Headaches are a very common problem, with recent research showing that approximately 47% of the global population suffers from them. Headaches can have many causes, however the evidence shows that a significant proportion (15-20%) are cervicogenic headaches. Physiotherapists provide effective treatment solutions for cervicogenic headaches, and can often help you avoid future headaches or significantly reduce the frequency and intensity of them.
What Is a Cervicogenic Headache?
Put simply, a cervicogenic headache is a headache that is caused by a problem in your neck. The part of your spine that is in your neck region is called your cervical spine, so a cervicogenic headache means that your headache is starting from your neck and spreading in to your head.
Cervicogenic headaches can persist for years on a regular basis and be very disruptive to your lifestyle, sport, work and leisure time. During a headache many people find it hard to concentrate, lose motivation to participate in the things they normally love to do, and we often get told by clients that they get a bit grumpy! Unfortunately, many people do not realise that effective treatment is available through appropriate physiotherapy. This means people often suffer unnecessarily for years, try ineffective or unnecessarily intense or expensive treatments, or end up taking lots of medication that could have been avoided.
How Can My Neck Cause A Headache?
The top three spinal vertebra and joints in your neck are closely associated with nerves that help to bring sensation, including pain signals, from your head. Because of this interaction, problems in your neck can cause referral along the nerves as they pass up in to your head, so you feel pain in your head even though the problem is actually in your neck! The muscles in the upper part of your neck also have a role to play in producing headaches, because imbalances in their length and/or strength causes changes in the way your upper neck moves and what postures it tends to hold.
How Can I Tell If My Headache Is Coming From My Neck
Physiotherapists with experience in diagnosing and treating headaches can effectively assess you to determine if your headache is coming from your neck. However even before you have an assessment, there are some checks you can do for yourself to see if your neck is a likely cause.
Common headache features that indicate your neck is a likely cause include;
• The pain usually begins at the back of your head or in your upper neck, and then spreads to the front of your head
• The pain is normally only on one side of your head, and does not swap sides
• The pain can be aggravated by sustained or awkward postures or positions, most commonly working at a desk. It can also be made worse by movement of your neck, especially fast movements like those involved in some sports.
• Your neck may also feel sore or stiff when you have a headache
• Cervicogenic headaches often occur in people with no history of neck trauma at all. However, if you have recently had a neck injury such as during sport or a car accident (whiplash) and are now experiencing headaches, then your neck could well be the cause
• Your headache may be able to be reduced or relieved (at least temporarily) by neck stretches, changing posture or position, or using massage or heat on your neck
• Approximately 1/3 of cervicogenic headache sufferers also report some dizziness, visual disturbances like blurring or difficulty focusing, or feeling light-headed at times during a headache
What Will My Physiotherapist Do To Assess My Headache?
Your physiotherapist will initially discuss your headache history, symptom patterns, aggravating and easing factors, medication use, any past trauma and also your general health profile. They will then perform a thorough physical examination of your neck as well as any other body areas that may be relevant such as your shoulders, upper back or lower spine. Sometimes cervicogenic headaches are linked to jaw clenching or teeth grinding, so your physio may also screen and test your jaw joint (tempero-mandibular or TMJ joint).
This combination of a full history and a thorough physical examination will allow your physiotherapist to confidently diagnose whether your headaches are fully or partially coming from your neck. They will then take the time to explain their findings to you, in language that you can understand. This will include;
• The reasons your headaches may have started, including giving you an overview of the relevant anatomy to help you understand the mechanism of cervicogenic headaches
• Explain why certain things trigger them or make them worse, and start giving you strategies to help you change posture or lifestyle factors that can be part of your headache solution
• They will then talk you through your management plan, the steps needed to effectively treat your headaches, estimates of time-frames to recovery, and outline the role of hands-on treatment (manual therapy) as well as exercise in your treatment
If your physiotherapist feels that your neck is not likely to be a significant cause of your headaches and that you need further investigation or referral, they will also discuss this with you. They will then provide you with the right referral to get this process started. If you are already seeing your GP about your headaches, they will also send them a letter to keep them informed of your treatment program.
How Can Physiotherapy Treatment Help Headaches?
Physiotherapists are the first-choice treatment providers for cervicogenic headaches. They use evidence based practice, which means their treatment techniques are backed by solid research and have been proven to be effective. Every client is different, and your treatment program needs to be personalised for your specific symptoms, history, physical findings, lifestyle and activity goals. Your physiotherapist will develop your individualised treatment plan by choosing the best combination of treatments including;
Manual (Hands-on) Therapy
Often the early stages of your treatment include a significant amount of hands-on techniques used to restore joint mobility as well as release muscle tension in the upper part of your neck.
Graded Exercise Prescription
Right from the beginning of your treatment you will usually be given initial exercises to stretch tight muscles and improve joint mobility. As you improve, your exercise program gradually progresses to include more work on strength, both of local muscles and then, depending on your ability and activity goals, up to higher intensity exercises that lead in to gym work and return to full sports and exercise. It is important that your exercise program is structured specifically for you – it’s definitely not a one-size-fit-all situation! You will have different patterns of weakness and tightness compared to other headache clients, plus returning to your activity and sporting goals will require different strength programs than someone with alternative goals. Not to mention that your overall posture, work or desk ergonomics, injury history and background fitness level all affect the type and progression of your exercise program.
Strategies For Work And Home
Your treatment is not just about what happens in the clinic! Your physiotherapist will discuss options with you to reduce situations that trigger or aggravate your headaches, and explore simple solutions to help you avoid or relieve a headache if you feel it coming on. This is especially important early in your treatment program because you won’t have had time to build up the flexibility and strength in your neck that will eventually increase your neck’s resilience and capacity to avoid being overloaded.
For desk workers this section also includes discussion about your ergonomics (desk set-up) and advice on how to set up your workspace correctly to minimise stress on your neck. The role of posture, and the importance of getting enough movement in your lifestyle to counter-act all those hours of sitting and remaining stationary, will also be included.
Education And Re-Assurance
As with many injuries, education and re-assurance is a very important but often under-valued part of your treatment. When you really understand why your headaches have been happening, the plan the get rid of them, and why certain activities can make them worse or better, you are much better able to achieve long-lasting relief. It allows you to be more active in your treatment throughout the initial stage and ensures that once you are feeling better, you have firm strategies in place to minimise your risk of future problems.
For some people a big source of relief is just knowing that your headaches have been examined by a skilled and experienced professional, anything more sinister has been fully screened and ruled out, and you have a clear plan for relief to follow. Really understanding how your exercise program is designed to correct specific imbalances and help you return to your full exercise, sport and work activities is also a big help to keeping you motivated to do your exercise consistently.
How Long Until I Will Feel Better?
This is very variable between people. If you have not had a significant history of headaches then often we can have you feeling much better within just a few treatments. The research indicates that man people feel significant relief within 2-6 weeks, however if you have a more significant headache history then things may take longer.
It is important to note the difference between time to relief and time to complete your treatment program. As we have discussed above, effective long-term relief relies heavily on restoring full muscle length and strength, and this takes time. So although we are often able to give you significant pain relief relatively quickly, you will need to be doing some ongoing structured exercise past this time to work on your muscle strength. This is especially important if you have a fairly long history of headaches, as research shows that over time your muscles become significantly weaker due to ongoing regular pain, so you will need longer to rebuild your strength. Just like when anyone goes to a gym to get stronger, significant and sustained increases in strength don’t come in just a week or two!
Treatment for headaches is a common request for us at Central Performance, so we have physiotherapists with extensive experience and expertise available. Many of our clients work at desks and feel that this combined with bad posture and not doing enough exercise is a primary factor in their headaches. Often they have taken significant amounts of medication over time, with only temporary or partial relief. Sometimes they have had investigations including head CT scans, MRI’s or neck x-rays, and these show nothing very significant so no effective treatment has been provided.
Given that physiotherapy delivered by a skilled and experienced clinician is effective, non-invasive and non-pharmacological, having a discussion with one of our physiotherapists could be your first step to effective relief from your headaches.