Headaches come in many different forms. The International Headaches Society has over 300 types of headaches in its classification system! The IHS system although very comprehensive is better suited for research purposes and perhaps less suitable for use in clinical practice.
A cervicogenic headache is characterised by pain referred to the head from the cervical spine (neck).These types of headaches are caused by abnormalities in the joints, muscles and neural structures of the neck region.
There is no one tell tale sign or unique feature that can differentiate between different types of headaches. We must look at a range of features from our clients history and our physical examination.
Signs and symptoms that may point us towards the diagnosis of a cervicogenic headache include:
- Pain on one side of the head, usually around the eye or temple, this can then become both sides if the nervous system centrally ‘winds up’ if the headache is left untreated.
- The pain usually feels like a dull ache, and can be constant.
- These headaches are often of gradual onset, perhaps with no apparent cause.
- Sometimes there can be associated features such as nausea and dizziness.
In our physical examination, there are 3 characteristics that can help us to distinguish a cervicogenic headache from other types, such as migraines.
- Impaired movement at the neck
- Poor control and strength of the deep neck flexor muscles which help support the head on the neck and prevent a ‘poking chin’.
- Reproduction of familiar head pain on palpation pressure, usually over joints or muscles of the upper neck on the same side.
There will usually be altered tone in the musculature around the neck, and myofascial trigger points will most likely be present. Myofascial trigger points in the small suboccipital muscles at the base of the skull, the upper trapezius, splenius capitis and cervicis, and sternocleidomastoid can all refer pain into the head.
Repetitive strain or overuse, sustained postures or emotional stress can all be triggers for bringing on a cervicogenic headache. So it is important to look out for lifestyle factors and psychosocial factors that may be having an impact address these. Sometimes we have to seek assistance from other healthcare providers such as a psychotherapist to help.
Posture can be a contributory factor or an effect of a headache. It can be hard to distinguish if the poor posture is as a result of the headaches, or if posture was what caused the headaches to begin with.Typically, a forward head posture can be seen. This is charactarised by rounded shoulders, with the chin protruding forward and extension through the upper part of the neck. This can result in shortening and increased tone of the neck extensors, which can then cause taut bands and myofascial trigger points.
How can we treat cervicogenic headaches?
A multi-modal approach is the best way to go about treating cervicogenic headaches. Here in the clinic, we like to use a combination of:
- Manual therapy: mobilisations at the neck have shown to be effective in the reduction of pain and in helping to restore optimal movement patterns.
- Medical acupuncture (including dry needling): This is used to treat myofascial trigger points that develop in the muscles around the neck and head. It can help to improve muscle tone, and it’s central regulatory effects can bring about a feeling of calmness and well being.
- Therapeutic exercise: It is important to give exercises to help train and activate the deep neck flexors for example, which may be weak and under used. This allows for better movement control around the head and neck. This in turn allows for improved posture, and therefore have an effect on pain and headache levels.
- Education: Becoming aware of the impact of certain lifestyle factors such as exercise, sleep, diet and stress.
If you suffer from headaches, why not give us a call and let us help you.
By Katie Farrell BSc, MISCP.
Brukner & Khan’s Clinical Sports Medicine Fourth Edition
Hall, T., Briffa, K. and Hopper, D. (2008). Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. Journal of Manual & Manipulative Therapy, 16(2), pp.73-80.
Jull, G., Falla, D., Vicenzino, B. and Hodges, P. (2009). The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain. Manual Therapy, 14(6), pp.696-701.
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