Cervicogenic Headache Exercises the prehab guys

Cervicogenic Headache Exercises

Do you have a headache after a whiplash injury? Do you experience pain that seems to start in the neck and then spread to one side of your head or arm? Does moving your head seem to start your headache or exacerbate your pain when you have a headache? If you answered yes to any of those questions, there’s a high chance you have a type of headache known as a cervicogenic headache. Lucky for you, there are extremely effective interventions for you including cervicogenic headache exercises!. In this article, you will learn everything you need to know about cervicogenic headache exercises so that you can start to feel better!


Cervicogenic Headache Exercises: First Understand The Anatomy and Physiology


What distinguishes a cervicogenic headache from your classic headaches like migraines or tension-type headaches is that cervicogenic headaches are actually caused by dysfunction(s) in your neck. Cervicogenic headaches are a form of referred pain – meaning that although the source of the pain is in the cervical spine, the sensation of pain is felt in the head as a headache. This happens because there are nerves in the upper cervical region (C1, C2, and C3) that have connections to nerves of the head (cranial nerve V via the trigeminal nerve spinal tract).


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Although some controversy exists, a vast majority of the literature agrees that the most common cause of cervicogenic headaches is dysfunction from the C2-3 zygapophysial joints (facet joints). However, there is also literature to support that cervicogenic headaches can arise from dysfunction in the C2-3 and C3-4 intervertebral discs of facet joints, as well as the atlantoaxial (C1-2) and atlanto-occipital (C0-1) joints. The most common causes of these upper cervical dysfunctions are whiplash-associated trauma as well as prolonged neck flexion or poor static postures


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Cervicogenic Headache Exercises: Consider A Pro If & When Needed

See your local physical therapist. They can create a specific plan of care tailored to treat your upper cervical dysfunction. A recent systematic review in 2013 by Racicki et al came to the conclusion that “conservative physical therapy treatment techniques are effective interventions for decreasing cervicogenic intensity and frequency, as well as neck pain.” In particular, utilizing a combination of mobilization, manipulation, and cervicogenic headache exercises like cervico-scapular strengthening exercises, are the most effective intervention based on the results of that systemic review.


Cervicogenic Headache Interventions: Manual Therapy

A well-trained physical therapist will examine your neck to see if there are any impairments or issues with the cervical facet joints specifically at the segments we mentioned above. Typically, palpation of the dysfunctional segment will recreate symptoms similar to the headache you experience, letting the physical therapist know that he or she is in the right spot. From there, a physical therapist may perform soft tissue mobilization to the suboccipital muscles with the intention of relaxing them. You can’t address the dysfunctional joints if the muscles around them are tense and guarded! From there, a physical therapist can either employ joint mobilizations or manipulation to the troublesome segments.


Upper Cervical Soft Tissue Work, Mobilization, and Manipulation

In the video above, Mike demonstrates a general upper cervical manipulation. While a manual therapist likes to be as specific as possible with their joint mobilizations, it’s difficult to say whether we are gapping  C0-C1 or C1-C2 or even C2-C3 joint. Next, I demonstrate some general soft tissue mobilization to obliquus capitis superior and inferior. Finally, I demonstrate one of many ways to mobilize the C0-C1 joint. The particular technique shown is a mobilization of the occiput, while stabilizing at the transverse process of the atlas.


Cervicogenic Headache Exercises: SNAGs

Following manual therapy, a physical therapist should teach you how to perform a Sustained Natural Apophyseal Glide, or SNAG, for short. This SNAG cervicogenic headache exercise is a way to provide yourself your own form of manual therapy. Essentially this exercise mimics the manual therapist’s hands and provides a joint mobilization to the joint.


Sustained Natural Apophyseal Glides (SNAGs)

Sample Neck And Headache Programming Exercise

To perform:

  • Use the EDGE of a towel. Using the edge, and not the middle of or a folded up towel is important as you don’t want the towel to slip off of your skin.


  • Place the edge of the towel on the desired segment.


  • Anchor the towel with the hand on the same side as your troublesome segment as shown.


  • With your opposite hand, reach up and grab the edge of the towel. If you give it a slight tug, you should feel a pulling/stretching sensation behind your neck at the segment. You should not feel any of your symptoms. 


  • While pulling the towel (towards your opposite ear), turn your head towards your hand at the same time and hold this position for 3 seconds. Only turn your head in your pain-free range of motion. Your line of pull should be horizontal, to just below the eye (I said towards the eye in the video on accident)


  • That’s 1 rep. Now repeat 10 times.


  • Perform this exercise twice a day.


BE GENTLE! At this point, we don’t know if you’re treating the right segments or even the right problem in the first place! If you think you have a cervicogenic headache, it may be worthwhile to go schedule an appointment with your local physical therapist.


Cervicogenic Headache Exercises: Neuromuscular Re-Education & Strengthening

Last but not least, you need to follow up manual therapy with some cervical and scapular strengthening as well as postural re-education. We’ll highlight a few of our favorite “bang-for-your-buck” exercises that accomplish both strengthening and postural re-education as shown below.


Cervicogenic Headache Exercises: Deep Neck Flexor and Extensor Exercises

Sample Neck & Headache [P]Rehab Program Exercise

While training the deep neck flexors in patients with cervicogenic headaches or neck pain is important, we believe that the deep neck extensors are far too often forgotten during rehabilitation. The deep cervical extensors (semispinalis cervicis, multifidus, and rotators) along with the craniocervical extensors (rectus capitis posterior major/minor and obliquus capitis superior/inferior) are key muscles for cervical spine segmental support due to their relatively small moment arms, attachments to adjacent vertebrae, and their high proportion (~70%) of slow-twitch muscle fibers.


To perform:

  • Start in the quadruped position, watch this video to see how to properly engage the scapular stabilizers in quadruped


  • Start first with a chin tuck in the quadruped position. This will activate your deep neck flexors. You should be able to see wrinkles in your chin.


  • While maintaining the chin tuck, work slow and controlled into cervical flexion. Cue here is to “use your eyes” to follow an object (iPhone shown in video)


  • Now here comes the best part of the exercise, the cervical extensors are already engaged in the quadruped position simply due to gravity. However, we can further preferentially activate the deep neck extensors in a segmental fashion on the return from cervical flexion (see video). Cue here with manual resistance at the spinous process or articular pillars.


Start with low load exercises like this one with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles it the cervical spine. Then, progress to high-load exercises with the aim of inducing morphological adaptations in order to increase the strength and endurance of the selected muscles and movements.


posture prehab guys cervicogenic headaches


Cervicogenic Headache Exercises: Supine Chin Tuck

Sample Neck & Headache Programming Exercise


Cervicogenic Headache Exercises: Relaxing The Upper Traps

According to Cools et al. (2014), “the prevalence of neck and shoulder pain is known to increase with computer workload. There is a strong relationship between chronic neck and shoulder pain and dysfunction of the scapula. The scapula functions as a ‘bridge’ between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability to the neck/shoulder region.” According to Bogduk and Govind (2009), “noxious stimulation of the atlanto-occipital and lateral atlanto-axial joints, the C2–3 zygapophysial joint, and the C2–3 intervertebral disc can produce pain in the occipital region.” We also know the upper trapezius muscle originates on the occipital bone and upper cervical C1-C3 spinous processes. Taking this information into consideration, it would be wise to address the upper trapezius for trigger points, muscle length deficits, and/or overuse.

The goal of this exercise is to primarily inhibit the upper traps from working. To promote muscular inhibition, you want to cue the shoulder blades into depression and downward rotation as this is the opposite muscle action of the upper traps. Keep your neck ‘long and relaxed’ during this exercise. If you feel your head rising off the table and wanting to extend, take a break and try again with less force.


To perform this exercise:

  • Lay on your stomach and get into a comfortable position. Consider a pillow under your stomach, or under your chest, if your spine goes into excessive lordosis or kyphosis when you lay on your stomach.


  • Rest your forehead on your heads and relax your arms on the table. Your head and arms should be fully supported so that you can relax.


  • Push your hands into the table and pull your shoulder blades down towards your feet.


  • Hold this position for 5s, and repeat for a total of 5 reps.


  • Your neck and the region of the upper traps should be relaxed while you perform this exercise.


Cervicogenic Headache Exercises: Postural Awareness

As always, maintaining good posture while seated for countless hours at work is always beneficial. Not just for cervicogenic headache prehab, but also for overall musculoskeletal health!


Sample Neck & Headache Programming Exercise


Say Goodbye To Your Headaches!


Closing Thoughts

According to the literature, most patients treated conservatively with physical therapy see significant improvements in headache frequency, duration, and intensity within the first four weeks, so don’t be dismayed if you don’t see immediate results!

In summary, cervicogenic headaches are a particular subset of headaches that are caused by dysfunction in the upper cervical spine. Dysfunctional segments can be made functional again with manual therapy techniques such as soft tissue mobilizations or joint mobilizations and manipulation. Manual therapy should always be followed up with exercise. In the case of upper cervical manual therapy, SNAGs are the perfect exercise to combat cervicogenic headaches. Last but not least, strengthening the cervical and scapular muscles in addition to facilitating proper posture, are imperative in keeping your headache at bay.


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  1. Cools AMJStruyf FDe Mey K, et al 2014. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. 
  2. Hall, Toby, Ho Tak Chan, Lene Christensen, Britta Odenthal, Cherie Wells, and Kim Robinson. “Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache.” Journal of Orthopaedic & Sports Physical Therapy 37.3 (2007): 100-07. Web.
  3. Jull, Gwendolen, Patricia Trott, Helen Potter, Guy Zito, Ken Niere, Debra Shirley, Jonathan Emberson, Ian Marschner, and Carolyn Richardson. “A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache.” Spine 27.17 (2002): 1835-843. Web.
  4. Racicki, Stephanie, Sarah Gerwin, Stacy Diclaudio, Samuel Reinmann, and Megan Donaldson. “Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review.” Journal of Manual & Manipulative Therapy 21.2 (2013): 113-24. Web.
  5. Schomacher, Jochen, and Deborah Falla. “Function and Structure of the Deep Cervical Extensor Muscles In Patients with Neck Pain.” Manual Therapy 18.5 (2013): 360-66. Web.



  • Dana
    Posted at 09:13h, 26 March Reply

    You guys are wow!! Being a physiotherapist im greatly benefting from your posts. Keep up the great work.

  • Sarah
    Posted at 04:32h, 09 May Reply

    Yes! Thank you! I’m a STOTT Pilates instructor and I love your articles, and seeing the interplay of PT with my work.

    Posted at 09:56h, 09 May Reply

    I am a 66 yr old gormer athlete, dancer in youth, tennis player whose life has come to a barely bearable standstill- 24/7 headache, pulsatile tinnitus, reverse neck curve with severe bilateral foramenal stenosis C3-4, 4-5 and advanced Ddd elsewhere too to bottom. Have tried many conservative treatments but use pain med very sparingky when i cant stand another minute of pain. So depressed. Also pulsatile tinnitus one plus year. Just started with DO – very expensive, he says it will take a long time for my body to heal itself- not a he k of alot of room in there. Pressure on spinal canal only moderate but compression extreme. I am in every other respect in excellent health and want to believe my body can heal itself and unlikely surgeon will want to touch- do much osteophyte etc mess. My chiro has been trying to adjust elsewhere, loosen meninges (?) but not sure if working. Mist days are godawful. Was doing gentle yoga , pilates, by ke for cardii with tolerable pain but last feemonths everything seems intolerable aja more headache, spine pain.

    • Michael Lau
      Posted at 12:03h, 10 May Reply

      Hi Diane. Have you seen a physical therapist for your issues? If you are in the United States and would like assistance finding a physical therapist, please email us at theprehabguys@gmail.com with your zip code and we will assist you.

    • Alasdair
      Posted at 01:50h, 07 February Reply

      You cannot loosen someone’s meninges (this is the wrapping around your spinal cord that gives it blood supply and keeps the spinal fluid from leaking) and be very careful with Csp adjustment if you have lateral stenosis. As you are high risk to a VBI (form of stroke).

      Your conservative therapist should be doing techniques other than adjustment and be adding rehabilitation exercises. I would personally try and see an ENT specialist for the tinnitus as it is rarely due to cervical dysfunction in my experience.

      Sadly spinal stenosis can be a really nasty beast as it is bony growths forming and the body doesn’t tend to absorb these. However the other areas of compensation can often be relieved. I wont comment to much on your case as it is hard to advise without having actually seen the patient, but one exercise that is usually very good for short term relief is take a tennis ball or squash ball (the harder the better) and place it under the skull (under the occiput) lay on the the ball for around 10 seconds and rotate the head looking for other ‘knots’. If any of the areas radiate the pain to a similar area to the headache then that’s a spot you really want to work through and also stretch.
      There is a lot of work you can do to help this between physiotherapists, osteopathes, physical trainers, occupational therapists and acupuncturists

  • Andre
    Posted at 14:04h, 04 August Reply

    I’ve been dealing with these headaches and neck pains for the last 5 years and they’ve become unbearable. So bad that I wake up with them now.

    Yesterday morning I did all of the exercises above and I felt better the whole rest of the day. Going to start doing these daily as part of my morning routine.

    This has worked better than any other exercising and stretching I have done so far.

    • Michael Lau
      Posted at 08:03h, 11 August Reply

      Andre – So happy to hear that you feel better!! Go gentle on the exercises, but they are KEY in keeping your headaches at bay.

  • Rafi ullah
    Posted at 02:54h, 25 April Reply

    superb explanation.keep up this good work

  • Blake Badman
    Posted at 13:54h, 18 August Reply

    This is such an unbelievably awesome and well put together article!

    Definitely going to consider purchasing a PrehabX subscription after reading the quality of this work.

    Amazing stuff guys!

  • anestencreams.com
    Posted at 03:14h, 31 August Reply

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  • Averil
    Posted at 01:47h, 09 January Reply

    Having recently sustained a head/neck injury with severe headaches particularly bad on waking I was able to identify (having a medical background esp biomechanics) that the culprit was CO/C1 extension, and I was aware that I was actually causing myself problems when tossing and turning during sleep. My correct neck posture during the day alleviated the symptoms. My ongoing solution (that is immediately helping) is to avoid upper cervical extension by a) taking 10mg amitryptiline at night which reduces the sleep movement to the hour before waking b) to have a memory foam shaped neck pillow but arranged with another pillow over to prevent C0/C1 hyperextension, even if this means I’m a bit more neck flexed than usual. The pillow also supports the jaw in side lying. And c) to try and program myself that when I start to thrash around and turn in the hour before waking to hold the back of my head/neck, the supporting feeling being the trigger to remind me to turn over with head supported and preventing too much cervical movement and jerking. A course of stronger anti inflammatories may also be appropriate.

    • Michael Lau
      Posted at 10:08h, 17 January Reply

      So sorry to hear about your discomfort and pain, but happy to hear that you have found an ongoing solution to your discomfort!!! Exercises are key, and you should incorporate the exercises in this article during your day routine as well! All the best!

  • Susie Worthington
    Posted at 12:15h, 11 March Reply

    I have had a cervicogenic headache for over a year and a half. It is due to C1-C2 inflammation, muscles pinching the Occipital Nerve, or that is part of the diagnosis. I have looked for forums but they were years old. Do you know of a forum that contains people with my situation that I can talk to? Dealing with the medical system has been horrible.
    Thank you

    • Michael Lau
      Posted at 14:17h, 11 March Reply


      So sorry to hear about your frustrations with the medical system! Unfortunately, we are not aware of any forums for people. Are you in the US? Try find a PT on the APTA website to find a PT near you who can help!

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