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Kathryn McIntosh, MD, PhD, PGY-1 Neurosurgery,1 Sean Taylor, MD, FRCPC,2 Sean D Christie, MD, FRCSC,3

1From Departments of Surgery Dalhousie University and Nova Scotia Health
2Assistant Professor, Neurology From Departments of Medicine, Dalhousie University and Nova Scotia Health
3Professor and Head, Neurosurgery From Departments of Surgery, Dalhousie University and Nova Scotia Health


CLINICAL TOOLS

Abstract: Treatment-refractory headache results in chronic, function-limiting pain despite multiple trials of preventive and abortive therapies. Among adults evaluated for headache, cervicogenic headache represents an important but relatively uncommon cause of headache, representing 4% of cases, with a female predominance. Identifying cervicogenic headache is clinically significant as it localizes the pain source to the cervical spine, guiding targeted, spine-focused management and avoiding ineffective treatments and unnecessary investigations.
As interest and evidence expand, there is a greater need to translate current knowledge into practical guidelines. We highlight the most current evidence regarding prevention, diagnosis and management of cervicogenic headache.
Key Words: Cervicogenic headache, neck pain, unilateral headache, cervical spine.

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Cervicogenic headaches are secondary headaches that originate from pathology in the upper cervical spine for which headache relief can be achieved through spine-focused therapy.
Prevention of cervicogenic headache involves addressing modifiable factors that support spinal health, including smoking cessation, regular physical activity, maintaining a healthy weight and adequate sleep.
Diagnosis of cervicogenic headache is primarily clinical and may be supported by response to targeted cervical interventions, including manual physical therapy or diagnostic nerve blocks.
Treatment of cervicogenic headache is primarily conservative and multimodal, with the strongest evidence supporting manual physical therapy. Radiofrequency ablation may be considered in select cases, evidence for other interventions remains limited.
The cervical flexion–rotation test selectively assesses C1–C2 mobility and is a quick, low-risk bedside maneuver. Marked asymmetry or reproduction of the patient’s familiar headache during the test strongly supports an upper cervical pain generator.
While not diagnostic, reproduction of a patient’s headache with firm palpation or sustained pressure over the upper cervical spine or suboccipital region can support a cervical source of pain.
Many patients with cervicogenic headache are individuals with prolonged, static neck positions such as smartphone-related neck flexion or “text neck”. A history of neck injury is also common.
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Related Terms: Back Health, cervicogenic headache, neck pain, unilateral headache, cervical spine