Cervicogenic Headache Exercises

This blog post contains the best exercises to get rid of Cervicogenic Headaches.

Cervicogenic Headaches are headaches that are referred from the muscles, joints, discs, ligaments and/or nerves of the neck.

It is often influenced by:

Exercises To Fix Cervicogenic Headaches

Cervicogenic headaches are usually associated with tightness/pain/injury/strain to the following structures:

(Keep in mind – You do not need to address ALL of the areas listed above. It really depends on where your headaches are specifically originating from.)


1. Base Of the Skull

base of skull

Tension at the base of the skull is usually associated with tightness in the Sub-Occipital muscles and Upper neck joints.

a) Sub-Occipital Muscles:

  • Rectus Capitis Posterior Major
  • Rectus Capitis Posterior Minor
  • Obliquus Capitis Superior
  • Obliquus Capitis Inferior

b) Upper Neck Joints:

  • Atlantooccipital Joint (O-C1)
  • Atlantoaxial Joint (C1-C2)
  • C2-4

Area Of Headache

sub-occipital headache

Headaches tend to start from the base of the skull and spread towards the eye region.

It can occur on one or both sides.

Signs that suggest over-activity In The Sub-Occipital Muscles

a) Feeling Of Having A Heavy Head

When the muscles at the base of the skull are tight, this can give the sensation of having a heavy head and/or a squashed neck.

b) Poor Upper Neck Mobility

Try out this quick test to see if you can flatten the back of your neck onto the floor.

sub-occipital tightness test

Instructions:

  • Lie down with your back on the floor.
  • Keep your knees bent and feet on the floor.
  • Push your hips upwards.
  • In this position, attempt to flatten the back of your neck on the floor.

Results: If you have a significant gap between the back of your neck and the floor, this may indicate you have tightness in the base of the skull region.

Recommended Exercises

If your headaches are referred from the muscles and/or joints at the base of the skull, perform the following exercises.

1. Releases

This will help reduce the amount of tension in the tight muscles.

Note: DO NOT apply too much pressure to this area if it is very sensitive. There are nerves in this region that can easily be aggravated by touch (eg. Occipital Neuralgia).

a) Massage Ball

Base of skull massage

Instructions:

  • Lie down on the floor.
  • Place a massage ball underneath the base of the skull.
  • Do not place the ball directly onto any bony structures.
  • Allow the weight of your head to completely relax onto the massage ball.
  • Perform gentle rotations of your head to cover the entire muscle.
  • Continue for 2-3 minutes per side.

Note: If this is too painful to perform, consider using a softer massage ball.

b) Using Thumbs

self massage suboccipital

Instructions:

  • Place your hands behind your head.
  • Push your thumbs into the Base of the Skull.
  • Perform gentle circles with your thumbs.
  • Continue for 60 seconds.

(Note: Please be careful of your thumbs!)

c) Hair Pull

Instructions:

  • Grab the hair at the base of the skull.
  • Gently pull the hair as to pull the skin.
  • Aim to feel a stretch sensation in the region.
  • Hold for 10 seconds.

2. Stretches

The next step is to stretch the tight muscles.

As this area is difficult to stretch, I have listed 3 different stretches for you to try.

Focus on the one that gives you the best stretch.

a) Wall Lean

base of skull stretch

Instructions:

  • Stand with your back facing towards a wall.
  • Lean your upper back against the wall.
  • Walk your feet slightly away from the wall.
  • Push your hips forwards.
  • Nod your chin downwards.
  • Gently tuck your chin in.
  • Completely flatten the back of your neck onto the wall.
  • Aim to feel a stretch at the back of your neck.
  • Hold for 30 seconds.

Tip: To cover the entire base of the skull, perform small rotations with your head whilst keeping the neck flat on the wall. Pause on any position where there is increased stiffness.

b) Base Of Skull Stretch

sub occipital stretch

Instructions:

  • Place one hand at the front of your chin and the other at the back of your head.
  • Apply a force to the front of your chin as to gently glide the chin backwards.
  • Whilst maintaining this pressure, proceed to pull your head forward/down.
  • Aim to feel a stretch at the back of your neck.
  • Hold for 30 seconds.

c) Base of Skull Stretch (Band)

sub-occipital muscle stretch with band

Instructions:

  • Loop a band under the base of the skull.
  • Hold onto both ends of the band with your hands.
  • Gently pull the band forwards to create tension.
  • Tuck your chin in.
  • Slowly nod your chin downwards.
  • Aim to feel a stretch at the back of your neck.
  • Hold for 30 seconds.

3. Decompress The Neck

This exercise can help decompress the upper neck region.

a) Neck Traction With Band

neck traction

Instructions:

  • Tie a thick resistance band to a stationary object. (Height: ~3-4 feet)
  • Lie on the floor with your knees bent.
  • Wrap the band under the base of the skull.
  • Whilst still holding the band with your hands, slowly shuffle your body away from the anchor point.
  • Let go and let the band pull your head.
  • Move as far away until you can feel a stretch at the back of your neck.
  • Completely relax.
  • Hold for 1 minute.

Note: Place a small towel between your head and the band to prevent your hair from being pulled.

b) Decompress Side Of Neck

lateral flexion neck stretch

Instructions:

  • Tilt your head away from the side you are trying to decompress.
  • Place your hand on the side of your head.
  • Pull head downwards.
  • Aim to feel a stretch on the side of your neck.
  • Hold for 30 seconds.
  • Repeat on the other side.

4. Strengthening exercises

The muscles at the base of the skull tend to compensate for weakness in the following 2 muscle groups:

a) Deep Neck Flexor Strengthening

The Deep Neck Flexors are a group of muscles involved with maintaining the ideal position of your head and neck.

Perform the following Chin Tuck/Nod exercise to strength this group of muscle.

chin nod

Instructions:

  • Sit up right.
  • Slightly nod your chin downwards.
  • Keep the back of your neck as elongated as possible through the exercise.
  • Gently slide your chin backwards.
  • Avoid over tensing your superficial neck muscles.
  • Aim for a gentle contraction at the back of your throat.
  • Hold for 5 seconds.
  • Repeat 20 times.

For more exercises like this, check out this post: Deep Neck Flexor Exercises.

b) Cervical Extension Strengthening

The Neck Extensors are a group of muscles that are involved with extension, control and stability of the neck.

Perform the following Neck Extension Static Hold exercise to strength this group of muscle.

posterior neck strengthening

Instructions:

  • Lie down on your stomach.
  • Nod your chin slightly towards your throat.
  • Gently tuck your chin in.
  • Whilst keeping the chin tucked in, lift your head off slightly off the floor.
  • Aim to feel a contraction in the muscles at the back of the neck.
  • Hold for 30 seconds.

For more exercises like this, see post: Neck Extensor Exercises.

5. Other factors to address

a) Forward Head Posture

forward head posture

A Forward Head Posture is where the position of the head is in front of the mid line of the body.

This head position can lead to over-activity of the Sub-occipital muscles and compression of the upper neck region.

For more exercises and strategies to address this issue:

See Post: Forward Head Posture

b) Eye Strain

 Did you know that the Sub-occipital muscles are connected to your eyes?

You can test it out for yourself:

  • Place your finger tips on the Sub-occipital muscles.
  • Close your eyes.
  • Keep your head still.
  • Move your eyes from side to side.
  • You should be able to feel contractions in the muscle.

As a result – If you have any issues with your eye sight, it can potentially cause a strain to the Sub-occipital muscles.

Consider getting your eyes checked if you feel that they may be contributing to your headaches.

2. Upper Trapezius

upper trapezius region

The Upper Trapezius is the muscle that sits between the top of your shoulders and the base of the skull.

Area Of Headache:

area of headache

Headaches tend to start from the base of the skull and spread towards the eye region.

Signs that suggest over-activity In The Upper Trapezius Muscle

a) Increased Tension and/or Pain

If you feel increased tension in the area between the neck and shoulder, this could be a sign of tightness and/or over-activity in this Upper Trapezius.

b) Uneven Collar Bone Height

uneven collar bone

Instructions:

  • Stand relaxed in front of a mirror.
  • Locate and observe the line of your collar bones.

Results: If the collarbone is significantly angled upwards (.. or downwards!), this may lead to increased tension in the Upper Trapezius.

c) Reduced Side Tilt In Neck

neck lateral flexion

Tilt your head towards each side.

Results: If there is reduced sideways movement of the neck, this may suggest that the Upper Trapezius is tight.

Recommended Exercises

If your headaches are referred from the Upper Trapezius, perform the following exercises.

1. Releases

This will help reduce the amount of tension in the Upper Trapezius muscle.

upper trap release ball

Instructions:

  • Locate the Upper Trapezius.
  • Stand in front of the corner of a wall.
  • Lean slightly forwards.
  • Place a massage ball between this muscle and the wall. (see above)
  • Apply an appropriate amount of pressure into the ball.
  • Make sure to cover the entire muscle.
  • Continue for 1 minute.

2. Stretches

Upper Trapezius Stretch

Instructions:

  • Tilt your head towards the opposite side that you would like to stretch.
  • Pace your hand on the side of your head and pull your head further into the tilt.
  • Aim to feel a stretch in the area between the neck and shoulder.
  • Hold for 30 seconds.
  • Repeat on the other side.

3. Strengthening exercises

 a) Shrugs

scapula elevation

Instructions:

  • Hold onto a weight on the side you want to strengthen.
  • Keep your elbows straight.
  • Shrug your shoulders towards your ears.
  • Feel the contraction in the Upper Trapezius.
  • Hold for 5 seconds.
  • Perform 10 repetitions.

Ways to progress:

  • Hold onto a heavier weight.
  • Hold the contraction for longer.
  • Shrug with the arm in different positions.

D. Other factors to address

a) Rounded Shoulders

rounded shoulders

Rounded Shoulders is where the shoulders are in a slouched forward position.

This can place an extra amount of stress on the Upper Trapezius muscle.

For More Information: Rounded Shoulders

b) Stress

Your Upper Trapezius is also called your “stress muscle”.

These muscles will tend to cause your shoulders to shrug and tense up when you are stressed.

c) Difficulty Raising Arm

For those that have difficulty raising their arm for whatever reason, the Upper Trapezius will often be over worked causing the shoulder to hitch when the arm is lifted.

3. Sternocleidomastoid

scm

The Sternocleidomastoid (or SCM for short) is a muscle that is located on both sides of the neck.

It is often tight due to an inefficient breathing technique and the Forward Head Posture.

Area Of Headache

area of headache scm

Headaches caused by the Sternocleidomastoid muscle tends to span from the back of the ear, jaw and temporal region.

Signs that suggest over-activity/tightness in The Sternocleidomastoid

a) Vertical Alignment Of The Sternocleidomastoid

scm vertical alignment

Instructions:

  • Take side profile shot of your head.
  • Locate and observe the line of SCM muscle

Results: If the line of the Sternocleidomastoid is vertical, it is likely that this muscle is tight.

b) Decreased Head Rotation

neck rotation

Instructions:

  • Tuck your chin in.
  • Try to look to the left and right.

Results: If you have a limited ability to rotate your head towards one side, this could indicate a tight Sternocleidomastoid on the same side that you’re rotating towards.

c) Increased Tension In Throat

If you feel an increased amount of tension in the throat region, this could be a sign of tightness and/or over-activity in the Sternocleidomastoid.

Recommended Exercises

Perform the following exercises if your headaches are due to tightness in the Sternocleidomastoid muscle.

1. Releases

a) Release with Pinch Grip

SCM Release

Instructions:

  • Locate the Sternocleidomastoid.
  • With a pinch grip, feel for a prominent band of muscle on the side of the neck.
  • Do not to press too deep as you may hit other sensitive structures of the neck.
  • Gently massage the full length of the muscle.
    • Spend more time on the areas which are tender to touch.
  • Duration: 1-2 minutes

b) Glides

Sternocleidomastoid glide

Instructions:

  • Make a gentle fist with the hand.
  • Tilt your head towards the opposite side that you are targeting.
  • Place the back portion of the fingers against the side of the neck. (See above)
  • Apply a firm pressure into the muscle.
  • Starting at the collar bone, perform slow upwards strokes towards the area behind the ear.
  • Perform 5-10 strokes.

2. Stretches

sternocleidomastoid stretch

Instructions:

  • Sit in front of a table.
  • Keep your chin in and down throughout this stretch.
  • Place your left fist on the left side of your chin.
  • Place your left elbow onto the table in front of you.
  • Rest the weight of your head onto your fist.
  • Tilt your head to the left.
  • Apply further pressure to the chin to increase the stretch.
  • Aim to feel a firm stretch in the right side of the neck.
  • Hold for 30 seconds.
  • Perform on the other side.

For more stretches to this muscle

See Post: Sternocleidomastoid Stretches

3. Strengthening exercises

a) Rotation Static Hold

neck rotation isometric

Instructions:

  • Whilst sitting upright, place your palm on the side of your head.
  • Gently turn your head into the hand.
    • Match the force of your hand.
  • Hold for 10 seconds.
  • Repeat 5 times.
  • Alternate sides.

b) Rotation

neck rotation exercise

Instructions:

  • Sit upright.
  • Gently tuck the chin in.
  • Keep the neck elongated.
  • Rotate your head towards the side:
    • To strengthen the left SCM, rotate your head towards the right. (And vice versa.)
  • Perform 10 repetitions.

4. Forward Head Posture

In a Forward Head Posture, the Sternocleidomastoid muscles are locked in a shortened position.

For a complete guide on how to fix this issue:

See Post: Forward Head Posture

5. Breathing Exercise

The Sternocleidomastoid is also a respiratory muscle that is recruited during times of increased respiration (eg. during exercise).

With poor breathing mechanics, this muscle can be overly active during relaxed breathing.

This can lead to increased tightness and tension in the Sternocleidomastoid.

a) Try this breathing exercise

(It is designed to help recruit your main breathing muscle (The Diaphragm) so that your Sternocleidomastoid muscles do not need to be recruited.)

breathing exercise

Instructions:

Note: Aim to keep your neck muscles COMPLETELY relaxed throughout this breathing exercise.

  • Lie on your back with your knees bent and feet on the floor.
  • Tilt your pelvis backwards to help flatten your lower back onto the floor.
  • Take a deep breath in through your nose and slowly exhale ALL of the air out through your mouth.
  • As you reach the point where you have completely emptied out your lungs, notice how your lower ribs and lower back sink towards the ground.
  • Maintain this lowered rib position through this breathing exercise by gently engaging your abdominal muscles
    • “Gently draw your belly button in.”
  • Take a deep breath in.
    • Aim to expand the entire circumference of your rib cage.
    • Your upper chest and neck should not be moving excessively as you breathe in.
  • Breathe out all the air out of you lungs.
  • Continue for 3-5 breaths.

4. Jaw muscles

The Masseter and Temporalis muscles are responsible for the closing of the jaw (Temporomandibular joint).

These muscles tend to get tight from the clenching/grinding/gnashing of the teeth (Bruxism).

(Note: Although headaches associated with the jaw are not technically considered a Cervicogenic Headache, they are a common muscular cause of headaches!)

Area of Headache

jaw pain

Headaches that are caused by tightness in the jaw muscles tend to span from the jaw to the temporal region.

Signs that suggest over-activity and/or tightness:

a) The 3 Finger Test

3 finger test for tight jaw

Instructions:

  • Open your mouth as wide as possible.
  • Place your middle 3 fingertips between your teeth.

Results: If you can’t easily fit your 3 fingers between your teeth, you may have tight jaw muscles!

(Keep in mind – everyone has different sized fingers and teeth!)

b) Increased Tension

If you feel tension in the jaw, this could be a sign of tightness and/or over-activity.

Recommended Exercises

1. Releases

a) Masseter and Temporalis Release

jaw muscle massage

Instructions:

  • Using the base of your palm, apply a firm pressure to the bottom of the jaw bone. (Masseter)
  • Proceed to apply an upward stroke towards the temple region. (Temporalis)
  • Aim to drag the skin in an upwards direction as you do this.
  • Make sure that you release the entire area where these muscles are located.
  • Repeat 10 upwards strokes.

2. Stretches

jaw stretch

Instructions:

  • Gently open your mouth.
  • Place 2 finger tips on the top of the teeth of the bottom jaw.
  • Open your mouth as wide as possible.
  • Using your fingers, pull your bottom jaw further downwards.
  • Whilst holding this position, look slightly upwards.
  • Aim to feel a stretch in your jaw.
  • Hold for 20 seconds.

3. Joint mobility

a) Jaw Translation

jaw translation

Instructions:

  • Open your mouth slightly so that there is a slight gap between your teeth.
  • Slide your bottom jaw from side to side.
  • Perform 20 repetitions towards each side.

b) Retraction/Protraction

Instructions:

  • Open your mouth slightly so that there is a slight gap between your teeth.
  • Glide your bottom jaw forwards and backwards.
  • Perform 20 repetitions.

4. Strengthening exercises

a) Closing The Jaw

For the majority of people, the muscles which are responsible for closing the jaw are usually quite strong.

However – if you feel that you have a weak jaw, it is always a good idea to strengthen it.

Here’s how to strengthen it.

Instructions:

  • Sit up right.
  • Hold your chin in slight tucked/nodded position.
  • Keep your neck elongated towards the sky.
  • Place a rolled up towel between your teeth.
  • Bite firmly without losing your head position.
    • Use as much force as you are comfortable with.
  • Hold for 5 seconds.
  • Perform 10 repetitions.
  • Progression: Place a thicker object in the mouth.

b) Mouth Openers

From what I’ve seen in the clinic, most people tend to be much weaker in their ability to open their jaw.

Here is how to strengthen it.

jaw open strengthening exercise

Instructions:

  • Sit upright.
  • Open your mouth as wide as possible.
  • With your fist, apply a gentle upwards force underneath your chin.
  • Keep your mouth open against this resistance.
  • Hold for 5 seconds.
  • Perform 10 repetitions.

5. Other factors to address

a) Jaw clenching/Teeth grinding

If you tend to clench or grind your teeth when your sleeping/ exercising/stressed, this can increase the tension in your jaw muscles.

If you are able, be more aware of when you are grinding or clenching and stop yourself.

(Obviously – this is quite difficult if you grind your teeth whilst you are sleeping!)

b) Malocclusion Issues

Malocclusion refers to the improper position of the teeth when the jaw is closed.

If the teeth of the upper and lower are not aligned properly, this can lead to the over use of the jaw muscles.

If you have teeth alignment issues, consider getting a review with your dentist.

c) Forward Head Posture

A Forward Head Posture can place the jaw in a position where the Masseter and Temporalis are forced to work harder than they should.

5. Eyebrow Muscles

Tightness in the muscles which are involved with movement of the eye brows can cause headaches.

These muscles include:

  • Frontalis
  • Occipitalis
  • Corugator Supercillii
  • Orbicularis Oculi

Area of headache

Headaches associated with the eye brow muscles tend to span from the back to the front of the head.

Signs that suggest over-activity and/or tightness

a) Increased tension around the muscle

  • Raise your eyebrows as high as possible.
  • Gain a sense of the amount and quality of tension in your head.

Results: If you experience a similar kind of tension with your headache, then you may have overactive eye brow muscles.

b) Forehead Wrinkles

forehead wrinkles

Since these muscles raise the eyebrows, an increased amount of wrinkles on your forehead may suggest over-activity of the eyebrow muscles.

(Keep in mind – this could just be normal age-related changes!)

Recommended Exercises

1. Releases

a) Frontalis/Corrugator Supercillii

frontalis massage

Instructions:

  • Place your palm on your eye brow.
  • Apply a firm pressure and proceed to glide your hand up towards the hair line.
  • Repeat 10 upward strokes.
  • Do both sides.

b) Occipitalis

occipitalis massage

Instructions:

  • Look downwards.
  • Grasp the back of your skull with your finger tips.
  • Apply a firm pressure into the skull.
  • Drag and pull your fingers tips forwards.
  • Repeat for 10 strokes.

2. Other factors to address

a) Stress levels

The function of the eye brows is to assist with facial expression.

Since these muscles are responsible for the movement of the eyebrows, they tend to be over active in certain emotional states.

(They are the muscles that cause the wrinkling of the forehead.)

Example: Being constantly stressed, worried, angry or surprised

b) Excessive Squinting

Squinting can lead to the over-activity of the eye brow muscles.

If your eyes get tired easily whilst looking at a screen, try giving your eyes regular breaks every 30 minutes.

Also – if you know you have poor eye sight, consider visiting your optometrist.

c)Ponytail” Headaches

This type of headache is due to tying up your hair too tightly.

The excessive tension will tend to over sensitize the scalp and can lead to headaches.


Conclusion

  • The 5 main muscles that cause cervicogenic headaches are:
    • Sub-Occipital muscles
    • Upper Trapezius
    • Sternocleidomastoid
    • Jaw muscles
    • Eye brow muscles
  • Depending on your presentation, you may need to address more than one muscle.
  • To make the most of the exercises, it is a good idea to address the other factors that may be contributing to the over activity of the respective muscle.

What to do next

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!


Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. Seek guidance from a healthcare professional before starting any exercise or implementing any recommendation. For more information: Medical disclaimer.

9 thoughts on “Cervicogenic Headache Exercises”

  1. Hi Mark

    Thank you very much I was waiting for this article for long. Actually this problem is very common in our area.

    Once again. Thanks a lot Sir.

    Reply
  2. Thank you for all the exercise help you have given. I have low back and neck issues, and your treatments are just what I need. Some the physical therapists have shown me but I tend to forget when I get home Your right here with me any time I need you. Thank you for sharing so much. Thank you for caring. Thank you for sharing. God bless you as you continue to help others.

    Reply
  3. Hello Mark.

    I’ve suffered from really bad eye strain in only my right eye for about 5 years now. i believe it’s because i have a slight head tilt. but doing chin tucks where i bring my head back and up seems to really be helping my eye strain. do you have any guess on what’s happening to my eye and how i can fix it?

    Reply
    • Hi C,

      Perhaps the position of your head is forcing you to use your right eye more?

      Another possibility is that your eye symptoms could be referring from the muscles of the neck (such as the sub-occipitals). These muscles tend to respond well to chin tucks.

      If you tend to look at a computer screen throughout the day, another thing to consider is the placement of your monitors. (ie. Perhaps you are looking towards one screen to the side?)

      Mark

      Reply
  4. Hi Mark
    very good post, thanks for doing it. I have had tinnitus since the age of 25, now i am 35. What do you think it can be the cause for tinnitus? maybe tight suboccipital muscles?

    Reply
  5. Great article Mark! Another nifty trick to help massage the Sub-Occipitals is to take two tennis balls, put them in a sock, and tie off the other end. Then lie down on your back, with knees bent, and place the back part of your neck on the two tennis balls. Move up and down, side to side, and round and round with small discrete movements as to massage the muscle out.

    Reply

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.