Headache Flow Diagram

For the investigation

Is the headache continuous?

Consider these red flags

  • Paraesthesia in face or head(Potential cervical hypermobility or instability)
  • <3/12 sudden onset with no reason & worsening symptoms
  • HA onset >50yrs of age – considered to be disease until proven otherwise, especially if migrainous in quality(Cranial Vasculitis – HA in temporal area with local symptoms)
  • >3/12 if sudden change in established Hx, especially if over 50yrs old
  • Sudden onset of vomiting (Tumour)
  • Headache with neck stiffness, fever & feeling unwell (Meningitis)
  • Distal pain following severe HA (Blood in the subarachnoid space/SAH)
  • Severe HA with pregnancy (Pre-eclampsia)
  • Consider recent trauma or recent surgery
  • Consider cord & VBI signs

It's most likely musculoskeletal



Checklist for Cervicogenic Headache

  • Unilateral head or face pain without sideshift; the pain may occasionally be bilateral
  • Pain localised to the occipital, frontal, temporal or orbital regions
  • Moderate to severe pain intensity
  • Intermitten attacks of pain lasting hours to days, constant pain or constant pain with superimposed attacks of pain
  • Pain is generally deep and nonthrobbing, throbbing may occur when migraine attacks are superimposed
  • Head pain is triggered by neck movement, sustained or awkward neck postures; digital pressure to suboccipital, C2, C3 or C4 regions or over the greater occipital nerve; valsalva, cough or sneeze might also trigger pain
  • Restricted active and passive neck range of motion; neck stiffness
  • Associated signs and symptoms can be similar to typical migraine accompaniments including:
    • nausea
    • vomiting
    • photophobia, phonophobia and dizziness
    • others include ipsilateral blurred vision, lacrimation and conjunctival injection or ipsilateral neck, shoulder or arm pain


  • ROM
  • Vertebral Artery Test
  • Upper Cx Stability test
  • Alignment/Mobility/Posture