Physical Therapy for Cervicogenic Headaches
Cervicogenic headaches are caused by musculoskeletal dysfunction in the neck that refers pain to the head through the nervous system. Cervicogenic headaches commonly affect one side of the head and can result from a traumatic injury to the cervical spine and neck muscles such as whiplash or due to muscle tension or strain from forward head posture. Physical therapy can reduce pain and address the underlying cause of cervicogenic headaches for sustainable headache management.
What is a Cervicogenic Headache?
Nearly 47% of the global population suffers from headaches, 15-20% of which are cervicogenic headaches. A cervicogenic headache is caused by musculoskeletal dysfunction in the neck that refers pain to the head through the nervous system. Cervicogenic headaches can last several minutes to several hours and commonly affect one side of the head. This type of headache is more common in those over age 33 and affects four times as many women as men.
Cervicogenic headaches can result from a traumatic injury such as whiplash from a car accident or from prolonged abnormal loading on the joints and muscles of the neck, such as forward head posture while working at a desk. During whiplash, the torso of the driver jolts forward while the neck is thrown back causing hyperextension of the neck followed by the head snapping forward (hyperflexion). This can strain the muscles and joints of the neck, causing neck pain that refers pain to the head, temple, and eye socket and causing a cervicogenic headache.
Forward head posture leads to increased tension in the muscles at the base of the skull and the first three segments of the cervical spine due to the slumped posture of the spine. Repetitive poor posture can flatten out the lumbar spine curve and exaggerate the thoracic spine curve. The back can also excessively round, which causes the head to look down to the floor. However, many work looking at a computer screen in front of them, so the head looks up and the chin pokes forward to keep the gaze straight. This abnormal posture leads to forward head posturing and subsequent neck-related cervicogenic headaches.
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Common sources of pain that contribute to cervicogenic headaches include:
The most common cause is dysfunction from the C2-C3 facet joints in the cervical spine, which are prone to injury due to the weight-bearing function they perform while supporting the head. These facet joints can be damaged through a traumatic injury like whiplash. The nerve that innervates the most commonly affected joint (C2-C3) in CGH are medial branches that continue their path to become the third occipital nerve. This nerve continues to course around the back of the head and around the scalp—the path followed by CGH pain.
Atlanto-occipital joint dysfunction, which is where the lower part of the occipital bone (base of the skull) connects with the first cervical vertebra (the atlas) and facilitates the passing of the spinal cord out of the skull and down into the cervical spine.
Intervertebral disc injury: the cervical intervertebral discs act as shock absorbers between vertebral bones, help facilitate neck movement, and maintain spacing for nerves and joints to function. When an injury occurs, this can compromise neck movement and lead to compression of the nerves and joints of the cervical spine and a cervicogenic headache.
Neck muscle strain: Overuse or disuse of certain neck and upper back muscles can lead to muscle fatigue, weakness, or tightness that can refer pain to the head.
Scapular dysfunction: the scapula functions as a bridge between the shoulder complex and the cervical spine, providing mobility and stability to the neck and shoulder region. There is a high correlation between chronic neck and shoulder pain and dysfunction of the scapula, which can then contribute to headache pain.
Compression of cervical nerves: Compression or irritation of the nerves of the cervical spine can result in cervicogenic headaches due to referred pain from the nerve to the head.
Symptoms of cervicogenic headaches include pain that originates at the back of the neck and radiates along one side of the forehead, temple, eye socket, and ear, and can radiate along the shoulder and arm on the same side. Cervicogenic pain is usually dull, non-throbbing pain. Individuals may also experience reduced flexibility of the neck and neck stiffness
Physical Therapy for Cervicogenic Headaches
Physical therapy can address the underlying cause of cervicogenic headaches and reduce pain to provide safe and sustainable headache management. A physical therapist provides a comprehensive musculoskeletal assessment to identify the underlying cause of headache pain, testing the function and strength of the shoulder, upper back, neck muscles, and spine.
The aim of the physical therapist is to relieve cervicogenic headache pain, improve mobility of the head, upper neck, mid-back, lumbar spine, and pelvis, strengthen the muscles stabilizing the neck and the scapular region, and address and minimize repetitive stresses on the neck throughout the patient’s day. Research has shown that conservative physical therapy treatment techniques, such as mobilization, manipulation, and cervico-scapular strengthening exercises, are effective interventions for decreasing cervicogenic headache intensity and frequency as well as neck pain.
Physical therapy for cervicogenic headaches can include:
Pain management using a TENs unit, which uses electrotherapy involving a low-voltage electric current to stimulate nerves and treat pain.
Manual therapy: soft tissue and upper cervical spine joint manipulations help to soothe muscles and decrease pressure in the region. Research has shown that manual therapy combined with exercise provides favorable outcomes for those with cervicogenic headaches.
Dry needling of trigger points in the neck and shoulder muscles to ease tension.
Myofascial release: Adhesions in the fascial connections can restrict normal movement of muscles between fascial planes in the neck and shoulder region. Myofascial manual stretching can address these adhesions and restrictions to relieve pain and increase the mobility of the neck.
Muscle stretching of the upper back and chest muscles (upper trapezius, levator scapulae, and pectoral muscles) to relieve tight muscles. The physical therapist may alternate cycles of contraction and relaxation to help relax and lengthen tight muscles to improve the range of motion of the neck.
Postural training to correct lumbar and thoracic posture while helping the patient create an ergonomic workspace. The therapist may guide the patient through sensorimotor exercises, such as progressive exercises on unstable surfaces, to promote reflexive stabilization and postural stability. The therapist also strengthens the core to support proper posture of the spine and neck.
Targeted strengthening of the deep neck flexors and scapular muscles to reduce neck tension and address weak muscles or muscle imbalances.
Are you experiencing chronic cervicogenic headaches? Work with a physical therapist to find relief and address the underlying musculoskeletal issue causing your headaches!
