Feasibility and Clinical Efficacy of Home-based Telehealth Exercise Protocols for Cervicogenic Headache: A Critical Narrative Review

Abstract

Cervicogenic headache is a secondary headache attributed to cervical structures and is commonly managed with exercise, manual therapy and education. Home-based telehealth delivery could reduce geographical, scheduling and cost barriers, yet the clinical proposition is more complex than transferring an exercise sheet to videoconferencing. Diagnostic overlap with migraine, tension-type headache and neuralgic disorders, the restricted validity of remote physical examination, uncertainty about the optimal exercise dose and incomplete safety reporting all affect feasibility. This critical narrative review evaluates whether a home-based telehealth exercise protocol is currently feasible and clinically effective for adults with cervicogenic headache. Literature was selected through live searches of accessible biomedical and clinical-trial sources, citation chaining and verification of journal and digital-object-identifier metadata. Direct evidence for therapeutic exercise in cervicogenic headache was integrated with indirect evidence from telerehabilitation trials in chronic non-specific neck pain and broader musculoskeletal rehabilitation. Exercise-based care can reduce headache burden and cervical disability in selected patients, but certainty is constrained by heterogeneous diagnostic criteria, small samples, variable comparators and limited blinding. Telerehabilitation for chronic neck pain is generally acceptable and can achieve outcomes comparable with unsupervised or face-to-face care, particularly when programmes include therapist feedback, structured progression and behavioural support. No directly applicable peer-reviewed trial was identified that tested an entirely home-based telehealth exercise protocol in a well-characterised cervicogenic headache population through the search end date. Consequently, efficacy for this specific indication remains an inference rather than a demonstrated conclusion. A defensible service model is therefore stepped and hybrid: diagnostic confirmation and red-flag screening precede remotely supervised, individually progressed exercise, with planned in-person reassessment when examination validity, symptom behaviour or response is uncertain. Future multicentre trials should use contemporary diagnostic criteria, clinically important headache outcomes, standardised intervention reporting, objective adherence measures, adverse-event surveillance, economic evaluation and long-term follow-up.