Headaches are one of the most common ailments that affect people’s lives daily. Everyone complains of different types of headaches, positions of pain, duration and cause of these headaches. Fortunately, physiotherapy can help assess treat and manage the symptoms as well as treat the root cause of the problem.

RED FLAGS!!!

This term describes symptoms that may relate to a sinister cause for your headache (2);

New or different headache to usual
“Thunderclap” headaches – Sudden or severe onset
Signs of neurological complications e.g. motor weakness, memory loss
New headache onset over the age of 50 years
Headache associated with systemic symptoms e.g. weight loss, night sweats
Headaches at night or on waking in the morning
Headache beginning after sneezing, exercising, head turning or after coitus.

If any of these relate to your current headache, you should inform your physiotherapist or doctor immediately.

Cervicogenic Headaches

This includes all headaches that are caused by a neck joint disorder. Research has shown that these account for 4% to 22% of all headaches seen clinically (3).

Signs and Symptoms

Requires your physiotherapist to interpret all symptoms and physical examination findings in order to correctly diagnose. Often people complain of tenderness at top of neck and base of skull. Neck stiffness with occasional restriction of movement may be present (2). The main difference between cervicogenic and migraine headaches is that your physiotherapist will be able to alter/relieve your pain. People usually describe their headache as the following;

Common sites for pain referral in cervicogenic headaches

Your headache may seem to radiate from the back to the front of your head.
Your headache be provoked or eased by a neck movement, a sustained posture, stomach sleeping or with your head turned to one side.
Your headache normally appears to be worse on one side of your head. The side is normally constant and does not swap sides.
Your headache appears to temporarily ease up when you apply pressure or you massage your neck or the base of your skull.

Cause

Various structures including both musculoskeletal and neurovascular may be the culprit; including the upper three neck joints, C2/3 disc, spinal cord coverings and neck muscles. A dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (1).

Upper cervical

Normally caused by your upper three neck joints, if they are too stiff or move too excessively or are locked in an abnormal position. Once these become stressed, pain signals are sent to the trigeminal nucleus which results in a cervicogenic headache.

Neck Muscles

Representing the pain referral pattern for the SCM muscle in the neck

The muscles around your neck, shoulder and shoulder blade may become stressed from poor posture causing weakness or overwork which results in referred pain causing headache symptoms.

Cervical and Occipital Nerves

Irritation of the nerves in your upper neck may cause your headache. Irritation may results from disc bulges, swelling or bony growths from arthritis.

So how can physio help?

Joint mobilisations can relieve stiff neck joints. Traction and gentle manipulation may be required.

Unstable neck joint will require specific muscle recruitment and strengthening techniques.

Tight or tender muscles will require a combination of stretching, massage, dry needling and muscle release techniques.

Other treatments involve posture correction, education as well as techniques to combat nerve dysfunction.

How will I know if it worked?

Relief is often instant. It is important that the underlying cause of your cervicogenic headache is treated so to prevent future headaches.

In the event of no relief being experienced, it’s important that your physio investigates it thoroughly to rule out sinister causes and to identify whether you may be experiencing one of the other types/mix of other headaches.

References

(1) Bogduk, N. (2001) 'Cervicogenic headache: anatomic basis and pathophysiologic mechanisms', Current Pain Headache Report, 5(4), 382-386.

(2) Page, P. (2011) 'Cervicogenic Headaches: An Evidence-led Approach to Clinical Management', International Journal of Sports Physical Therapy, 6(3), 254–266.

(3) Watson, D. H. and Drummond, P. D. (2014) 'Cervical referral of head pain in migraineurs: effects on the nociceptive blink reflex',. Headache, 54, 1035-1045.

My neck is causing my headache?

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