Cervicogenic headache is defined as pain on one or both sides, localized to the neck and back of the head which may project to regions on the head and/or face. Head pain is aggravated by neck movement, sustained awkward head positions, or pressure on the upper neck or back of the head on the side of symptoms [1,2,3].

Diagnosis

Diagnosis of cervicogenic headaches is made primarily from the patient’s history and a negative neurological exam. Neuroimaging is only indicated in patients with a positive neurological examination findings or presence of a “red flag” (warning signs in the medical history suggesting a more serious medical condition) [2]. Chiropractors are well trained to take a thorough history and perform a neurological examination. If we detect any signs that your condition is more suitable for medical treatment we will recommend a referral to your GP.

Evidence based summary for manual therapy [53]

The highest current standards of scientific evidence – randomised controlled research trials (RCTs) – show moderate (on a scale of inconclusive, moderate and high) quality evidence that spinal manipulation is more effective than placebo manipulation, friction massage, and no treatment [4]. This is a higher rating than that achieved for any other manual therapy. There is moderate quality evidence that spinal manipulation is similar in effectiveness to exercise [5]. Moderate quality evidence exists that natural self-mobilizing glides of the joints in the back of the neck are more effective than placebo [6].

Other evidence based effective non-invasive physical treatments or patient education [53]

Neck exercises [4]

Back-in-Action clinical comment

Chiropractic assessment and treatment of cervicogenic headaches is aimed at finding and reducing tension and the causes of tension in the joints and muscles. In our experience treating the symptoms and underlying causes of cervicogenic headaches benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, cranial work, neck exercises, referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, cryotherapy (heat and/or ice), postural improvements, ergonomic advice, foot orthotics and relaxation counselling.