• Dr. Donald Littlewood

I slept funny and now I have a headache...

How many times have you woken up in the morning, gotten out of bed and turned your head to do something, only to realize you can’t and it shoots pain from your neck up behind your ear. That, my friend, is a cervicogenic headache.

Hey all! My name is Dr. Donald Littlewood and I am a chiropractor in downtown Toronto. My practice focuses on two areas: headaches, neck pain & posture as well as the LGBTQ+ community. Today, I want to give you the tools to recognize a cervicogenic headache & some quick action steps you can take to nip them in the bud when you do get one.

Cervicogenic headaches are considered a secondary headache meaning that their cause is located somewhere other than the head. In the case of a cervicogenic headache, the source is right in the name. Cervicogenic means originating from the cervical spine, or neck.

There are a few things I look for when I am suspecting someone has a cervicogenic headache and I wanted to share them with you. I generally look for two out of the following four criteria:

  1. Temporal relationship between neck pain & the patient experiencing a headache

  2. Headache improves when the neck pain improves

  3. Range of motion in the neck is decreased and pain is made worse by tissue palpation and/or orthopedic testing

  4. Pain is made better by facet nerve block injections

[NB: as a chiropractor, I am not allowed to give nerve blocks & patients come to see me before they get to that point]

The science behind CGH

A question I get asked daily is: “how did ______ happen?” And cervicogenic headaches are no different.

Cervicogenic headaches come from the neck, we know that already, but where? Well, of course with science, there is almost never one cause & effect relationship and CGHs are no exception. But the good thing with CGH is that we understand a lot of the physiology behind them, so let me break it down for you.

The first thing we need to talk about is convergence.

Convergence is essentially when two things come together. In the case of a CGH, it is sensory fibres from the neck and some of the nerves of the face/head that connect on what is called the trigeminocervical nucleus. It is because of this convergence that we get pain from our neck up into our head.

Now that we’ve chatted about convergence, I want to talk about what structures are thought to cause the pain we feel.

In short, its anything that is innervated by the C1-C3 nerve roots, but what does that actually mean? Well, I’ll break it down in terms of muscles & joints:

  • Joints: C0-C1 [the joint that connects your head to your neck] and the facet joints all the way down to C2/3

  • Muscles: suboccipital, sternocleidomastoid, upper trapezius, paraspinals [semispinalis, splenius & multifidis]

So I think I have painted a pretty clear picture that these headaches come from the neck, so the obvious next place to go is some treatment options.

Treatment of CGH

There is a fair amount of research done on what drugs can be used to help with the sings & symptoms of a cervicogenic headache, and the research leads us to the same answer: none.

There doesn’t really seem to be a drug out there that is effective in decreasing the frequency or intensity of a cervicogenic headache. But what does exist are manual therapy, exercise & acupuncture.


A full meal deal blog post on acupuncture is coming, don’t you worry, but for now I wanted to give you the quick and dirty on how it works and how I use it for cervicogenic headaches.

Acupuncture was developed in ancient China and has recently made a name for itself in Western medicine. It has been used to treat conditions of all different nature & severity. In my practice, I use acupuncture to help relax or activate muscles [yes, it does both], promote tissue healing for both acute and chronic conditions as well as pain & headache management.

The methodology behind acupuncture can be different as well. There are traditional points that are used across the globe, but there is also a “new” form of acupuncture called dry needling that focuses on inserting acupuncture needles directly into the trigger points found in the muscles.

Dry needling has been shown to be effective [both in research & in my clinical practice] in decreasing both the frequency & intensity of cervicogenic headaches by way of reducing trigger points.

Manual therapy

Manual therapy is anything that uses the practitioners hands to treat the patient, generally soft tissue work and adjustments.

Soft tissue work is the treatment of the muscles & ligaments of the body. It can be done in several different ways, but the end goal is always to relieve muscle tension, reduce trigger points and increase the area’s range of motion.

In the case of a CGH, soft tissue work is done to the upper trapezius, suboccipital, SCM & paraspinal musculature. There are other muscles that I like to work on even though they don’t have a direct effect on the headache, they do have a direct effect on the pain and range of motion of the neck.

Adjustments are what you think of when you go to see a chiropractor; the popping/cracking noise you hear. This portion can be a bit scary to some, especially on your first treatment, so let’s go through it for a second.

In a cervicogenic headache (or neck pain without a headache), we can observe a decrease

in the range of motion of the neck. This means that the joints aren’t moving properly and so they cause pain to let your body know that there is something up. So, we get in there and adjust.

The end goal of an adjustment is always movement. Adjustments are performed on joints that aren’t moving in order to encourage its normal motion. The added benefit of pain relief makes adjustments even more therapeutic.

Therapeutic exercise

I like to break down exercise into two forms: therapeutic & recreational. Therapeutic exercise is done specifically to rehabilitate an injury and recreational exercise any other type of exercise [weight training, cardio, walking, etc]. Both of these types of exercise are equally important, but for the purpose of this blog, I want to talk about therapeutic exercise.

Therapeutic exercise is intentional & specific. In terms of cervicogenic headaches, exercise has been shown to be as effective as manual therapy when it comes to decreasing headache frequency & intensity, both major indicators of quality of life.

For cervicogenic headaches, we want to target the muscles I already talked about: suboccipitals, upper trapezius, SCM & the paraspinals. What does this look like? Well, I thought I would give you one really great exercise you can do to help with these headaches.

Now before I do, I want to go full disclosure on ya: I have shown you this before & I will show this to you again. This is truly one of the best exercises you can do for your neck pain & your headaches.

Chin tucks

Chin tucks are an amazing exercise that strengthens your deep neck flexors & lower cervical extensors [which are really important for posture, by the by] as well as stretches your scalenes & suboccipital muscles.

So how do you do them?

Literally all you have to do is give yourself a double chin. That’s it. Double chin, hold for 2 seconds & relax. Repeat this 10 times a few times a day.

Final thoughts

Cervicogenic headaches may not be the most common type of headache, but they can be debilitating when they do rear their ugly head. With proper treatment, these headaches tend to go away fairly quickly & we can train our bodies to decrease their recurrence. I have so many more headache reduction strategies in my arsenal, so I decided to create a free resource for you. Head on over to this link to get your copy of them today to keep your headaches at bay!

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