Could Physiotherapy help with your headache?

Cervicogenic Headache

There are many different types of headaches. One particular type of headache that has been shown to respond well to physiotherapy treatment is the “cervicogenic headache”. The classification of different types of headaches is controversial which makes it difficult to identify the exact prevalence of this type of headache, however some studies have estimated that 1 in 4 adults will experience cervicogenic headache throughout their life time with women being 4 times more likely to be affected. 

What is cervicogenic headache?

Cervicogenic headache is a type of headache that is referred from structures around your neck. Most studies conclude that headache is caused predominately by structures centered around the first three spinal levels- C1, C2 and C3  

Signs and Symptoms of cervicogenic headache:

  • Unilateral (one-sided) headache often triggered by neck movements or sustaining awkward neck postures e.g. sleeping on your front with your head turned to the side or using a laptop at a low desk
  • Often but not always patients will have restriction in their neck movement. 
  • When assessed by a Physiotherapist a common finding is resistance on mobilisation of the upper cervical joints. This is often combined with an increase in headache symptoms with sustained external pressure over the symptomatic cervical segments.
  • Some patients experience relief with pressure or massage of the muscles around the neck or base of the skull

What causes cervicogenic headache?

Cervicogenic headaches are caused by musculoskeletal disturbance in the neck. This is typically higher up in the neck in the joints between the skull and the first three spinal segments. Studies have shown that structures in these joints can refer into the face via “convergence”.

For those that want to get super technical:
The nerves that provide information from the first three spinal segments (i.e. the afferent nerve fibres of C1, C2 and C3) converge onto neurons that receive information from the branches of the trigeminal nerve, the largest of the cranial nerves. This convergence is the way that researchers have explained how dysfunction in the cervical spine can cause referral into areas innervated by the cervical nerves and the trigeminal nerve i.e. different parts of the head and face. 

This picture is from a study that mapped areas of pain experienced in subjects after different parts of their neck were noxiously stimulated thus demonstrating how widely the cervical spine can distribute referred pain. 
Courtesy N. Bogduk & J. Govind (2009)

This disturbance or dysfunction of the cervical spine can be as a result of neck trauma e.g. after a whiplash injury or concussion or more commonly it can occur as a result of repetitive forces or sustaining awkward neck positions e.g. prolonged neck flexion from slouching over a desk or poor postures associated with repetitive household tasks.  

Other Causes of Headache


As mentioned above cervicogenic headaches are only one type of headache. Your Physiotherapist will perform a thorough assessment that includes both taking a thorough history as well as physical testing. They will screen for “red flags” or signs that your headache might not be of musculoskeletal origin and will refer you on to a Doctor specialist if they think this is the case.  

How physiotherapy can help cervicogenic headache:

Treatment will be individualized to target the specific factors we’ve identified as contributing to your headache. Treatment might include:

  • Cervical joint mobilization
  • Soft tissue massage and dry needling
  • Exercise to retrain the muscles around the neck and shoulder, in particular the “deep neck flexors”
  • Exercises to retrain cervical and whole body proprioception and posture
  • Education and advice in regard to modifying contributing factors e.g. addressing ergonomics/ organization of the workplace 

Patients often report immediate results post Physiotherapy treatment. Your Physiotherapist will also be able to show you some ways that you can achieve similar results at home to treat your headache independently e.g. self-release and mobilization techniques.  

References:

  1.  https://www.ichd-3.org/
  2. N. Bogduk & J. Govind (2009) Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests and treatment. The Lancet Neurology, 8(10): 959-968.
  3. D. Campbell & C Parsons (1944) Referred pain and it’s concomitants. J Nerve Ment Dis, 99: 544-551.
  4. S. France, J. Bown, M. Nowosilskyj, M. Mott, S. Rand, J. Walters (2014) Evidence for the use of dry needling and physiotherapy in the management of cervicogenic or tension- type headache: A systematic review. Cephalalgia, 34 (12): 994-1003.
  5. S. Racicki, S. Gerwin, S. Diclaudio, S. Reinmann & M. Donaldson (2013) Conservative physical therapy management for the treatment of cervicogenic headache: A systematic review. Journal of Manual and Manipulative Therapy, 21(2): 113-124.