Written by Dr. Ryan Edgar, PT, DPT
All too often I hear people complaining of frequent migraines and headaches that medication just won’t touch so they simply wait it out and decide that this is how it is, there’s nothing that can be done about it. What if I said there’s a possibility the “migraine” isn’t forming in your head and is actually being caused by your neck? You may think to yourself, “well that’s ridiculous, I’ve had these headaches for years and my neck has only felt stiff, not really painful,” but there could be so much more to it.
The concept I speak of is known as Cervicogenic Headaches. These headaches stem from the neck and are very common within the general population. It is estimated that between 0.4% and 2.5% of the world, which seems small but when you do the math that’s an average of 116 million people suffering from cervicogenic headaches and the percentage only rises within pain management clinics to around 20%.
Cervicogenic headaches can often be misdiagnosed since they mimic primary headaches such as migraines and cluster headaches which are of vascular origin. Cervicogenic headaches are considered secondary since they are caused by inflammation, or injuries to the head and neck. Because of the similarities there are multiple signs and factors that help differentiate these types of headaches from each other. To start, cervicogenic headaches are typically unilateral, or occurring on one side. This does not mean that they can not be caused by both sides of the neck, but for the most part one side will be worse than the other. Another noticeable trait is the presence of trigger points in the muscles around the neck and at the base of the skull. Trigger points form when small, localized areas of muscle fibers become taut bands which form nodules within a much larger muscle. Trigger points found in the neck can refer pain to areas like the forehead, eyes, and even the cheek. A lot of the time the trigger points are not noticed until palpated. Sustained neck positions causing the headache are also a differentiating factor. A lot of the time this is a result of poor posture while sitting or standing. Finally, noticeable symptoms that are similar to migraines include nausea, dizziness, blurred vision, and even difficulty swallowing.
So, what can physical therapy do to help counteract and treat these types of headaches? There are a number of things that can be done, but first and foremost a proper examination and screening process would be performed by your physical therapist. This includes an assessment of your posture, cervical range of motion, muscle strength and length, and cervical structures such as the vertebrae and ligaments. A very common observation made during the postural assessment is the signs of “Upper Crossed Syndrome”. This is when the head sits forward and the shoulders are rounded. When your head is forward the cervical flexors become weak and overly stretched, which results in tight suboccipitals and upper trapezius muscles. Rounded shoulders are due to weak rhomboids and scapular stabilizers, which tighten pectoral muscles and make it difficult to naturally have correct posture while sitting or standing. When all this occurs it creates excessive stress on the neck and creates tension at the base of the skull. When the therapist assesses the range of motion of the neck they are determining any kind of limitations or restrictions. There is an inverse relationship seen between cervical active range of motion and headaches. If there is a reduction in motion within the cervical spine there is an increase in the frequency of headaches.
After the assessment has been made, and we have a good idea of what is primarily causing the muscle tension and headaches, the treatment can begin. Interventions that may be included in the plan of care include: trigger point release (TPR), instrument-assisted soft tissue massage (IASTM), therapeutic exercises, and mobilizations. TPR and IASTM help to release the tight musculature and break up any fascial adhesions that are restricting the normal movement of the cervical vertebrae. Mobilization of the cervical spine will also help to improve movement and range of motion. Afterwards, an exercise regimen should be implemented to counter upper crossed syndrome. This will include strengthening the muscles around the shoulder blades (scapular stabilizers) and the cervical flexors, as well as stretching the tight musculature such as the pectoral muscles and upper trapezius. All of this will not only help to alleviate the headaches but also prevent the headaches from returning.
There are several ways that physical therapy can help aid in the reduction of headaches and keep you from having to use medication to alleviate the pain. If you believe that you’re suffering from cervicogenic headaches, or if you’ve tried everything under the sun to treat your headaches but nothing has helped, then it may be well worth your time to contact a physical therapist.
If you have any questions about cervicogenic headaches, or want to start feeling better today, give us a call at (860) 352-2463 in our Canton office, or (860) 679-0430 in our Avon office. Magna Physical Therapy & Sports Medicine Center LLC is here to help.
Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001; 1 (1): 31-46