Etiology — what causes it

Headache referred from the upper cervical spine (C0–C3), driven by convergence of upper cervical afferents with the trigeminal nucleus caudalis. Contributors include upper cervical joint dysfunction, deep cervical flexor weakness, and prolonged forward-head postures.

Epidemiology — who gets it

Cervicogenic headaches account for approximately 15–20% of chronic and recurrent headaches (Sjaastad criteria, Cephalalgia). Often coexist with mechanical neck pain. More common in women.

Clinical signs

Reproduction of headache with upper cervical PA pressure or flexion-rotation testing (Hall flexion-rotation test — strong specificity for upper cervical involvement), restricted upper cervical range, deep neck flexor endurance deficit, palpable upper trapezius and suboccipital tenderness. Normal neurological exam.

Symptoms

Unilateral or unilateral-dominant headache, often starting in the occipital or upper cervical region and radiating forward. Provoked by neck movement or sustained posture. Tends to be moderate intensity, dull, and longer in duration than migraine. No prominent autonomic features.

Best evidence for chiropractic treatment

Jull et al. (Spine 2002) demonstrated that specific upper-cervical manual therapy combined with deep neck flexor training reduces headache frequency and intensity at 12 months better than either alone. Bronfort et al. and subsequent reviews confirm benefit (Côté et al., Spine J Treatment Recommendations). Avoidance of cervicogenic-aggravating habits and education on triggers complement the active care.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Cervicogenic headache responds well to specific upper-cervical manual therapy combined with deep neck flexor training — published evidence supports lasting improvement.