How Do We Manage Cervicogenic Headaches?

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How Do We Manage Cervicogenic Headaches

Cervicogenic headaches are typically unilateral headaches that occur from a multitude of factors including postural syndrome, muscular imbalances, and many more. We might to evaluate other things including workstation ergonomics, sitting, and standing postures, as well as how they perform tasks/activities. Sometimes those elements can contribute to the patient’s current clinical presentation.

Understanding what reproduces the patient’s familiar symptoms as well as what typical activities that they perform daily will help provide valuable information. Understanding what the patient experiences is vital to ultimately guide clinical practice and the plan of care.

Treating cervicogenic headaches can seem challenging, but there are some solutions plausible to help reduce impairments and functional limitations.

When treating individuals with cervicogenic headaches, a multimodal approach would be optimal. There should be some incorporation of manual therapy directed to the cervical/thoracic spine, deep neck flexor strengthening, and sensory motor control reeducation.

Strengthening of the deep neck flexors, cervical spine, and upper-quarter muscle are beneficial to help reduce cervicogenic headaches.1 Deep neck flexor exercises are easy to perform and may be used as a strategy when performing various functional tasks throughout the day.

Evidence suggests that a multimodal approach utilizing manipulative therapy and exercise can reduce symptoms for individuals with cervicogenic headaches, although there is no additive benefit when combined.2 Also, the study performed by Jull et al2, demonstrated that each group were equally effective in reducing symptoms of headache and neck pain, and the effects were maintained over a 12-month period regarding the use of manual therapy and exercise interventions.2 A systematic review looked at the effectiveness of conservative physical therapy interventions for cervicogenic headaches.3 The results demonstrated that manipulative therapy was significant effective, however, showed that there was not clinically or statistically significant differences.3 Out of all of interventions, the results indicated that both cervical manipulation and mobilization combined with exercise was the most effective conservative interventions addressing cervicogenic headache intensity, frequency, and neck pain.3

The literature has demonstrated that combining manual therapy and exercise would be beneficial for an individual who is experiencing cervicogenic headaches.1

There are many other approaches to treat individuals with cervicogenic headaches. Healthcare is truly individualized, and the clinician should utilize a patient-focused approach. Understanding the available literature and interventions that are out there, will be beneficial to ensure that the patient is receiving best practice and yield successful outcomes.

Article Written By Eric Trauber, PT, DPT, OCS, CSCS, FAAOMPT


  1. Fritz JM, Brennan GP. Preliminary examination of a proposed treatment-based classification system for patients receiving physical therapy interventions for neck pain. Physical Therapy. 2007; 87: 513-524.
  • Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. SPINE, Volume 17: p. 1835-1843.
  • Racicki S, Gerwin S, DiClaudio S, Reinmann S, Donaldson M. (2013). Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of Manual and Manipulative Therapy, Volume 21, Number 2: p. 113-124.