Physical Therapy for Cervicogenic Headaches [Infographic]

Jun 22

Cervicogenic headaches are caused by musculoskeletal dysfunction in the bony structures or soft tissue of the neck that refer pain to the head through the nervous system, commonly affecting one side of the head. The neck (cervical region) is comprised of seven vertebrae that are surrounded by spinal nerves, ligaments, and muscles. The C1 and C2 are the first two cervical vertebrae and are uniquely shaped as they form the atlanto-occipital joint, which allows for forward bending, backward bending, and rotation of the head and neck.

The trigeminocervical nucleus is located in the upper cervical spine, which is an area of convergence of sensory nerve fibers. One such nerve is the trigeminal nerve, which relays pain signals to the face, forehead, and temple. Cervicogenic headache pain gets transferred from the neck to the trigeminal nerve through the trigeminocervical nucleus.

There are two types of muscles that support neck movement, the neck flexors and neck extensors. The neck flexors run along the front side of the neck and allow for forward neck bending. The neck extensors run along the backside of the neck and allow for backward bending of the neck. Together, the neck flexors and extensors are responsible for providing stability and support to the head and neck.

Traumatic injury such as a whiplash from a car accident, which can damage the C1-C3 vertebrae and facet joints of the cervical spine. Repetitive or acute trauma to these vertebrae can damage these joints and cause nerve irritation and subsequent headaches.
Prolonged abnormal loading on the joints and muscles of the neck, such as forward head posture while working at the desk.
Atlanto-occipital joint dysfunction: trauma or degeneration of the AO joint where the occipital bone connects with the first cervical vertebrae.
Cervical intervertebral disc injury such as a bulging or herniated disc in the upper cervical spine, which can compress nerves of the cervical spine.
Neck muscle strain or neck muscle weakness due to overuse or disuse of certain neck and upper back muscles. Muscles can become tight, weak, and fatigued and refer pain to the head.
Scapular dysfunction can contribute to headache pain as the scapula functions as a bridge between the shoulder complex and cervical spine, providing mobility and stability to the neck and shoulders.
Compression of cervical nerves refers pain from the nerve to the head through the trigeminal nerve if these nerves are compressed or irritated.
Temporomandibular joint disorder is a disorder of the temporomandibular joint that causes tightness of the jaw muscles, which can refer pain to the head.
Cervical osteoarthritis and rheumatoid arthritis that causes arthritic degeneration of the neck joints which can compress nerves of the cervical region.

Cervicogenic headaches normally affect one side of the head. Pain originates at the back of the neck, radiating along one side of the forehead, temple, eye socket, and ear. Pain may even radiate into the shoulder and arm on the same side of the headache. Pain is often a dull, non-throbbing pain and can be accompanied by reduced flexibility in the neck and neck stiffness. Individuals may be sensitive to lights and sounds as well.

Physical therapy is the gold standard treatment for cervicogenic headaches and can address the underlying cause of the headache. The goal of the physical therapist is to reduce the severity and frequency of cervicogenic headaches by targeted strengthening of the deep muscles of the neck and upper back, stretching any tight muscles, addressing any compressed nerves in the cervical region, and minimizing repetitive stresses on the patient’s neck.

Pain management using ice, heat, massage, and electrotherapy to reduce pain
Manual therapy soft tissue and upper cervical spine joint manipulations to decrease pressure in the region and address mobility deficits and muscle tightness in the cervical spine and surrounding muscles
Dry needling of tight muscular trigger points in the neck and shoulder muscles that can refer pain to the head
Myofascial release and manual stretching to address adhesions in fascial connections that may be restricting muscle movement
Muscle stretching of the upper back and chest muscles to relieve muscle tightness and improve range of motion in the neck
Postural training to correct lumbar and thoracic posture as well as learn how to make ergonomic adjustments to maintain good posture during daily tasks
Muscle re-education involving building endurance in the neck flexors and extensors in various positions and teaching the muscle groups to work together for optimal stability to support the neck
Targeted muscle strengthening of the deep neck flexors and extensors and scapular muscles