Top 5 Fridays: My Top 5 Techniques for Cervicogenic HA | Modern Manual Therapy Blog

Top 5 Fridays: My Top 5 Techniques for Cervicogenic HA

Here are my Top 5 Treatments for Cervicogenic or Tension HA.

Many people are misdiagnosed with migraine HA or even have migraines that are triggered by cervicogenic HA.  These are my go-to treatments for mechanical HA.

1) Subcranial Shear Distraction
  • Gapping this area increases subcranial space as proven by pre and post test MRIs (unpublished but Rocabado has literally 100s of slides showing this) 
  • this relieves pressure on upper cervical spine and greater occipital nerve both of which refer to the cranium, cervical spine and upper traps

2) Unilateral OA nod
  • this is indicated when the patient has unilateral complaints and as a progression from the subcranial shear technique
  • also indicated with transverse ligament laxity as it does not stress the ligament being a unilateral technique
  • make sure to only perform 3-5 reps as it can be very uncomfortable
  • prep the area first with some ST techniques

3) 1st rib
  • TrPs in the upper traps also can refer superiorly to the cranium
  • prepping this area with IASTM or FR works well prior to the first rib releases

4) prolonged OA gapping/cervical retraction in supine

  • in supine, one hand on occiput, other on the forehead
  • have the patient retract into a pillow and hold at near or end range, progressing into end range if not starting there 2-3 minutes
  • for unilateral complaints, rotate head toward the involved side, SB the cranium away with the axis through the nose and gap the involved side for 2-3 minutes
  • easily taught to the patient at the onset of a HA, they may use over heat

5) upper thoracic thrust manipulation
  • shown by research to have similar effects to cervical thrust and mobilization
  • a safer alternative risk wise to cervical thrust
  • helps relieve thoracic and B upper trap "tightness"


  1. Great Video post Erson...very helpful

  2. HarrisonvaughanptJune 29, 2012 at 8:26 AM

    I agree with Jesse, great content!

  3. Exceptional post, Dr. E! Wonderful stuff!

  4. Thanks for the compliments guys! Hope the techniques help!

  5. Great site! Would it be okay to try this out considering I am a fresh PT? I'm partly untrained with manual techniques yet but I know that with practice I can perfect this. I'm just a bit wary >_<

  6. None of the techniques are dangerous. Make sure they are indicated, as in those areas having some sort of dysfunction. Always start lightly and progress the forces to tolerance. MDT rules are ok if it causes increase during Tx, as long as it does not remain worse (for 5-10 minutes) afterward, that ensures you are not aggravating anything. Practice on co-workers or family/friends if you're wary.

  7. Tried practicing them first with our senior PTs :) Coincidentally, I have a new patient who manifests with tension HA. Thanks a lot sir!

  8. Good luck! Let me know how it works out for you! Cervical retractions for HEP if it relieves their complaints.

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  10. Great stuff! Don't be scared of the OA manipulation though. It works wonders!

  11. I'm not scared of it, I just do need find the use for it among the other techniques I use that still improve ROM and decrease pain with much less risk. Never felt like an OA gap thrust even moved or got a good cavitation like other joints in the spine.