cervicogenic headache - trigger point therapy

Myofascial Trigger Point referrals from muscles in the neck can cause Cervicogenic Headache

Symptoms are similar to tension headaches and migraines. However, cervicogenic headaches often begin in muscles in the upper neck.

If you have cervicogenic headache – trigger point therapy can help! For general headache info, please see this intro.

Typically, people who have cervicogenic headaches experience a headache accompanied by neck pain and stiffness. Certain neck movements can provoke cervicogenic headaches.

In most cases, cervicogenic headaches develop on one side of the head. Often, they settle right behind one eye.

Some other symptoms of a cervicogenic headache include:

  • pain and stiffness of the neck
  • pain around the eyes
  • sensitivity to light and noise
  • nausea
  • blurred vision

That sounds quite a bit like a migraine or a tension headache!

Except, that cervicogenic headaches usually include these symptoms too:

  • Reduced range of motion in the neck
  • Pain in the neck, shoulder, or arm on one side
  • Head pain that is triggered by certain neck movements or positions

It is important to determine which muscles are contributing to myofascial dysfunctio in your neck.

Cervicogenic vs Other Headache Types

The pain and other other symptoms of cervicogenic headache are referred into the head from structures in the neck. The symptoms are very similar to tension headaches and migraine headaches. The primary difference is that cervicogenic headaches start a with event in the neck:

  • Keeping your neck in an odd position for an extended time.
  • A sudden movement of the head or neck.
  • A recent injury, such as whiplash.

So far, the issue is not well studied. However, there is a mechanism that turns tension headaches and migraines into chronic headache. We assume that central sensitization also turns episodic cervicogenic headaches into chronic headaches.

For treatment of cervicogenic headache pain – trigger point therapy can be a powerful tool for relief.

Cervicogenic Headache Characteristics

cervicogenic headache - trigger point therapy

If these symptoms1 sound familiar it is because they are similar to migraine symptoms.2

You may wake up with  cervicogenic headache from “sleeping wrong”. Usually, your pain is on one side of your head.

Many times, it settles in one spot – maybe behind your eye. Your neck is stiff and doesn’t bend fully to one side.

You have sensitivity to light and noise, nausea and blurred vision. In fact, it’s a lot like the tension headaches and migraines some of your friends have.

Lately, you’ve been keeping a headache diary and you noted these things:

  • It seems like it really starts further back and then moves up towards your eye
  • It seems to happen after particular movements of your neck or if keep your neck a certain way.
  • Your pain extends from your neck to shoulder to arm on one side.
  • Certain things seem to trigger your headaches, similar to migraines.

Official classification of headache types, duration and frequency has been done by the Internation Headache Society.3 However, they consider cervicogenic headache to be a secondary headache.

Cervicogenic headaches can last for for many hours – or even many days. Left untreated, they take on the same type of chronic character as other headaches. This probably comes from central sensitization.

OTC pain medication (NSAIDs) can be effective for the temporary treatment of cervicogenic headache if the underlying cause is inflammation.

You many have heard that certain anti-seizure medication and anti-depressants can be helpful in some cases.

Frequent use of pain medications for cervicogenic headache can cause medication overuse headache or rebound headache.

Cervicogenic Headache – Trigger Point Therapy

medical history myofacial therapy trigger point

We focus on history, lifestyle, pain patterns and other symptoms to sort out your myofascial pain. There is a myofascial component to many types of headaches.

Notably, myofascial pain is not caused by contracted or ‘tense’ muscles. They have no electrical activity.

Chronic Headache – Myofascial TriggerPoint Referral Patterns

We can clearly see how referral patterns of head and neck muscles evoke the pain patterns of migraines, tension headaches, cervicogenic headaches. They even overlay the symptoms of cluster headaches and TMJ headache pain. Some of the factors that activate those muscles may not covered by doctors. Those activation factors are things we care a lot about.

Myofascial activations are a part of most headache patterns!

Sometimes, when people are in chronic pain, medical history reveals problems with body mechanics. Body mechanics includes all the various ways that hold ourselves and move as we do things. Sometime is it how we hold ourselves when we are NOT doing things, like sitting.

Repetitive Use

When ever we are making repetitive movements, we should be mind of using proper body mechanics. This will help minimize repetitive stress injuries and myofascial activations. For instance, lifting in a stooped posture and then twisting is always ill-advised. Doing it repetitively is worse. Therefore, if this type of lifting is required, we should rethink the task and try to organize it in a way that reduces stooping and twisting.

However, even simple movements matter. For instance, what if your desk is arranged phone on the wrong side. In fact, with every call, you have to twist your head and neck and reach over with your arm to the wrong side of the desk This is poor body mechanics. Fixing it might be as simple as moving the phone.

It pays to think about basic body mechanics in this common sense way each time we engage in a repetitive activity. Fortunately, we’re starting to teach this important skill to young people, as in this student guide at University of Michigan.


We can experience chronic overload when we do things like wear high heels, carry a heavy bag or lean into our work.

However, acute overload happens when we decide to lift, push, pull or otherwise move something that is too heavy for us. Most often, we overload our muacles with an eccentric contraction.

For example, lifting a heavy box, correctly using your legs instead of your back, requires concentric contractions of your quads. However, setting that same heavy box down, slowly and with control, require eccentric, lengthening contractions. These should be done carefully.

Spill it!

Of course, if you have a diagnosis from your doctor, we need to know. If you have recent imaging or other test results, even better!

We’ve all been knocked around a bit. We’d like to know everything you can think of about prior accidents, injuries, surgeries and other treatments.

It is important to know about previous or current medical conditions that could impact our treatment. Anything from high blood pressure to TMJD to disc problems are vital information.

Hopefully, medications align with your diagnosis. Sometimes, certain medications will also modify our reatment options. Some drugs interfere with nutrient absorbtion.

Increasingly, supplement use is common. Typically, we’re on the look out to make sure you whether you taking certain supplements.

Cervicogenic Headache – Trigger Point Referrals Overlap

There are several common patterns that are similar to the pain patterns of cervicogenic headaches. For example, the patterns of the SCM, upper trapezius and temporalis muscles all refer pain strongly to the side of the head and the area above and behind the eyes.

In addition, trigger points in some of these muscles can also cause nausea, blurred vision, vertigo, sensitivity to light and other hearing and visual disturbances. Sound familiar?

First, take a moment to consider where your own pain is during a headache. We will usually have you draw it. Pay attention to the location and how it radiates.

Where Does The Pain Refer?

Next, we take a look at referral patterns for that part of the body. Sometimes, there is more than one referral pattern that seems to match your pain.

Myofascial referrals may explain most of your pain pattern!

Treatment of cervicogenic headache focuses on treating underlying neck problems. Typically, these underlying causes are in the C1-C3 region at the top of the spine.

Notably, the SCM muscle in the front of the neck is closely associated with the C2/C3 nerve roots. Furthermore, these nerve roots are associated with pain patterns and other issues with your eyes.

Some cervicogenic headaches seem to originate with muscles in the back of the head and neck. First, the suboccipital muscles refer up into the back of the head. In addition, trigger points in these muscles can also cause occipital neuralgia.

In fact, research proves that one of suboccipital muscles attaches directly to the lining of the brain. Therefore, releasing trigger points in this area is vital.

Determining accurately which muscles are causing myofascial pain is crucial to treating cervicogenic headache.

From the outset, education is important. It is our job as therapists to educate you about our assessment and our process. Then, throughout our treatment, we continue this education process.

Myofascial treatment can get at some aspects of cluster headache pain that you might not have thought of!

Unfortunately, sleep posture and sleep disturbances contribute to many myofascial pain syndromes. However, this is especially important for relief from chronic headaches. Because of this, we always have a thorough discussion about how you sleep during an initial assessment.

Diaphragmatic breathing is at the foundation of myofascial trigger point treatment. But, if you don’t know how to do it, we will teach you. On the other hand, if you already know about it, we will help you deepen the technique.

Of course, the medications and supplements you are taking matter too. Usually, reducing drug consumption is a good thing. However, it should be done gradually and in consultation with your physician.

Keeping a headache diary is an important tool for understanding headaches. Also, it is how we clearly see things that improve our headaches – or not.

Structural variations need to be explored and understood. Once treatment begins, they can be accomodated or corrected in various ways.

It is surprising, but most of us our not taught proper body mechanics. Whether we are at home or at work, we need to learn how to use our body correctly.

Most people are self-conscious about their posture. But, identifying the postural aspects that should be improved is a challenge. Even harder, is understanding how they vary with movement. Ultimately, devising a strategy for improving them is essential.

All of these issues can be successfully addressed!

However, it usually takes more than hands on work to really erase the pain and keep it away.

First, the chances are that we were not your first stop. As a general rule of thumb, the longer you have experienced headaches, the longer it will take to make them go away.

Secondly, there are usually at least some factors that might be part of your headache picture that are out of our scope of practice.

In contrast, if we are treating someone for tennis elbow, we can work on the muscles at play. We can talk with you about some modifications for your game and your lifestyle. Then, we can tell you that if you feel the OTC pain reliever you are taking isn’t needed anymore that you can stop taking it. Finally, we can offer you stretches and other self-care advice that are pretty straightforward

However, if you are suffering from serious headaches, you may have some other more complex factors at play. Often, you may be working with other providers on vascular (blood vessel), neurological, psychological and other issues. You may be taking prescription medications that you should discuss with your doctor.

Chronic headache treatment is often inter-disciplinary.

Myofascial tigger point therapy – it’s how you work this!

Education is the first step in the myofascial treatment protocol.

Sometimes, we may not be good enough at explaining how myofascial pain works and how it activates your headaches.

However, we believe that people can make more progress when they know more about their condition. So, we try to understand what your learning style is give you as much information as you want – but hopefully not too much!

Typically, we performing series of miniature cycles of test/assess, treat and test/assess again. It is an informed exploration for both of us.

We have an initial assessment from your history, postural and range of motion exams, etc. Then, we use various treatment techniques before testing and assessing again.

Manual Therapy Techniques

First, we specifically expertly use manual pressure release therapy, neuromuscular techniques, and deep stroking, friction, skin rolling. When indicated, we also use fascial stretching. Sometimes, we use less common techniques like cupping, spray and stretch and acoustic compression.

Muscle Activation

In addition, we may also use active and passive muscle activation techniques. This includes reciprocal inhibition, postisometric relaxation, contract/relax, strain/counter-strain and muscle energy techniques. Sometimes, we also use hot/cold therapy.

Range of Motion/Testing

Finally, routinely run the muscle we are treating through its entire, pain-free range of motion. This is part of your treatment. However, it also the start of a new test/assess cycle.

We learn together whether your range of motion has increased and whether your pain is reduced. We may have you get up and use your body in the way that causes pain to ‘test’ more dynamically.

As we finish our hand-on work, we transition into learning new movement strategies and self-care.

Myofascial tigger point therapy – it’s how you work this!

For general myofascial wellness, a quiet, regular self-inspection of our own bodies will often tell us where trouble lies. In addition, it will also give us the opportunity to address problem areas.

For example, in Tai Chi, we go through a slow, controlled series of movements. However, we are not trying to stretch or strengthen anything. Rather, we are re-calibrating our nervous system and our myofascial system with each other. Instead, it is basically a form of movement or neuromuscular therapy.

However, during these gentle movements, we may notice variations in our range of motion. In fact, limited range of motion is a symptom of an unhappy muscle. Plus, we may experience pain. That is also a symptom of an unhappy muscle.

In activities like the Yamana rolling ball technique, we also go through series of movements. However, as we move, we are rolling over muscles that may be sore. So, we also have the opportunity to treat them with manual compression.

Cluster Headache – Myofascial TriggerPoint Compression

First, the most basic self-care tool is the tennis ball. Actually, we suggest using two tennis balls in a sock. Also, the sock gives you a “handle” so you don’t drop the ball. Finally, two balls will give you more options and control.

Sometimes, we use fitness balls, large foam rollers or handheld rollers such as the Tiger Tail for self-compression.

However, awesome tools like the Backknobber can be used sitting, standing or lying down. Happily, it allows you to target specific areas in each muscle you want to work with. In fact, the leverage of the tool and pinning it between your body and floor allows access to quite a number of back and neck muscles. In addition, this approach can also be used with some large chairs, recliners and couches when sitting.

There are other approaches to passive self-compression for muscles of the head.

Myofascial self-care helps reduce the frequency and severity of migraines!

Cervicogenic Headache – Trigger Point Self-Care Stretches

Typically, certain muscles tend to be tight in most chronic headache patients. Your therapist will give you specific advice about muscles that you should stretch.

However, most of us need to stretch our pecs, SCM, upper traps and levator scapula. After self-compression, these muscles can be stretched gently and effectively. You may also benefit from stretches of certain muscles on the back of your neck. Unfortunately, most of these muscles are over-stretched by head forward posture anyway. Your therapist can help you target specific muscles in the back of the neck.

Neck rolls and other vigorous neck stretches are always a bad idea.

It is the time to explore problems with the muscles of your TMJ more thoroughly. In addition, this is the time to strengthen your deep cervical flexors, serratus anterior, lower traps and other postural muscles.

Myofascial self-care helps reduce the frequency and severity of cervicogenic headaches!

Cervicogenic Headache – Trigger Point Perpetuation

Structural Variations

For instance, a difference in either the actual or apparent length our legs is not uncommon. In fact, a difference of 1/4″ can cause myofascial pain.

On the other hand, our legs might be the same length and the two sides of our pelvis might be different sizes. Imbalances caused by myofascial trigger points can pull one side of your hip up while the other falls.

In addition, we can find ourselves out of balance from front to back. For example, this can happen as the result of Morton’s Foot Structure. The slight downward angle created in the foot is like adding a heel to your shoe. Surprisingly, it can pitch your entire body forward. In fact, Morton’s Foot Structure can contribute an inch or more to head forward posture.

Some of us have relatively short upper arms. This means that computers, desks and other furniture is not built for us. Because of this, we might benefit from some changes to our workspace and other environments.

Either way, we are built the way we are and it is ok.4

All of these variations can be accomodated or corrected. Myofascial therapists know how!