Why Upper Cervical and TMJ Treatment Should Be Combined in Cervicogenic Headache Management

by Son PMR(Physical medicine & Rehabilitation ) & Chiropractic Clinic in Seoul

Cervicogenic headache (CGH) typically originates from dysfunctions in the upper cervical spine (C0–C3), presenting as occipital and suboccipital pain. However, in many clinical cases, upper cervical treatment alone does not provide complete or lasting relief. This often indicates an overlooked component—temporomandibular joint (TMJ) dysfunction.

Neurological Link: The Trigeminocervical Nucleus Complex (TCC)

The Trigemino-Cervical Nucleus Complex (TCC) is a brainstem region where afferent sensory input from the upper cervical spinal nerves (C1–C3) and the trigeminal nerve converge.

  • Nociceptive signals from the TMJ and masticatory muscles (such as the masseter, temporalis, and pterygoid muscles) enter the brainstem via the spinal nucleus of the trigeminal nerve (CN V) and project to the TCC.

  • Simultaneously, dysfunction in the C1–C3 zygapophyseal joints and surrounding soft tissues also activates the TCC.

This shared neuroanatomical pathway explains the frequent overlap of TMJ-related pain and upper cervical headache, as both regions influence the same central pain processing center.

Scientific Evidence

  1. Bartsch & Goadsby (2003)
    "The trigeminocervical complex: a unifying brain stem region for pain transmission from the head and neck."
    → Demonstrated that afferents from both the upper cervical spine and trigeminal system converge within the TCC, making it a central hub in cervicogenic headache.
    Brain. 2003;126(Pt 7):126–78.

  2. Cooper et al. (2013)
    "The role of temporomandibular disorders in cervicogenic headache: A clinical perspective."
    → Highlighted how TMJ dysfunction (TMD) contributes to cervicogenic headache and how its correction often leads to symptom relief.
    J Oral Rehabil. 2013;40(9):624–632.

  3. Fernández-de-las-Peñas et al. (2007)
    "Manual therapy in myofascial trigger point treatment: a systematic review."
    → Found that integrative approaches to cervical and masticatory muscle dysfunction reduce headache and facial pain.
    J Bodyw Mov Ther. 2007;11(3):225–232.

Clinical Implications

When only the upper cervical spine is treated, patients may experience partial relief, but persistent nociceptive input from untreated TMJ dysfunction may continue to sensitize the TCC, causing recurrent or lingering headaches.

Therefore, addressing both upper cervical misalignment and TMJ dysfunction is essential for effective, long-term relief in cervicogenic headache patients.

Integrative Treatment at Son Cheolho Rehabilitation Clinic

At Son Cheolho Rehabilitation &  Chiropractic Clinic, we provide a comprehensive approach to cervicogenic headache by
evaluating and correcting both upper cervical alignment and temporomandibular joint function.
This dual-targeted strategy aims to restore neurological balance within the TCC, leading to more stable and lasting outcomes.

👍Consultation and Appointment Information

Son PMR & Chiropractic Clinic( 2nd floor, 229-1 Gucheonmyun-Ro, Gangdongu, Seoul, South Korea) 

by  Dr Son MD & DC 
Contact: 02-482-8875 in Seoul( +82-2-482-8875)

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