Migraine headaches arise without an identifiable cause, while cervicogenic headaches (CGH) are attributed to causes from the cervical spine. However, migraines and CGH can co-exist in the same patient so they can be difficult to distinguish.

A diagnostic and treatment strategy is provided: applying a sustained pressure to the upper cervical spine can be used to both provoke as well as reduce a headache. In the cervical spine review of the subject of this particular case study, protraction of the upper cervical spine provoked, and retraction reduced the headache.

A positive outcome was achieved with a combination of hands on therapy and a home exercise programme for self-mobilisation, deep neck flexor strengthening, and shoulder strengthening.