Headaches can be brutal. They make it hard to work, focus, enjoy family time, or even tolerate light and noise. Many people assume all headaches are “migraine” or just tension, but there is another common type that often slips under the radar: cervicogenic headaches.
Cervicogenic headaches are headaches that actually start in the neck. The pain you feel in your head is referred from irritated joints, muscles, or nerves in the upper cervical spine. That is why medications alone often do not bring lasting relief—because the true source of the problem is not being addressed.
Physical therapy is uniquely positioned to help with this type of headache. By targeting the joints, muscles, posture, and movement patterns of your neck and upper back, a physical therapist can help calm irritated structures and retrain your body to move in a way that is less likely to trigger headaches in the first place.
In this guide, we will cover:
- What cervicogenic headaches are and how they differ from other headaches
- Common causes and triggers
- How physical therapists evaluate neck-related headaches
- Treatment strategies used in the clinic
- Simple habits and exercises that can support your recovery
What Is a Cervicogenic Headache?
A cervicogenic headache is a head pain that comes from a problem in the neck. Instead of starting in the brain or blood vessels, the headache is referred pain from structures like:
- Joints between the upper neck vertebrae
- Discs and ligaments in the cervical spine
- Muscles in the neck, shoulders, and upper back
- Nerves that travel from the neck into the head and face
The brain has a hard time telling where certain types of pain are coming from, so it “maps” pain from the neck as if it is coming from the head. The result is a headache that may feel like it is behind the eye, in the temple, or along one side of the skull, even though the root issue is in the neck.
Common Features of Cervicogenic Headaches
While only a healthcare provider can give you a diagnosis, cervicogenic headaches often have patterns like:
- Headache that usually affects one side of the head
- Pain that starts in the neck or at the base of the skull and moves upward
- Headache triggered or worsened by certain neck positions or movements
- Neck stiffness or reduced range of motion
- Tenderness when the neck or upper back muscles are pressed
- Sometimes associated with shoulder or arm discomfort on the same side
Many people with cervicogenic headaches also have tension or migraine headaches, which can make things more confusing. A physical therapist helps untangle which symptoms are neck-driven and which may need other approaches.
How the Neck Causes Headaches
To understand cervicogenic headaches, it helps to look at how closely the neck and head are linked.
Joints and Nerves of the Upper Neck
The top three vertebrae in the neck sit right under the skull and form joints that allow you to nod and turn your head. Nerves from these joints and surrounding tissues share pathways with nerves that carry sensation from parts of the head and face. When these neck structures become irritated, inflamed, or stiff, the nervous system may interpret that irritation as head pain.
Muscles, Posture, and Tension
Muscles at the base of the skull and along the neck and shoulders work hard to hold your head up and control movement. Poor posture, stress, and repetitive positions can overload these muscles, causing trigger points and tension that refer pain into the head.
Common culprits include:
- Forward head posture from computer or phone use
- Long hours of driving or desk work without breaks
- Habitually holding the phone between your ear and shoulder
- Heavy bags or backpacks carried on one side
When these patterns repeat day after day, the muscles never fully recover, and the neck joints may start to stiffen. Over time, this becomes a fertile ground for cervicogenic headaches.
Common Causes and Triggers of Cervicogenic Headaches
People develop cervicogenic headaches for many different reasons, including:
- Whiplash or trauma: car accidents, sports impacts, or falls that strain the neck.
- Degenerative changes: arthritis or disc changes in the cervical spine.
- Poor workstation setup: monitors too low, chairs without support, or laptops used on beds or couches.
- Repetitive or sustained postures: long periods of looking down at phones or tablets.
- Muscle imbalances: weak deep neck and upper back muscles with overworked superficial muscles.
- Stress and clenching: bracing through the shoulders and neck during stressful times.
Often it is a combination of these factors rather than just one. The job of a physical therapist is to identify which are most important for you and build a plan around them.
When Headaches Need Immediate Medical Attention
Most cervicogenic headaches are musculoskeletal and respond well to conservative care. However, some headaches signal serious medical issues that need immediate attention. You should seek urgent medical care if you experience:
- Sudden, severe headache unlike anything you have had before
- Headache with fever, rash, stiff neck, or confusion
- Headache with vision changes, trouble speaking, or weakness on one side
- Headache after a significant head injury with vomiting or loss of consciousness
- Headache with chest pain, shortness of breath, or other concerning symptoms
Physical therapists are trained to screen for these “red flags” and refer you out if something does not fit a musculoskeletal pattern.
How Physical Therapy Evaluates Cervicogenic Headaches
At Cawley Physical Therapy & Rehabilitation, an evaluation for cervicogenic headaches is thorough and hands-on. It typically includes:
Detailed History
Your therapist will ask about:
- Where your headaches start and where they spread
- How often they happen and how long they last
- What makes them better or worse (certain movements, positions, activities)
- Any history of injuries, surgeries, or other health conditions
- Your work tasks, hobbies, and typical daily posture
- Any associated symptoms like dizziness, eye strain, jaw pain, or numbness
This helps narrow down whether the neck is likely involved and which structures may be contributing.
Physical Examination
Your therapist will then look at:
- Neck range of motion: how easily and symmetrically you can turn, bend, and look up or down.
- Joint mobility: how the joints in your cervical spine and upper back move when gently tested.
- Muscle length and strength: especially around the deep neck flexors, upper trapezius, levator scapulae, and shoulder blade stabilizers.
- Posture: alignment of your head, shoulders, and thoracic spine in sitting and standing.
- Headache reproduction: whether certain neck movements or pressures reproduce your typical headache.
All of this information guides a personalized plan to treat the root causes of your headaches rather than just the symptoms.
If your headaches always seem to start in your neck or upper shoulders, it is worth having your spine evaluated by a physical therapist. Contact Us today for a free pain assessment
Physical Therapy Treatment for Cervicogenic Headaches
Once your therapist understands your specific pattern, treatment focuses on calming irritated structures and teaching healthier movement patterns.
Manual Therapy
Hands-on techniques may include:
- Gentle joint mobilizations to improve movement between cervical vertebrae
- Soft tissue work on tight muscles in the neck, shoulders, and upper back
- Trigger point release in muscles that refer pain to the head
- Mobilization of the upper back and rib cage to support better posture
Manual therapy often provides short-term relief and sets the stage for exercises to “hold” those improvements.
Targeted Exercises
Exercise is where long-term change happens. Your program may include:
- Deep neck flexor training: small, precise movements that strengthen the muscles that support the front of your neck without overusing the big surface muscles.
- Scapular and upper back strengthening: exercises for the mid-back and shoulder blade muscles that help keep your head and neck in a better position.
- Stretching tight muscles: gentle stretches for the upper trapezius, levator scapulae, chest, and other overactive muscles.
- Neck range-of-motion work: controlled movements to improve mobility without provoking pain.
The goal is not to force the neck into extreme positions, but to restore comfortable, controlled movement.
Posture and Ergonomics
Your therapist will likely help you adjust your workstation, driving position, and other daily setups. This might include:
- Raising your screen closer to eye level
- Adjusting chair height and lumbar support
- Positioning keyboards and mice to reduce shoulder and neck strain
- Learning “reset” positions for breaks during long tasks
Small changes here can make a big difference in how often your headaches show up.
Movement and Habit Coaching
Treatment also focuses on how you move throughout the day:
- How you look down at your phone (bringing the phone up versus dropping your head)
- How you lift, carry, and reach
- How often you take breaks and change positions
- Strategies for stress-related muscle tension, like simple breathing or relaxation drills
By changing the habits that irritate your neck, you reduce the triggers that feed cervicogenic headaches.
Simple At-Home Strategies (General Guidance)
While nothing replaces an individualized plan, there are a few gentle strategies many people find helpful:
Chin Tucks (Very Gentle)
- Sit or stand tall with shoulders relaxed.
- Gently glide your head straight back, as if making a double chin, without tilting up or down.
- Hold 3–5 seconds, then relax.
Repeat 8–10 times a few times per day. This helps encourage a more neutral neck alignment.
Shoulder Blade Squeezes
- Sit or stand with arms relaxed at your sides.
- Gently draw your shoulder blades back and down, like putting them into your back pockets.
- Hold 5 seconds, then relax.
Repeat 10–15 times. This builds endurance in the muscles that anchor your shoulders and support your neck.
Micro-Breaks from Screens
Every 30–45 minutes:
- Look away from your screen.
- Gently turn your head right and left, then up and down within a comfortable range.
- Roll your shoulders a few times.
These small breaks give your neck a chance to reset and help prevent tension from building.
If any exercise increases your headache or causes new symptoms (like sharp pain, numbness, or dizziness), stop and discuss it with a healthcare provider.
Cervicogenic Headache Care at Cawley Physical Therapy
At Cawley Physical Therapy & Rehabilitation, we understand how draining chronic headaches can be. Our approach to cervicogenic headaches includes:
- A thorough evaluation to confirm that your headaches are neck-related
- A tailored combination of manual therapy and exercise to calm pain and restore movement
- Ergonomic and posture coaching that fits your actual work and home life
- Education so you know what is happening and how to manage flare-ups
- Support and accountability as you build new, healthier habits
The goal is not just fewer headaches, but more control, confidence, and freedom in your daily life.
If you are in Northeast Pennsylvania and ready to explore a neck-focused approach to headaches, we are here to help. Contact Us today for a free pain assessment.
Frequently Asked Questions About Physical Therapy for Headaches: Treating the Root Cause of Cervicogenic Headaches
1. How do I know if my headaches are cervicogenic and not migraines or tension headaches?
It can be difficult to tell on your own, because different headache types often overlap. Cervicogenic headaches tend to start in the neck or at the base of the skull and usually affect one side. They are often triggered or worsened by certain neck positions or movements and may be accompanied by neck stiffness or tenderness when you press on specific muscles or joints. Migraines often involve throbbing pain, light or sound sensitivity, and nausea, while tension headaches may feel like a tight band around the head. A physical therapist or other healthcare provider can take a detailed history, examine your neck, and help determine whether your symptoms are at least partly driven by your cervical spine. Many people actually have a combination of headache types, and neck treatment can still be very helpful.
2. Can physical therapy help if I have had headaches for years?
Yes, physical therapy can still be beneficial even if your headaches have been around for a long time. Chronic headaches often involve not just irritated joints and muscles, but also nervous system sensitivity and long-standing movement and posture patterns. Addressing these factors takes time, but it is possible. A therapist will not only work on the neck and upper back directly, but also teach you how to move, sit, and work in ways that place less strain on your cervical spine. You may also learn strategies for managing stress-related muscle tension and pacing your activities. While long-standing headaches rarely vanish overnight, many people notice improvements in frequency, intensity, or duration of attacks once they start addressing the mechanical and lifestyle contributors, rather than relying only on medication.
3. Will neck exercises make my headaches worse?
Neck exercises should not make your headaches significantly worse when they are properly selected and progressed. However, if you perform movements that are too aggressive, move too quickly, or push into sharp pain, you might temporarily aggravate symptoms. This is why it is important to start with gentle, controlled exercises that focus on posture, deep muscle activation, and small ranges of motion. A physical therapist will monitor your response and adjust as needed, adding challenge gradually as your tolerance improves. You may feel mild muscle fatigue or a gentle stretch, which is normal, but your headache should not spike dramatically. If it does, that is useful information; your therapist can tweak positioning, intensity, or exercise choices so you continue to progress without provoking flare-ups.
4. How long does it usually take to see improvement from physical therapy for cervicogenic headaches?
Timeframes vary based on how long you have had headaches, how severe they are, and what else is going on with your neck and general health. Some people notice changes within a few sessions, such as slightly easier neck movement, less stiffness on waking, or shorter headache episodes. Others, especially those with years of headaches or multiple contributing factors, may need several weeks or months of consistent work to see clear progress. Think of it as retraining a system that has been stuck in a certain pattern for a long time. Your therapist should set realistic expectations, check in about your goals, and adjust your plan as you go. The aim is steady, sustainable improvement rather than quick but short-lived relief.
5. Do I have to stop my normal activities while I am in therapy for headaches?
In most cases, you will not need to stop everything you are doing. In fact, one of the goals of physical therapy is to help you stay as active as possible while reducing pain. That said, your therapist may recommend temporary modifications to certain tasks that clearly aggravate your headaches, such as prolonged looking down at a phone, heavy lifting with poor mechanics, or long hours at a poorly set-up workstation. Instead of complete rest, you will work together to find tolerable versions of those activities, plus appropriate breaks and stretches. Over time, as your neck becomes stronger, more mobile, and better supported, you can usually resume more of your usual routine with fewer symptoms. The focus is on helping you live your life with less pain, not taking away the things you enjoy.