downloadHeadaches 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:

In our physical examination, there are 3 characteristics that can help us to distinguish a cervicogenic headache from other types, such as migraines.

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:

If you suffer from headaches, why not give us a call and let us help you.

By Katie Farrell BSc, MISCP.

Chartered Physiotherapist

References: 

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.

The Physio Matters Podcast: Episode 34 with Toby Hall