Treatment of Cervicogenic Headache

There is no specific treatment protocol for cervicogenic headache (CGH), and a combination of different techniques may need to be tried to alleviate the pain.

This page discusses a few noninvasive treatment options for CGH that are usually tried first.

Manual Therapy

Manual therapy involves joint mobilization and manipulation for CGH. This method focuses on procedures such as massage, manipulation, and/or physical therapy. Treatment with manual therapy has shown to provide favorable outcomes, especially when combined with exercise. ¹ Lance Whorton, R., & Kegerreis, S. The Use of Manual Therapy and Exercise in the Treatment of Chronic Cervicogenic Headaches: A Series of Case Studies. Journal of Manual & Manipulative Therapy (2000), 8(4), 193–203. ^{, 2} Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002;27(17):1835–1843. Spinal manipulative therapy may relieve pain by relieving pressure on joints and improving nerve function. Before having manual therapy, it is important to rule out any serious underlying medical conditions or neck injury in order to reduce the risk for serious complications.

See Manual Physical Therapy for Pain Relief

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS electrotherapy technique involves the use of a device that produces low-voltage electric current to stimulate nerves and treat pain. The device consists of electrodes on small, sticky pads that are placed over the area in pain, and electric current is passed through the electrodes. This stimulates the sensory nerves, creating a tingling sensation in the area, thereby reducing the feeling of pain. It is possible to control the frequency of electric current to suit individual needs. A TENS unit can also be used at home for pain relief.

See Transcutaneous Electrical Nerve Stimulators (TENS)

Instrument-Assisted Soft Tissue Mobilization (IASTM)

IASTM technique involves an assessment into the deep layers of tissues in the cervical region to identify restrictions within tissues. This is done by using handheld instruments and gently rubbing the affected area using specific massage techniques. Restrictions in tissues may form due to development of fibrous muscle tissue, scar tissue, chronic inflammation, or degeneration. Once the restrictions are identified, they are mobilized by gently stretching or pulling with the help of instruments that use traction force.

See Specific Manual Physical Therapy Techniques

Medications

Doctors may prescribe medications used for migraines, tension-type headaches, or neuralgias (nerve pain) to relieve CGH pain. Some of the commonly used medications for CGH are:

• Tri-cyclic antidepressants
• Anti-epileptic drugs
• Analgesics including non-steroidal anti-inflammatory drugs (NSAIDs), selective cyclooxygenase-2 (COX-2) inhibitors, and narcotic analgesics
• Muscle relaxants
• Botulinum toxin

While medication alone typically does not eliminate CGH pain, it may provide enough pain relief to improve patient compliance for manual therapy or other rehabilitation programs. As with all prescription medications, it is important to take them as directed by the doctor in order to lower the risk of side effects or complications.

Therapeutic Exercise

Neck pain resulting from muscle imbalance, forward head postures, and rounded shoulders may be treated with therapeutic exercises. These exercises focus on strengthening and stretching the neck and its supporting muscles. A physical therapist or other health professional may design a neck exercise program specifically for the patient.

A post-isometric relaxation (PIR) technique may be used to help relieve muscle tightness and trigger-point pain in tense and shortened neck muscles. Physical therapists use alternate cycles of contraction and relaxation to help relax and lengthen the muscles for improved range of motion.

See Trigger Point Exercises for Neck Pain

Mind-Body Therapy

If chronic pain persists despite treatments, various mind-body therapies may help with pain management:

• Cognitive behavioral therapy teaches strategies for positive thinking and problem solving
• Biofeedback aims to train the mind and body to become more aware of physiological responses that may be causing pain, and how to manage them

See Mind-Body Therapy for Neck Pain

Other mind-body treatments such as mindful meditation and relaxation techniques can be continued at home after consulting with a doctor.

Self-Care Techniques to Avoid CGH Pain

Self-care methods can help some people manage their CGH symptoms from starting or getting worse. The following options can help control CGH symptoms:

• Avoiding postures or movements that provoke the pain to start
• Maintaining a good posture while sitting or driving—by sitting tall with shoulders back and without protruding the head forward
• Using a neck brace can be helpful while sitting upright or sleeping in a chair
• Using a supporting travel pillow (similar to a neck brace) on the plane or bus to avoid excessive side-bending or flexion
• Avoiding tummy-sleeping posture if waking up with pain is a problem
• Finding the right pillow to prevent the head from being too high or too low when sleeping

See Ten Tips for Improving Posture and Ergonomics and Pillows for Neck Pain

Treatment strategies without a confirmed source of the CGH pain are mostly speculative in terms of their effectiveness. CGH pain which cannot be relieved by a combination of noninvasive treatments may require more invasive treatment options, such as injections or surgery.

See Surgery for Neck Pain