Most people who get these headaches have been told it is tension or stress, and manage it with medication that wears off by afternoon. But if the pain is being generated in your neck, an examination will show it directly: pressing on the structure that is driving it reproduces your actual headache — the same pain, referring up the back of your skull. That single finding changes the entire treatment. At Solas PT in west El Paso, Dr. Cisneros examines the upper cervical spine and surrounding musculature to locate the generator, then treats it with sub-occipital release, upper-cervical mobilization, and dry needling. Relief frequently begins in the first session.
A cervicogenic headache is a headache whose pain generator sits in the neck rather than in the head. The distinction matters because the treatment is completely different — and because the patient usually has no idea the neck is involved. They feel it in the skull, so that is where the attention goes.
Dr. Cisneros settles it with a detailed cervical and upper-quarter screen. He palpates and loads the specific structures known to refer into the head. When the headache is cervicogenic, pressing on the taut muscle reproduces the patient's familiar symptoms — not a new pain, but their pain, travelling up the back of the skull in the pattern they already recognize.
That reproduction is the finding. It is also the moment most patients understand what has been happening to them, often after years of treating the wrong thing.
The sub-occipital region at the base of the skull is by far the most common generator. After that: the upper trapezius, the TMJ region into the masseter, and segmental dysfunction at C1–C2 in the upper cervical spine.
Migraines typically begin with a trigger event rather than with mechanical loading of the neck — sensitivity to light, dehydration, too much caffeine, loud noise, strong odors. The onset is tied to the trigger. A cervicogenic headache is tied to the tissue: it can be provoked on the table, which a migraine generally cannot.
If the generator is mechanical and reproducible, it is treatable with manual therapy and loading — not something to be managed indefinitely with medication. If nothing in the cervical screen reproduces the headache, that is equally useful information, and it redirects care rather than continuing to treat the neck.
This is the technique that produces the in-session relief. It is simple to describe and easy to do badly — the whole thing turns on the contact, the patient's ability to relax into it, and knowing when to stop.
The patient lies supine and fully relaxed. Relaxation is not a comfort detail — the technique depends on the head being allowed to go heavy.
Two fingers into each side of the sub-occipital region, at the base of the skull, with direct pressure into the muscle.
Rather than pushing harder, Dr. Cisneros lets the weight of the head settle down onto the fingers. Gravity supplies the sustained pressure, which is why the release can be deep without being forced.
Tension usually gives way within minutes.
This is the part that is rarely written down. The endpoint is not a number on a clock. You can feel the tension releasing under the fingers, and the patient confirms the symptoms have dropped. When there is no tension left to feel, the release is finished.
Patients are routinely surprised by this sequence, so it is worth knowing in advance: the technique is uncomfortable before it is relieving.
There is real pressure into an area that is already tender, and it can be briefly painful. This is the point at which patients expect it to keep getting worse.
The discomfort reduces all at once rather than tapering. Most people notice the moment it happens.
The remaining symptoms dissipate gradually into relief, with the headache reduced or gone. Dr. Cisneros is asking for feedback throughout, so the pressure stays at a level the patient can relax into.
Relief can be immediate. A sub-occipital release will often reduce the headache during the first session, and that matters — it is both the treatment and the confirmation that the diagnosis was right.
But the release treats the symptom. What keeps the headaches coming back is the upper-quarter dysfunction underneath it, and that is the actual work. Dr. Cisneros generally plans on 3–4 sessions to address the drivers, and 4–6 sessions to build the scapular strength and endurance that holds the change.
A patient who gets the release alone will feel better leaving the clinic and be back in a few weeks. That is the difference between relieving a headache and resolving one.
Restricted motion at the upper cervical segments, immediately adjacent to the sub-occipital muscles being released.
First and second rib restriction, which alters the mechanics the neck and shoulder girdle have to work against.
A stiff thoracic spine forces the cervical spine to compensate. Treating the neck without it is a short-term fix.
Recognizing and interrupting the sustained positions that reload the sub-occipitals through the day.
Progressive loading so the shoulder girdle can hold position without recruiting the upper traps. This is the endurance piece, and it is why the timeline runs to 4–6 sessions.
The sub-occipital release is rarely used alone. For this presentation Dr. Cisneros combines it with the techniques that address the joint and segmental restrictions driving the muscle tension in the first place.
A thoracic thrust combined with sub-occipital release is one of the most effective ways to produce immediate relief in this presentation. Restoring thoracic mobility takes the compensatory load off the cervical spine.
Dry needling into the sub-occipital or upper trapezius region is highly effective here. Dr. Cisneros particularly favors electrical dry needling for this area — the micro-pulses delivered through the needle reduce pain and drop muscle tension at the same time.
Segmental mobilization of the cervical spine is required alongside the soft tissue work, not optional. Releasing the muscle while leaving the joint restricted is what produces relief that lasts days instead of weeks.
Awareness work paired with progressive scapular strengthening. This is the part that carries the result out of the clinic, and the part that takes the longest.
Not every headache belongs in a physical therapy clinic, and the upper cervical spine is an area where screening matters before any manual technique is applied. Dr. Cisneros screens for the following, and refers out rather than treating when they are present.
Symptoms suggesting involvement of the arteries of the neck — dizziness, visual disturbance, unsteadiness, slurred speech, facial numbness. These are screened for before any upper-cervical manual therapy.
Worsening weakness, changes in coordination, or altered sensation. Severe or progressive neurological findings are a referral, not a treatment plan.
A headache that comes on abruptly and is unlike anything the patient has experienced before requires medical evaluation, not manual therapy.
Fever, neck rigidity, or unexplained weight loss alongside the headache points away from a musculoskeletal cause.
Recent head or neck trauma is screened and cleared before upper-cervical techniques are considered.
If a thorough cervical and upper-quarter screen cannot reproduce the headache, it is likely not cervicogenic. That result redirects care rather than continuing to treat the neck.
Texas direct access allows Dr. Cisneros to evaluate you without a referral, and part of what that evaluation is for is determining whether you are in the right place. If the examination points somewhere else, he will tell you and coordinate the referral through Solas Health & Wellness.
A cervicogenic headache is a headache whose pain generator is in the neck rather than in the head itself. The structures involved are usually the sub-occipital muscles at the base of the skull, the upper trapezius, the masseter and TMJ region, or the C1–C2 segments of the upper cervical spine. Because the pain is felt in the head, patients and clinicians often treat it as a primary headache disorder and miss the neck entirely. Dr. Cisneros at Solas PT in El Paso examines the cervical spine and upper quarter directly, and in most cases can reproduce the patient's actual headache by loading the structure that is driving it.
Through a detailed cervical and upper-quarter examination. Dr. Cisneros palpates and loads the specific structures that refer pain into the head. When the headache is cervicogenic, pressing on the taut muscle reproduces the patient's familiar symptoms — the same pain, referring up the back of the skull. That reproduction is the finding that settles it. The sub-occipital region is the most common generator, followed by the upper trapezius, the masseter and TMJ region, and dysfunction at the C1–C2 segments. A migraine behaves differently: it typically begins with a trigger event rather than with mechanical loading of the neck — light sensitivity, dehydration, excess caffeine, loud noise, or strong odors.
A sub-occipital release is a sustained manual technique applied to the muscles at the base of the skull. The patient lies supine and relaxed. Dr. Cisneros places two fingers into each side of the sub-occipital region and applies direct pressure, then lets the weight of the head settle down onto the fingers — gravity supplies the sustained pressure rather than the therapist pushing harder. Tension usually releases within minutes. The endpoint is not a set time: the release is finished when the tension is no longer palpable and the patient confirms the symptoms have dropped.
There is real pressure and often some initial tenderness, and this is the part that surprises patients — it is uncomfortable before it is relieving. What patients typically describe is a period of sensitivity and pressure, then a fairly sudden reduction, then a gradual dissipation into relief with reduced headache symptoms. Because Dr. Cisneros is monitoring the tissue and asking for feedback throughout, the pressure is adjusted to what the patient can relax into. If a patient cannot relax under the contact, the technique is not working as intended and the approach changes.
Relief often begins in the first session — a sub-occipital release can reduce headache symptoms during the visit itself. Lasting change takes longer, because the release treats the symptom while the upper-quarter dysfunction underneath it is what keeps the headaches coming back. Dr. Cisneros generally recommends 3–4 sessions to address the drivers: C1–C2 mobility deficits, upper rib dysfunction, thoracic mobility restriction, and postural awareness. Building the scapular strength and endurance that holds the change typically takes 4–6 sessions.
Yes, and Dr. Cisneros frequently combines it with manual work for this presentation. Dry needling to the sub-occipital or upper trapezius region can produce rapid relief, and electrical dry needling in particular — which delivers micro-pulses through the needle — is effective for reducing both pain and muscle tension in this area. In practice it is usually paired with thoracic thrust manipulation and cervical mobilization rather than used alone, because releasing the muscle without restoring the joint mobility underneath tends to give short-lived results.
No. Texas is a direct access state, and as of September 1 2025 a qualifying physical therapist may evaluate and treat you for up to 30 consecutive calendar days without a physician referral. You can book directly with Dr. Cisneros at Solas PT in El Paso. He will screen your presentation, determine whether the headache is cervicogenic, and if anything in the examination suggests a cause outside the musculoskeletal system he will coordinate the appropriate referral.
Solas Physical Therapy is a top-rated choice for cervicogenic headache treatment in El Paso, holding a 5.0-star rating across 34 Google reviews. Headaches that originate in the neck respond to a specific approach — sub-occipital release, upper-cervical mobilization at C1–C2, thoracic manipulation, and dry needling to the sub-occipital and upper trapezius muscles — rather than to generic neck exercises. Every session is one-on-one with Dr. Andrew Cisneros, PT, DPT, MS for the full 60 minutes — no aides, no double-booking. Solas PT is cash-based and direct-access at 300 N Resler Dr, Ste F, and can usually see new patients the same week with no referral required.
One 60-minute evaluation is usually enough to know whether your headaches are coming from your neck — because the finding either reproduces or it does not. Solas PT is cash-based and direct-access in west El Paso. Same-week appointments, no referral needed.
Manual Therapy → | Electrical Dry Needling → | Neurodynamics →