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Almost 25% of all headaches are referred from the cervical spine. Fortunately, chiropractic treatment of cervicogenic headache (CGH) is very effective.  Manipulation of the cervical spine along with myofascial release and exercise are proven to alleviate symptoms and decrease reccurrence.

The pathophysiology of CGH is debatable, but the anatomical basis is thought to be a convergence of sensory neurons from the cervical spine and trigeminal nerve in the trigeminocervical nucleus located in the upper cervical spinal cord. This convergence allows bidirectional referral of pain between the neck and head. Furthermore, the identification of myodural bridges between the spinal cord dura and suboccipital musculature has obvious mechanical implications. Other less complicated theories suggest mechanical irritation of the greater occipital nerve as it emerges from the suboccipital region.

However sometimes the origin of a headache is not so benign.

(Read on to review the signs and symptoms of ominous pathology and download our updated headache exam form.)

Once we identify a cervicogenic etiology – treatment is simple.

  1. Correct postural stresses and repetitive motions that overload the irritated musculoskeletal tissue.
  2. Treat the affected tissue with manipulation and myofascial release to reduce symptoms.
  3. Prescribe the right exercises to promote balance and increase strength/capacity of weakened tissue.

What happens when the etiology is unclear?

First and foremost, take a detailed history of every patient.  Often, patents will tell you their diagnosis well before your physical evaluation. Their collection of symptoms and timeline often matches textbook examples of typical conditions. Providers should become very concerned when the patient’s history does not sound familiar. Your exam serves to refine your short list of possibilities.

Check out this exam form highlighting the most sensitive and specific tests for head and orofacial diagnoses.

ChiroUp has continually refined this exam form as new data yields relevant information. The exam includes sections dedicated to identifying threatening pathology.  The section on “Worrisome HA”, adapted from the American Headache Society (1,2) allows chiropractors to screen patients for possible VBAI.

Hori E, et al. (2018) elaborated on worrisome findings in a recently published a paper outlining the most common symptoms in ER patients presenting with VBAI:

“Of the 29 (VBAI) patients, 23 presented with an occipital headache and/or nuchal pain. The pain was persistent in 26/29 and ipsilateral in 29/29. However, only 16/29 reported a typical sudden onset. Only 12/29 complained of severe pain, while the other 17/29 presented with dull pain.” (3)

The ChiroUp mission is to take the most up-to-date research and make it usable in both clinical care and direct patient education. ChiroUp is designed to help evidence-based chiropractors achieve the best outcomes with every patient, every day.

If you haven’t tried ChiroUp yet, click here to start your free trial today. Learn how easy it is to perform at the top of your game and grow your practice through consistent results.


  1. Silberstein SD, Lipton RB, Dalessio DJ. Overview, diagnosis, and classification. In: Silberstein SD, Lipton RB, Dalessio DJ, eds. Wolff’s Headache And Other Head Pain. 7th ed. Oxford, England: Oxford University Press; 2001:20
  2. Dodick DW. Adv Stud Med. 2003; 3 (6C): S550-S555
  3. Hori E, et al. Characteristics of Headache and Neck Pain in Spontaneous Vertebral Artery Dissections. No Shinkei Geka. 2018.

About the Author

Dr. Brandon Steele

Dr. Brandon Steele


Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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