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Headache Treatment With Physiotherapy

Is Your Neck Giving You Headaches? Four Quick Tests To See If Your Headaches Are Coming From Your Neck

Headaches can really affect your lifestyle. You may find it hard to concentrate at work, & it can make you not want to socialise much because lots of noise or bright lights make it feel worse. Exercise doesn’t seem very appealing, & many people become a bit short-tempered. You may also start to catch yourself taking regular painkillers as if it’s become a normal thing to do.

Does this sound familiar? If it does, lets look at some ways to help you manage things better.

I Haven’t Been Asked about My Neck Before?

A common scenario I find as physio who treats lots of headaches is this:
A client comes in with a pain or injury, and during their history it comes out that they have regular headaches. It is not what they’ve come in for, but it just comes out with general health questioning during their assessment. They’ve usually had them for years and have seen a few GP’s but not really got any answers about why they happen or how to treat them. Sometimes they’ve had a head CT scan or seen a neurologist, but once any serious pathology is ruled out they just get a vague diagnosis of “migraine” or “tension” headaches. From there they just end up taking regular pain killers or other medication to get them through – not a great long-term management option, especially if they have any stomach, liver or kidney problems. 

The unfortunate thing is when that when I ask the client “Have you ever had your neck assessed to see if it is causing some of your headaches?” the client almost always replies “No, I didn’t even know that was a thing!” Well, it is, and it’s surprisingly common. And the frustrating thing is that it can often be treated effectively without the need for regular medication, it just needs the right assessment and treatment.

Are Neck-Related (Cervicogenic) Headaches Common?

According to the WHO, headache is the world’s most common pain disorder & affects 66% of the global population. Research shows that around 25-35% of headaches are either partly or fully caused by problems in the neck. Your neck is officially called the cervical spine, and when it is responsible for producing your headache it is called a cervicogenic headache. Studies show that cervicogenic headaches are among the most common type of headache, roughly as common as migraine headaches.

As well as pain, cervicogenic headaches may give you other symptoms such as;

  ⁃ mild blurred vision, making looking at a screen for long is hard work

  ⁃ nausea

  ⁃ aversion to bright lights or sounds

How Can I Tell If My Headaches Are Coming From My Neck?

Diagnosing headaches can be tricky because you may have different types of headaches at different times. For example you may have infrequent migraine headaches alongside more regular cervicogenic or hormonal headaches. Each headache type may have different triggers, or sometimes you may not have been able to identify any definite triggers at all. And just to complicate things more, one type of headache may trigger or exacerbate another type!

Even though diagnosing different types of headaches can be complex, cervicogenic headaches have some definite common patterns & features.  So if you know what to look for you can easily get an initial indication of whether your neck may be part of your problems. So now lets look at four simple tests you can do yourself to see if your neck may be involved with your headaches.

Test 1: Your Pain Begins At The Back Of your Head And Then Spreads To The Front

Cervicogenic headaches usually start at the back of the skull & then radiate forwards to the temples, cheek, forehead, eye or jaw area. You may also feel some pain in the upper neck, but this is not always the case. Just because you don’t have any neck pain doesn’t mean that your neck is not the cause.

Test 2: The Pain Is Worse On One Side Or Only On One Side, & Doesn’t Swap Sides

Cervicogenic headaches are normally only on one side or at least worse on one side. They usually don’t swap sides during a single headache, but they can swap sides between headaches. So if your headache is worse on the left it will generally stay on the left for the duration of that headache, but the next time you get a headache it may be on you right.

Test 3: Neck Posture Can Start, Increase Or Decrease Your Headache

You may notice that certain neck positions can bring a headache on or increase it. The most common situation is extended periods looking at screens, and it is be especially related to using laptops, smartphones or ipads/tablets because the position we are in when using them is ergonomically poor. (We saw a lot of this when more people started working at home during COVID because they were often on laptops sitting in dining chairs at dining tables or kitchen benches rather than properly set-up desktops). On the flip side, gentle neck movement or stretching often temporarily eases the headache at least to some degree. 

Test 4: Pressing Or Massaging Your Upper Neck Can Increase Or Decrease Your Headache

Firm pressure or massage around your upper neck or the base of your skull can temporarily increase or relieve your headache. Often people with cervicogenic headaches say they instinctively massage, press or stretch their neck when they have a headache because it feels better for a while. You may also find that pressing on a certain point in your upper neck “connects” with the pain in your head, as it refers pain to your temples, eyes, jaw area or the side of your head.

These four simple self-tests will give you an idea of whether your headaches may be coming from your neck. Even if your neck is only part of the problem, effectively treating your neck can significantly reduce your headache frequency and intensity. Less headaches means less impact on your work and social life, and importantly it can also significantly reduce your need for pain killer medications.

How Can Physiotherapy Treat Cervicogenic Headaches?

Effective physio management of cervicogenic headaches involves a combination of three things;

1. Manual therapy (hands-on treatment) for acute pain relief

2. Exercise including specific muscle strengthening, mobility drills, and functional strengthening. Like with most musculoskeletal things, the stronger you are the better and more resilient you are.

3. Correction of other contributing factors such as ergonomics (especially relating to extended periods on laptops, tablets/iPads or smartphones) or lifestyle issues such as being excessively sedentary or ensuring your optical prescription is correct.

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