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Headaches

Headaches can be a very limiting condition which can persist for many years. Three common types of headaches are tension-type headaches, migraines, and headaches secondary to a disorder in one of the top three or four joints in the neck. These neck-related headaches are referred to as Cervicogenic Headaches. It is important to identify the cause of the headache to help treat it appropriately.

Signs and Symptoms of Headaches

Cervicogenic headache
  • Affects dominantly one side of the head and does not usually change sides
  • Pain begins in the neck
  • Associated with neck, shoulder or arm pain
  • Headache is aggravated by neck movement or neck postures
  • Associated with tenderness in the neck and restricted neck motion
Migraines
  • Headache attacks lasting 4-72 hours
  • Affects one side of the head – can change sides within or between attacks
  • Pulsating quality
  • Moderate to severe intensity – limits daily activity
  • Aggravated by physical activity
  • Nausea or vomiting
  • Sensitivity to light and sound
Tension type headache
  • Headache lasting 30 mins to 7 days
  • Pressing, tightening, non-pulsating quality
  • Bandlike headache affecting both sides of the head
  • Mild to moderate intensity – may inhibit, but not prohibit activity
  • Not aggravated by physical activity
  • No nausea or vomiting
  • Sensitivity to light and sound

How can your physiotherapist help?

Your physiotherapist will first undertake a full assessment to determine if the headache symptoms fit the pattern for cervicogenic headache, and if there are problems with the joints and muscles, particularly in the upper part of the neck.

There are several possible results of this examination.

  1. The clinical assessment may indicate that the headache is originating from the neck (cervicogenic headache), and physiotherapy treatment the best approach to address this issue.
  2. The assessment might suggest the headache is another type (eg, migraine or tension-type headache). This means that the assessment revealed that the joints and muscle system of the neck were normal and is not the source of pain. With these types of headaches, primary treatment is provided by your doctor. However, physiotherapy may also be beneficial to help control symptoms. Soft tissue massage and relaxation therapy may help to relieve tension and pain.
  3. In certain cases, people with migraine and tension-type headaches may also have problems in their neck that are independent of their headache. In these cases, primary treatment is for the headache is still provided by the headache, but physiotherapy management is also important to help address the neck dysfunction (Jull, APA, 2019).

In the management of cervicogenic headaches, physiotherapists will use a variety of treatment methods which include:

  • Exercise to improve flexibility, strength and movement accuracy of the muscles around the neck and shoulder girdle
  • Manual therapy and tissue massage to help release tight structures and improve movement and pain which is common in cervicogenic headache
  • Fine neck muscle and proprioception retraining to improve postural stability
  • Advice regarding maintaining good posture in the work and home environments to avoid aggravating neck pain and headaches
Reference

Jull, G. (2019). Neck-related (cervicogenic) headache | Choose physio. [online] Choose.physio. Available at: https://choose.physio/your-body/neck/neck-related-cervicogenic-headache [Accessed 11 Mar. 2019].

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