between 2% and 4% of the population; however, among patients with chronic headaches, the prevalence is upward of 20%.
Clinical treatment guidelines include the use of manual therapy as a first treatment option for the management of patients with cervicogenic headaches, though no specific recommendations have been made regarding which type of manual therapy is most effective. Chiropractors perform manual therapies more than any other profession including manipulation (thrust) and mobilization (non-thrust) with the goal of restoring motion and reducing pain and disability. Some studies have favored mobilization over manipulation for improving headache intensity, frequency, and duration while others have come to the opposite conclusion. Because each patient’s case is unique, the decision on which type of manual therapy to employ should be based on the clinician’s discretion.
Ultimately, treatment will likely include several manual therapies and address musculoskeletal issues beyond the cervical spine that may be contributing to their chief complaint. Such issues may include temporomandibular disorders, upper cross syndrome, forward head posture, or musculoskeletal disorders involving the thoracic spine and scapula. In addition to manual therapies, neck-specific exercises have also been demonstrated to benefit the cervicogenic headache patient, though much like manual therapies, the decision on which specific exercises to use is often left to the healthcare provider to decide.
Interestingly, researchers have observed that dysfunction in the neck may also play a role in other forms of headache. For example, a systematic review of 13 studies published in 2022 concluded that mobilization techniques, trigger point therapy, manual lymphatic drainage, massage, and stretching techniques each benefit migraine headache patients—especially when used in combination. So, if you suffer from headaches and your current treatment plan isn’t providing the relief you would hope for, consider consulting with a doctor of chiropractic to see if manual therapies applied to the cervical spine region may be of benefit.
