There are over 67 different types of headache, one of which is cervicogenic headache. This type of headache is due to pain referred from the upper part of your neck and is relatively common, especially in desk workers, people who regularly do overhead activities or look up for extended periods, and people under a lot of pressure or stress. Women are between 2-4 times more likely than men to be affected by cervicogenic headaches.
Physiotherapy can provide effective and lasting relief from cervicogenic headaches, and importantly it can reduce or cease reliance on regular medication use to control symptoms.
Your neck is made up of seven vertebrae (bones), and its anatomical name is the cervical spine. There is a disc between each vertebra, and nerves leave your spinal cord and exit at each level. Cervicogenic headaches are mainly due to referred pain from irritation of the upper three cervical spinal nerves or the structures they supply. This includes muscles, joints and discs in the upper neck. There is a complex interaction between the nerves of the upper neck with an area of our upper spinal cord called the trigeminocervical nucleus, and nerve signals can get mixed up in this area so that our brain interprets pain signals from structures in our neck to be falsely coming from our head. Hence we feel that we have a headache even though the painful structure is located in our neck.
Like most types of headache, the precise cause of cervicogenic headaches can be hard to define. The role of posture in cervicogenic remains a little unclear although sitting with a poked-chin posture, as is common when at a desk for long periods, puts more stress on the upper neck may be a causative factor for cervicogenic headaches.
Cervicogenic headaches often start as pain in your neck that gradually spreads upwards and progresses from the back of your head to then reach your temples, face, forehead and eyes. You may also feel some dizziness or nausea. The headache may be on one side of your head or both, but will not swap sides during the headache. Headaches are usually brought on or worsened by certain neck movements or sustained postures such as desk work, driving, repeated lifting or carrying. They are more common after neck trauma such as whiplash injuries or falls which jar the neck and head.
Your physiotherapist will first work through a thorough assessment with you. This will include a comprehensive history plus physical examination to clarify your diagnosis, identify specific structures that are producing your pain, and talk through any previous history that may impact your treatment or recovery plan. At Central Performance we believe that client education is a crucial part of any treatment program, so your physio will take the time to fully explain your diagnosis and treatment plan during your first session.
Your physio treatment will begin with effective hands-on techniques or manual therapy. These include the latest proven techniques to restore joint movement, release muscle tension and reduce your pain. Right from the start we introduce structured exercises into your treatment to reinforce the improvements gained using manual therapy plus start to reactivate and strengthen your neck muscles. Your physiotherapist will also discuss your ergonomics (desk set-up) with you and provide you with resources to check and correct your workplace arrangement, as this can be a factor in causing cervicogenic headaches. If your chair doesn’t support your back, or your keyboard, screen or mouse is not correctly positioned, then it is very likely you will be spending a lot of time in poor postures and your headaches are likely to continue or recur in the future. Often improving your ergonomics doesn’t require buying new equipment, just simply adjusting your current equipment so that it is correctly positioned for you.
As your pain resolves, your treatment begins to focus more on strengthening exercises and re-educating correct movement patterns. Extensive research shows that some muscles around your neck, especially a group called your deep neck flexors, become smaller and weaker in people who have regular headaches and neck pain. But the good news is that specific exercises to strengthen these deep neck flexor muscles have been shown to be effective in reducing or abolishing your current headaches plus reducing your risk of future headaches.
As you improve it is important to screen for any contributing factors outside of your neck itself that are contributing to your current pain, or increasing your risk of future problems. For example having a stiff thoracic spine (the spine between your shoulder blades) often gives you a hunched posture which puts increased stress on your upper neck area, and this can put you at risk of more ongoing headaches. Similarly, patterns of tightness and/or weakness around your upper body and shoulder girdle muscles can contribute to changes in your posture and neck position. Your physio will assess these issues individually and discuss their findings with you to help you understand how to relieve your headaches for the long-term.
At this stage exercise is the focus of your treatment. Your physio will guide you through a program to build strength and restore muscle length for optimal neck movement and lasting headache relief. Many clients find that progressing to our Clinical Pilates program or seeing one of our accredited exercise physiologists is a great option at this stage. These programs are personalised to help you build all of the strength, stability and flexibility you need to return to doing the things you love and keep headache-free. This is especially important if you plan to return to vigorous or high-loading sports and exercise like overhead work at the gym, regular swimming or racquet sports. Your physio will discuss this with you when they feel you are ready for these more advanced exercise programs.