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  • Writer's pictureSam Kelokates

Cervicogenic Headache And Physical Therapy

Cervicogenic headaches are a prevalent type of headache that primarily originates from the cervical spine or neck region.


Unlike other headaches, which are caused by issues within the brain or vascular system, cervicogenic headaches are referred pain, which means the source of the pain is not where it is felt.


This can make diagnosis and treatment particularly challenging.

physical therapist assessing the neck of a patient with cervicogenic headache

The pain from cervicogenic headaches typically starts in the neck and then is referred to one side of your head or the face.


The headache may be triggered or worsened by neck movement or a particular neck position. This type of headache is often mistaken for migraines or tension headaches, which is why a precise diagnosis is crucial for effective treatment.


Non-pharmacological treatment options play a significant role in managing cervicogenic headaches. These methods focus not just on helping the pain, but also on addressing the underlying causes associated with the cervical spine.


Physical therapy, in particular, is critical in this approach. It helps in improving postural control, strengthening neck muscles, enhancing mobility, and implementing strategies to prevent pain recurrence.


Through targeted exercises, manual therapy, and patient education, physical therapists, like at Kelos Physical Therapy, provide a holistic treatment plan that can significantly improve the quality of life for those suffering from cervicogenic headaches.



 

What is Cervicogenic Headache? What Causes it?


Cervicogenic headaches are distinct in that their primary source lies not in the head but in the cervical spine or associated structures.


Understanding the anatomy and common triggers of these headaches is essential for identifying and treating them effectively.


Anatomy Involved in Cervicogenic Headaches


The cervical spine, consisting of the first seven vertebrae at the top of the spine, plays a crucial role in supporting the head and enabling a wide range of head and neck motions.


Key anatomical structures involved in cervicogenic headaches include:

  • Cervical Vertebrae/Joints: Dysfunction in the cervical joints (facet joints) can also be a significant source of headache

  • Neck Muscles: Tension or spasms in neck muscles, especially the suboccipital muscles which connect the skull to the spine, can trigger headache pain.

  • Cervical Nerves: The cervical nerves (C1-C4) can become irritated or compressed where they exit the spine, leading to referred pain in the head.


Common Triggers and Underlying Conditions


Cervicogenic headaches can arise from various triggers and underlying pathological conditions:


  • Trauma: Incidents such as whiplash are significant contributors, causing structural changes or persistent inflammation in cervical components.

  • Mechanical Issues: Dysfunction in the lower cervical spine, though not a direct source of pain, can contribute to conditions that exacerbate upper cervical distress.

  • Muscle Dysfunction: The tightness and trigger points in the upper trapezius, levator scapulae, scalenes, and suboccipital extensors are often more pronounced in individuals with CGH compared to those with migraines or no headaches.

  • Muscular Atrophy and Imbalance: Weakness in deep neck flexors, increased activity in superficial flexors, and atrophy in suboccipital extensors can impair the support of cervical segments, contributing to cervicogenic headache.


How Neck Problems Refer Pain to the Head


The connection between neck issues and head pain in cervicogenic headaches is due to the intricate network of nerves in the upper cervical region.


The C1–C3 spinal nerves, closely associated with the trigeminal nerve pathways, facilitate the referral of pain from the neck to the head. This neurological crossover is why the pain originating from cervical structures is perceived in the head, misleading it to be thought of as a typical headache.


Understanding the intricate anatomy, potential triggers, and clinical presentation of cervicogenic headaches allows for targeted therapeutic interventions, emphasizing the importance of a thorough and precise approach to diagnosis and treatment.


Diagnosis and Clinical Features


Diagnosing cervicogenic headaches is complex due to their symptoms' similarity to other headache types. Key clinical features include:

  • Unilateral Dominance: Often described as a “ram’s horn” pattern, where pain starts at the back of the head and radiates forwards.

  • Neck Movement and Posture: Symptoms that worsen with specific neck movements or postures.

  • Physical Examination: Tenderness in the upper three cervical spine joints and the presence of associated neck pain or dysfunction.

  • Selective Nerve Blocking: A definitive diagnosis can be achieved through controlled nerve blocks, which can isolate and confirm the source of the headache.


Can Physical Therapy Help with Cervicogenic Headaches?


Physical therapy is not only effective in treating cervicogenic headaches but is also crucial in diagnosing and differentiating them from other types of headaches.


With a focus on the structures of the neck and occiput, physical therapy employs a detailed method of examination, assessment, and treatment tailored specifically to the nuances of cervicogenic headache origins and symptoms.


Diagnostic and Treatment Approaches in Physical Therapy

Physical therapists utilize a comprehensive assessment approach that includes a detailed history, physical examination, and functional testing to diagnose cervicogenic headaches accurately. Here is a comprehensive post about what a physical therapy evaluation might look like: https://www.kelosphysicaltherapy.com/post/what-is-headache-physical-therapy


This approach helps in distinguishing cervicogenic headache from other headache types like migraine or tension-type headache, based on the headache’s response to neck movement, posture, and physical examination of the cervical spine.


Physical Therapy Techniques for Cervicogenic Headaches


Physical therapy offers a variety of techniques specifically aimed at treating the cervical spine and related structures to alleviate the pain and dysfunction associated with cervicogenic headaches:


  1. Manual Therapy:

  • Spinal Manipulation and Mobilization: These techniques help in restoring normal movement, relieving pain, and improving function of the neck joints. Manipulation involves a quicker, thrusting motion to the spine, while mobilization involves slower, controlled movements.

  1. Therapeutic Exercises:

  • Neck Strengthening and Flexibility Exercises: Targeted exercises that strengthen the deep neck flexors and improve the flexibility of the cervical muscles can help stabilize the neck and reduce the stress on its structures.

  • Upper Quarter Strengthening: This includes exercises for the shoulders and upper back, which support the neck and help in maintaining proper posture.

  • Thoracic Spine Exercises: Incorporating thoracic spine mobilization and strengthening exercises can indirectly relieve stress around the neck and improve overall pain symptoms.

  1. Additional Techniques:

  • Dry Needling: This technique involves inserting a fine needle into myofascial trigger points to release muscle tension and pain.

  • Relaxation Exercises: Techniques such as deep breathing or progressive muscle relaxation can help to relax tension muscles and decrease stress that is contributing to headaches.


Evidence Supporting Physical Therapy for Cervicogenic Headache


Research supports the efficacy of physical therapy in managing cervicogenic headaches.


For instance, a study by Jull et al. highlighted that a six-week physiotherapy program including manual therapy and exercise was effective not only in reducing headache symptoms but also in decreasing medication intake in both short-term and at a one-year follow-up.


In a delphi study from 2021 looked at the role of physical therapy in treating cervicogenic headaches, indicating consensus on treatments such as active and passive mobilization exercises, ergonomic training, and mobilization with movement as beneficial for patients with cervicogenic headache.


Overall, physical therapy offers a non-pharmacological treatment for cervicogenic headaches, focusing on the underlying causes of pain rather than just stopping pain in the moment like medications.


Through a combination of manual therapies, structured exercise programs, and lifestyle adjustments, patients can achieve significant relief from headaches and a return to normal function.


Get Help for Cervicogenic Headache!


Cervicogenic headaches, originating from the cervical spine, represent a complex and often misunderstood type of headache.


Physical therapy has shown to be vital in the treatment of cervicogenic headaches. With techniques like spinal manipulation, mobilization, targeted exercises, and possibly adjunctive therapies like dry needling or relaxation exercise, physical therapy addresses not only the symptoms but also the root causes of the pain.


This approach not only helps with the immediate pain but also works to prevent future episodes by strengthening and conditioning the cervical structures.


However, the key to successful treatment lies in a personalized approach. Each patient’s journey with cervicogenic headaches is unique, which is why a tailored physical therapy program, designed around the specific needs and conditions of the individual, is essential. Regular sessions, active participation, and ongoing communication with your physical therapist are instrumental in achieving the best outcomes.


If you’re battling with headaches that seem to originate from your neck, or if you’ve experienced limited success with other treatments, consider physical therapy as a pivotal part of your headache management strategy.


Kelos Physical Therapy is dedicated to providing a thorough assessment and crafting a personalized treatment plan that targets your specific needs.


We encourage you to reach out and schedule a consultation. Take the first step towards reclaiming your comfort and freedom by contacting our clinic today.


Let us help you navigate your path to recovery with care, expertise, and a commitment to your health. To book an appointment or for more information, please call us directly at 267-459-3191.


Together, we can work towards a life free from the pain of cervicogenic headaches.

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