Neck related (cervicogenic) headaches
Headaches are a common and everyday complaint that people of all ages can suffer. An estimated 50% of the world’s entire population are believed to have experienced some form of headache within the past 12 months. There are many, varied types and causes of headaches, but an often overlooked one is the cervicogenic headache, which is a common presentation to us here at The Physio Nook. This is what we are talking about here
Anatomy:
The neck is a very busy area. There are many structures making up the cervical spine, as well as many others linking to the neck. Muscles that assist in respiration attach to the cervical vertebrae, blood vessels and nerves running to and from the brain pass through the neck, muscles that provide control to the shoulder girdle and upper back also have attachments in the neck, then there’s the structures forming the cervical spine such as vertebrae, ligaments and discs. So there are a large number of potential sources of neck pain and cervicogenic headache.
So what causes the headache?
It is widely believed that the upper 2 to 3 cervical vertebrae are responsible for referring pain into the head. Specifically, the facet joints on each side are usually implicated. Usually these joints move freely allowing normal neck movement. When there is injury or abnormal stress on the muscles, ligaments or other structures affecting the upper cervical spine, the facet joints can become restricted and cause nerve root irritation, which then refers pain into the head, causing a headache. Muscles in the region such as the scalenes, sternocleidomastoid, upper trapezius, levator scapulae (to name a few...) can also develop tightness and myofascial trigger points, which can also contribute to headaches.
Signs and Symptoms:
These can include but are not limited to-
- Stiffness and reduced movement of the neck;
- Poor posture (e.g. a “poke chin”) especially when seated at a desk;
- An associated traumatic injury to the neck such as a whiplash or a sporting injury;
- Pain often starts at the base of the skull posteriorly and can radiate to the front of the head or behind the eyes;
- The headache is often unilateral, but not always;
- The pain is not usually described as a “throbbing” headache;
- Secondary symptoms such as nausea, dizziness or blurred vision may be present.
What can physiotherapy do?
First and foremost, a thorough subjective and objective examination is required to identify whether the headache is arising from the neck, and to exclude any other serious or sinister pathologies. Assuming the neck is implicated, several high quality studies have advocated an individualized physiotherapy program predominantly comprised of the following…
Manual Therapy- including joint mobilizations and massage or trigger point therapy. Research has shown that manual therapy alone can have a similar effect to commonly used medications prescribed for headaches and migraine.
Exercise- particularly stretches to alleviate tightness in postural and “anti-gravity” muscles, as well as deep neck flexor strengthening to provide stability and control around the cervical spine.
Postural correction & advice- the classic slouched posture with rounded shoulders and a poke chin put too much stress and compression through many of the structures suspected of causing cervicogenic headaches. Facilitating correction of this posture is crucial in alleviating anyone’s symptoms. Advice on workstation set up can also help greatly.
I hope this summary will help you or someone you know. As always, we are here at The Physio Nook to help out with any musculoskeletal disorders you may have, headaches or otherwise! Feel free to call us, email, or drop in for a great service.
Paul Woodward
Principal Physiotherapist
The Physio Nook.
The neck is a very busy area. There are many structures making up the cervical spine, as well as many others linking to the neck. Muscles that assist in respiration attach to the cervical vertebrae, blood vessels and nerves running to and from the brain pass through the neck, muscles that provide control to the shoulder girdle and upper back also have attachments in the neck, then there’s the structures forming the cervical spine such as vertebrae, ligaments and discs. So there are a large number of potential sources of neck pain and cervicogenic headache.
So what causes the headache?
It is widely believed that the upper 2 to 3 cervical vertebrae are responsible for referring pain into the head. Specifically, the facet joints on each side are usually implicated. Usually these joints move freely allowing normal neck movement. When there is injury or abnormal stress on the muscles, ligaments or other structures affecting the upper cervical spine, the facet joints can become restricted and cause nerve root irritation, which then refers pain into the head, causing a headache. Muscles in the region such as the scalenes, sternocleidomastoid, upper trapezius, levator scapulae (to name a few...) can also develop tightness and myofascial trigger points, which can also contribute to headaches.
Signs and Symptoms:
These can include but are not limited to-
- Stiffness and reduced movement of the neck;
- Poor posture (e.g. a “poke chin”) especially when seated at a desk;
- An associated traumatic injury to the neck such as a whiplash or a sporting injury;
- Pain often starts at the base of the skull posteriorly and can radiate to the front of the head or behind the eyes;
- The headache is often unilateral, but not always;
- The pain is not usually described as a “throbbing” headache;
- Secondary symptoms such as nausea, dizziness or blurred vision may be present.
What can physiotherapy do?
First and foremost, a thorough subjective and objective examination is required to identify whether the headache is arising from the neck, and to exclude any other serious or sinister pathologies. Assuming the neck is implicated, several high quality studies have advocated an individualized physiotherapy program predominantly comprised of the following…
Manual Therapy- including joint mobilizations and massage or trigger point therapy. Research has shown that manual therapy alone can have a similar effect to commonly used medications prescribed for headaches and migraine.
Exercise- particularly stretches to alleviate tightness in postural and “anti-gravity” muscles, as well as deep neck flexor strengthening to provide stability and control around the cervical spine.
Postural correction & advice- the classic slouched posture with rounded shoulders and a poke chin put too much stress and compression through many of the structures suspected of causing cervicogenic headaches. Facilitating correction of this posture is crucial in alleviating anyone’s symptoms. Advice on workstation set up can also help greatly.
I hope this summary will help you or someone you know. As always, we are here at The Physio Nook to help out with any musculoskeletal disorders you may have, headaches or otherwise! Feel free to call us, email, or drop in for a great service.
Paul Woodward
Principal Physiotherapist
The Physio Nook.