Cervicogenic Headaches

Many of our patients here at Oahu Spine & Rehab are suffering from  migraines or headaches when they first become our patients. A cervicogenic headache is a referred pain perceived in the head from a source in the neck. Diagnosing a cervicogenic headache is seldom an easy task.  This type of headache is, in many ways, similar to more well-known types of headaches such as migraines and tension headaches. The problem with the cervicogenic headache is that conventional headache treatments seldom provide relief. Furthermore, the condition is not always curable, but once correctly diagnosed, can be manageable with the help of our integrated health center here in Kailua.

Who is at risk for a cervicogenic headache?

Women are three times more likely than men to suffer from cervical headache.  Women in managerial or professional occupations are more susceptible to headache than women in either clerical or blue collar occupations.

The Symptoms of Cervicogenic Headaches

Although symptom location may vary widely prevalent sites of pain are retro-orbital, frontal, temporal,  and occipital areas of the head.  Usually suboccipital pain and neck pain are also present.  These symptoms have strong tendencies to be unilateral with  no changing sides.  Other studies report bilateral symptoms, although they area rare.  Pain is described as an ache or dull, boring pain,  that varies in intensity from low grade to severe.  At times throbbing or pulsing pain may be reported, but typically in migraine headaches with throbbing coinciding with the pulse.  Associated symptoms include nausea, vomiting, phonophobia and photophobia, visual disturbances (blurred vision, spots, flashing lights), difficulty in swallowing, dizziness, light headedness, general irritability, and inability to concentrate.  Symptoms are ipsilateral in pain.  Headache pain is often present on awakening and may worsen progressively with increased activity levels. Other patients may have an onset of symptoms during or toward the end of the day, with neck pain as a warning sign.

How are cervicogenic headaches precipitated?

Cervicogenic headache commonly is precipitated or intensified mechanically by sustained neck flexion while working at a desk, typing, studying, driving a car, or reading.  Often patients have difficulty in identifying specific aggravating factors.  Although stress, tension ,anxiety and depression also may be provocative factors, they are common to other headache types.  Cervical spine pathology may trigger muscle contraction (tension), or, conversely, tension may provoke existing pathology to produce headache.  It is easy for patients to blame stresses in their life as a causative factor, but millions of people with significant stress and tension in their lives are symptom-free.   Thus musculoskeletal causes of headaches should not be ruled out.

How do posture and muscle impairment contribute to cervicogenic headache?

Faulty postural habit can lead to abnormal stresses in the cervical and upper thoracic spine.  In particular,  forward head posture affects the biomechanics of the head and neck region, putting greater stress on muscles that function as stabilizers of the head.  If forward head posture is maintained, it becomes fixed through adaptive shortening in upper cervical joints and posterior superficial and deep  myofascial structures.

What types of physical therapy treatments are useful in reduction of cervicogenic headache?

The goal of physical therapy is to address objective findings of the evaluation.  If faulty posture pattern are found, the therapist most likely will find impaired mobility in the upper cervical spine and subsequent forward shoulder with general weakness in the posterior shoulder girdle musculature.  Initially, the therapist must correct myofascial and joint restrictions in the cervical and thoracic regions, generally with mobilization and manipulation of affected areas.  Modalites that help to relax the patient and provide therapeutic effect before mobilization include moist heat, ultrasound, massage, and cervical traction.  Other important aspects area postural correction and reeducation by encouraging axial extension and shoulder retraction.  Reinforce the importance of postural ,maintenance to reverse the pain cycle that results from strain on joints and various soft tissues of the cervical spine.

What exercises are believed to be of most benefit for patients with cervicogenic headaches?

Stretching exercises should target muscles of the upper quadrant with extensibility losses and weakness.  Stretching should focus posterior neck muscles and deep muscles: upper traps, LS , scalenes, suboccipitals, and pectorals.  Strengthening exercises should help to maintain gains in joint mobility after mobilization and stretching by focusing on  the mid and lower traps, rhomboids and deep cervical flexors.

Below are stretches that patient can do initially to alleviate tension on upper cervical area and chest region.

Hold stretch position for 30 sec x 3 twice a day

image_010246— Upper Trap Stretch

image_000365— Levator Scapulae Stretch

image_000371 — Scalene Stretch
image_000374— Suboccipital Stretch

image_006281 Doorway Stretch

 

All stretching photos are from http://www.hep2go.com/!

Here at OSR in kailua, we are able to come up with strengthening exercises should help to maintain gains in joint mobility after mobilization and stretching by focusing on  the mid and lower traps, rhomboids and deep cervical flexors.

 

References:

Orthopedic Physical Therapy Secrets 2nd Edition, Jeffrey D. Placzek, MD PT, David A. Boyce, PT, EdD, OCS, pp 255-258

HEP2GO Cervical stretches

 

 

 

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