Cervicogenic Headache Relief: Targeted Gonstead Chiropractic Treatment in Ringwood

1. Introduction

 

Headaches are one of the most common reasons Australians seek primary healthcare, with over 1.7 million GP visits related to them annually. Among these various headache types, the Cervicogenic Headache (CGH) represents a significant challenge. CGH is defined as a secondary headache, meaning the pain originates not in the brain itself, but is referred from musculoskeletal or neural structures in the neck, primarily the upper three cervical segments (C1–C3).  

When CGH restricts movement and diminishes the ability to perform daily tasks, many Australians seek effective, evidence-based, conservative care. Chiropractic practitioners specialise in the assessment and management of spinal mechanical issues, providing a non-pharmacological pathway to address this physical source of pain. Recent evidence suggests that specific cervical spinal manipulation is superior to conventional physiotherapy in managing CGH symptoms. This article explores the nature of CGH and outlines why targeted Gonstead chiropractic treatment, integrated within a multimodal care strategy, is positioned as an optimal, precision-based option to assist in symptom management and long-term functional improvement.

 

2. What is a Cervicogenic Headache?

Cervicogenic headache is classified as a chronic secondary headache that arises from the atlanto-occipital and upper cervical joints, with pain perceived in the head and/or face.  

Anatomy and Neurophysiological Basis

 

The root cause of CGH lies in the convergence of sensory pathways in the upper cervical spinal cord, known as the Trigeminocervical Nucleus (TCN). This nucleus acts as a relay station where pain signals from the head (via the trigeminal nerve) and the upper neck joints (C1–C3) meet.  

When mechanical dysfunction, such as stiffness, restricted movement, or trauma, affects the C1–C3 joints, the resulting abnormal sensory signals feed into the TCN. The brain can misinterpret this constant, amplified input from the neck as referred pain originating in the head, causing the characteristic headache pattern.  

Prevalence and Relevance in Australia

 

CGH is a common cause of chronic headache that is often misdiagnosed, leading to discrepancies in reported prevalence (ranging from 0.4% to 18% of all headache types). The true prevalence is believed to be higher than medically reported due to the complexity of distinguishing CGH from common primary headaches like migraine, particularly among practitioners lacking specialized musculoskeletal training. CGH is typically a chronic condition most common in people aged 30 to 44, affecting males and females almost equally.  

 

3. How Does the Condition Happen?

 

CGH is caused by any injury or condition that irritates the pain-sensitive structures of the upper cervical spine.

 

Biomechanical Causes and Triggers

 

The pain is often precipitated by neck movement, sustained awkward head positioning, or direct pressure over the upper cervical or occipital region on the symptomatic side. The most frequent anatomical source of CGH involves pathology of the C2-3 zygapophyseal (facet) joint, implicated in up to 70% of cases.  

Causes that lead to this joint and nerve irritation include:

• Trauma: Neck trauma, most notably whiplash from motor vehicle accidents, is a common trigger, often leading to arthritis or dysfunction of the C2-3 facet joint.  
• Postural Strain: Chronic tension or spasms in the deep neck muscles (e.g., suboccipital extensors) and upper shoulder muscles (e.g., upper trapezius) due to sustained poor posture (e.g., prolonged desk work) can increase the area’s sensitivity and mechanical stress on the C1–C3 joints.  
• Joint Dysfunction: Restricted movement (hypomobility) in the atlanto-axial joint (C1/C2) is considered the most important clinical finding in CGH diagnosis, as this segment accounts for 60% of all cervical rotation.

 

Differential Diagnosis: CGH vs. Migraine

 

It is critical to distinguish CGH from migraine and tension-type headache, as symptoms often overlap (e.g., unilateral pain, nausea, and light sensitivity can occur in CGH).

CGH is defined by its musculoskeletal characteristics, including:

• Pain that starts in the neck and is aggravated by specific neck movements or sustained postures.
• The headache is often ‘side-locked’ (does not swap sides).
• Presence of limited range of motion (ROM) and pain reproduction upon pressure over the upper cervical joints.

In contrast, migraine typically presents with a more pronounced sensitivity to light and sound, often involving nausea and vomiting to a greater degree. 

4. Who Does It Happen To?

 

CGH can affect a wide range of individuals, particularly those whose occupation or lifestyle involves chronic neck strain.

Typical Demographics and Risk Factors

• Age and Gender: CGH is typically a chronic headache most common in people aged 30 to 44, with no significant gender predominance.
• Occupational Risk: Individuals in occupations requiring sustained awkward head positioning or prolonged static postures (such as office workers, painters, or manual labourers) are at high risk due to the chronic strain placed on the C1-C3 joints.  
• Prior Trauma: A history of neck trauma, such as whiplash, significantly increases the likelihood of developing CGH due to potential facet joint pathology.  

5. Symptoms and Impact

 

The symptoms of CGH reflect the neurophysiological connection between the neck and head, resulting in pain that can range from moderate to severe.

 

Hallmark Symptoms

 

CGH symptoms commonly include:

• Unilateral (one-sided) pain or pain predominantly felt on one side, typically starting in the neck or back of the head (occiput) and spreading forward to the eye or temple.
• Pain that is non-throbbing (or rarely throbbing) and moderate in intensity.
• Restricted cervical range of motion (ROM), particularly in rotation.
• Pain aggravated by specific neck movements or sustained postures.  
• Associated pain in the shoulder, arm, or upper back on the same side.  
• May be accompanied by mild nausea, vomiting, or sensitivity to light/sound (though less common and less severe than in migraine).

 

Urgent Medical Warning Signs (Red Flags)

 

While CGH is a secondary headache, practitioners must always screen for signs of serious underlying pathology. Immediate medical attention is required for any of the following “Red Flags”:

• Thunderclap Headache: Sudden, severe onset of pain (often described as the worst headache ever).
• Neurological Signs: New-onset weakness, sensory changes, double vision, or altered consciousness.
• Vascular Dissection: Ripping/tearing sensation in the neck, or concurrent chest pain (suggestive of arterial dissection).
• Systemic Symptoms: Headache with fever, night sweats, or unexplained weight loss (suggestive of infection or tumour).

6. How to Help / First-Line Interventions

 

The initial management of CGH involves addressing mechanical stressors and encouraging active self-management. Staying active is crucial, as prolonged rest is generally counterproductive for mechanical neck pain.  

 

Lifestyle and Symptom Modification

1. Thermal Therapy: Applying cold packs initially may help reduce inflammation and pain sensation in the stiff or tender neck/occipital area. Alternating with heat packs can relax tight muscles (e.g., upper trapezius and suboccipitals).  
2. Posture and Ergonomics: Modifying the workstation setup to ensure optimal neck and shoulder posture is essential to prevent chronic strain. Patients should avoid prolonged static postures and change positions frequently.  
3. Gentle Exercise: Gentle stretching and active mobilisation exercises are recommended to help increase neck ROM and manage muscle tension associated with CGH. Foundational core stability exercises focusing on the deep neck flexor muscles are crucial for long-term recovery.

 

 

7. Other Treatments or Proven Interventions

 

Management of CGH often requires a multimodal approach, integrating conservative care alongside more invasive options for refractory pain.

Manual Therapy and Exercise

• Physiotherapy and Exercise: High-quality evidence supports the use of manual therapy (mobilisation and manipulation) combined with targeted therapeutic exercises for the management of CGH. Specific exercises targeting deep neck flexors and motor control training are effective in reducing symptoms and are often maintained long-term.
• Massage and Soft Tissue Therapy: Techniques like soft tissue massage and trigger point therapy are beneficial adjuncts to manual adjustments to assist in releasing overworked muscles (e.g., sternocleidomastoid, upper trapezius) that contribute to the pain referral.  

Specialist and Invasive Options

• Pharmacologic Management: Pharmacologic treatment (e.g., NSAIDs) is generally recommended as a first-line therapy for symptomatic relief of CGH.
• Diagnostic Nerve Blocks: The definitive criterion for confirming CGH is complete relief of headache pain after controlled diagnostic local anaesthetic blockade of the suspected cervical structure (e.g., the C2/3 zygapophyseal joint or the third occipital nerve).
• Interventional Procedures: For intractable (unresponsive) CGH, specialists may use minimally invasive procedures like targeted nerve blocks (occipital or cervical facet joint injections) or Radiofrequency Ablation (RFA) of the third occipital nerve for long-term pain relief, where acceptable evidence supports these procedures.

 

8. How Chiropractic Helps

 

Chiropractic care is positioned as the optimal non-pharmacological intervention for CGH due to its precision-based approach to correcting the biomechanical and joint restrictions driving the pain referral. A recent randomized controlled trial (RCT) found that cervical spinal manipulation (CSM) resulted in significantly better improvements in pain intensity, frequency, functional disability, and quality of life for CGH patients compared to conventional physiotherapy and thoracic spinal manipulation. Furthermore, systematic reviews suggest SMT has a better effect than massage for CGH.  

By utilizing highly specific assessment and adjustment techniques, chiropractic care aims to modulate the TCN and restore normal function to the C1–C3 joints.

The Chiropractic Assessment Process

A detailed clinical assessment is crucial for accurate diagnosis and exclusion of red flags:

1. Red Flag Screening: Mandatory screening for neurological deficits and serious underlying pathology is conducted, ensuring immediate medical referral when necessary.
2. Clinical Diagnosis (Upper Cervical Dysfunction): Assessment relies on a cluster of findings, including:
   • Cervical ROM: Measuring overall neck movement.
   • Flexion-Rotation Test (FRT): Specifically assessing rotation at the C1/C2 joint, a hallmark area of dysfunction in CGH.
   • Palpation: Identifying palpable upper cervical joint dysfunction and impairment in deep neck muscle function.  
3. Imaging Considerations: Diagnostic imaging is generally not routinely indicated for acute, uncomplicated headache but may be required if red flags are identified or if Gonstead X-ray analysis is needed to confirm specific structural findings.  

Specific Gonstead Methods for CGH Management

The Gonstead Technique employs a precision-based, structural approach specifically designed to address misalignments in the upper cervical spine, the anatomical source of CGH.  

1. The Gonstead Analysis and Nervoscope

The system relies on a rigorous, five-step analysis to locate the exact segment causing nerve interference (subluxation):

• Instrumentation (Nervoscope): This dual-probe instrument detects uneven heat distributions along the spine, which are indicative of localized inflammation and nerve pressure at specific segments (e.g., C2/C3).
• X-ray Analysis: Full-spine, weight-bearing X-rays are used to analyze alignment, structural integrity, and disc health, providing the precise details needed to determine the line of correction.
• Palpation and Visualisation: Static and motion palpation are used to confirm findings of swelling, tenderness, and restricted joint movement.

This detailed, multi-step analysis ensures the chiropractor can target the primary issue in the C1–C3 region, avoiding non-specific “shotgun” approaches.  

2. Targeted Gonstead Adjustments

 

Gonstead adjustments utilize a specific-contact, short-lever-arm, High-Velocity, Low-Amplitude (HVLA) thrust, applied with minimal rotation to restore appropriate movement to restricted spinal segments.

• Mechanism of Action (Biomechanical Correction): Specific adjustments to the C1–C3 joints help restore normal mechanics and proprioceptive input. This action aims to reduce the mechanical strain and abnormal sensory signals flowing from the neck into the TCN, which is hypothesised to reduce central hypersensitivity.  
• Neurophysiological Effect: Spinal manipulation has been shown to impact central pain processing, helping to prevent secondary hyperalgesia (increased pain sensitivity) and improve sensory-motor integration, which is vital for long-term stability and pain management.  
• Specialised Tables: Gonstead uses specific equipment, such as the Cervical Chair, designed to achieve optimal patient positioning for highly specific corrections in the neck region.

By combining precision manual therapy with evidence-based exercise advice, Gonstead chiropractic care offers an optimal strategy to assist in the long-term management of CGH, focusing directly on the physical structures responsible for the pain.

9. Your Next Steps

 

Cervicogenic headache is highly treatable through conservative care, but success depends on correctly identifying the C1–C3 joint dysfunction. The first crucial step is obtaining a precise, detailed assessment that investigates the biomechanical factors contributing to your pain.

A professional assessment using the precision of the Gonstead system will determine the specific structural issues in your neck and establish a safe and effective plan tailored to your needs. The goal is to move beyond temporary pain management toward long-term functional stability and headache reduction.

If you’re in Ringwood or nearby suburbs, our experienced Gonstead chiropractors can help you find relief and restore movement. Book your consultation with Ringwood Chiropractic today.

 

10. Other Options: Multidisciplinary Care

 

For optimal long-term results, particularly in chronic or complex cases, a collaborative, multidisciplinary approach is highly recommended. Ringwood Chiropractic operates within this framework, recognising that integrated healthcare provides the most comprehensive support.  

This collaborative team often includes:

• General Practitioners (GPs): Central to coordinating care, screening for inflammatory conditions, and managing pharmacological intervention.
• Physiotherapists / Exercise Physiologists: Specialists in designing tailored therapeutic exercise and motor control programs, crucial for strengthening deep neck flexors and ensuring long-term stability.
• Pain Management Specialists: May be consulted for definitive diagnostic nerve blocks or interventional procedures like Radiofrequency Ablation (RFA) in cases of refractory pain.
• Psychologists/Counsellors: Help patients manage the stress and psychosocial factors often associated with chronic pain.

This integrated approach ensures the patient receives holistic care guided by the best available evidence.

 

11. References

1. Australian Commission on Safety and Quality in Health Care (ACSQHC). (2022). Low Back Pain Clinical Care Standard. Retrieved from https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard.  
2. Bogduk, N., & Govind, J. (2009). Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurology, 8(10), 959–968.
3. Gonstead. (n.d.). Overviews of Gonstead Technique. Retrieved from https://gonstead.com/overviews-of-gonstead-technique/.  
4. Jull, G., et al. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 27(17), 1835–1843. DOI: 10.1097/00007632-200209010-00004.
5. Jull, G., et al. (2023). Early research validated manual examination of the upper cervical segments. Musculoskeletal Science and Practice. DOI: 10.1016/j.msksp.2023.102787.
6. Laslett, M., & Williams, M. (1994). The reliability of selected pain provocation tests for sacro-iliac joint pathology. Spine, 19(11), 1243–1249.
7. Morshedi, N. (2023). Lumbar Radiculopathy Treatment. StatPearls. Retrieved from ((https://www.ncbi.nlm.nih.gov/books/NBK448172/)).  
8. Nambi, G., et al. (2024). Comparative effectiveness of cervical vs thoracic spinal-thrust manipulation for cervicogenic headache. PLoS One, 19(3). DOI: 10.1371/journal.pone.0300737.
9. National Institute for Health and Care Excellence (NICE). (2020). Low back pain and sciatica in over 16s: assessment and management. NICE Guideline NG59.
10. Robinson, D. A. (2023). Sciatica. In StatPearls. StatPearls Publishing. Retrieved from ((https://www.ncbi.nlm.nih.gov/books/NBK507908/)).  
11. Royal Australian College of General Practitioners (RACGP). (2022). Imaging in adults with acute low back pain. First Do No Harm. Retrieved from https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/first-do-no-harm/gp-resources/imaging-in-adults-with-acute-low-back-pain. 
12. Vernon, H., et al. (2001). Efficacy of spinal manipulation for chronic headache: A systematic review. Journal of Manipulative and Physiological Therapeutics, 24(7), 457–466.