for neck-related (cervicogenic) headache
There are many causes of recurrent headache that can persist for many years. Three common types are tension-type headache, migraine, and headaches secondary to a disorder in one of the top three or four joints in the neck. These neck-related headaches are commonly called ‘cervicogenic’ headache. Cervicogenic headache is usually felt on one side of the head. It is always the same side and, unlike migraine, neck headaches do not swap sides. Cervicogenic headache is of mild-to-moderate intensity and is always accompanied by neck pain. Most typically, the pain begins in the neck and then spreads to a headache.
What causes cervicogenic headache?
Excessive strain caused by poor working postures (prolonged sitting, working in awkward neck postures) can irritate the upper joints of the neck and cause a headache. The joints can also be injured by trauma. This could be a sporting or recreational injury or a motor vehicle crash. In the late middle-aged to older age groups, osteoarthritis of the upper neck joints is another common cause of cervicogenic headache.
Neck pain and headaches are typically made worse by sitting or working for a long time in one (often poor) posture, and are typically aggravated by neck movements. The neck is tender and movements are often slightly restricted or stiff. About one-third of people with cervicogenic headache also report some light-headedness, unsteadiness or visual disturbances.
How do I know if I have cervicogenic headache?
It can sometimes be confusing to know if you have a cervicogenic headache, as the symptoms of different types of headaches are often quite similar. Neck pain and tenderness are common symptoms of migraine, tension-type and cervicogenic headache. In migraine and tension-type headache, this neck pain is often a spread of the headache into the neck. In cervicogenic headache, it is the opposite. The neck pain starts and then spreads into the head. This headache is from a local cause in the neck. Likewise, neck movements are stiff and painful in cervicogenic headache.
Correct diagnosis is important, as each headache type requires a different treatment method. GPs, neurologists and physiotherapists may all play a role in diagnosis.
How can treatment methods used by physiotherapists help with neck-related (cervicogenic) headache?
Your physiotherapist will first undertake a full examination 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.
- The clinical examination might indicate that the headache is coming from the neck (cervicogenic headache), and physiotherapy treatment is the best management.
- The examination might suggest the headache is another type (eg, migraine or tension-type headache)—that is, the neck joints and muscles were found to be normal. In these cases, management by your GP is the primary treatment, and some physiotherapy methods such as relaxation therapy and soft tissue therapy may assist in management as part of a multidisciplinary approach.
- People with migraine and tension-type headaches may have problems in their neck that are independent of their headache. In these cases, physiotherapy treatment of the neck may offer some help in conjunction with treatment from the GP.
Physiotherapists use a variety of treatment methods for best practice management of cervicogenic headache.
Education, advice and assurance
This is to ensure the person understands the nature of their headache, is assured of its benign nature, and has the knowledge to actively participate in the care of their neck.
This is an effective treatment method used to help ease the headache, neck pain and any associated symptoms.
The exercises are prescribed depending on your requirements, and are designed to:
- ease pain
- improve posture and postural habits
- improve movement and flexibility of the neck
- train the supporting muscles of the neck and shoulder girdle
- train strength and endurance of the neck muscles
- train balance, movement accuracy, as well as head and eye movement control when light-headedness or unsteadiness are symptoms of the headache disorder.
Advice for work and home
Prolonged and awkward postures, as well as poor lifting and carrying techniques will aggravate the neck pain and headache. Your physiotherapist works with you to develop best work, activity and lifestyle habits to relieve unnecessary strain on the neck.
It is important to care for your neck to help prevent recurrent headaches. Your physiotherapist will work with you to devise a program of simple and convenient exercises and lifestyle habits relevant to your needs. It is best to try to include them into daily routines so that good neck postures and movement become normal habits. A plan will be developed to help manage and rapidly settle any future flares of headache and neck pain rapidly.
How effective are treatment methods used by physiotherapists for cervicogenic headache?
There is an increasing body of evidence supporting the treatments offered by physiotherapists for the treatment of cervicogenic headache, particularly manual therapy and exercise. A comprehensive management program will include education, manual therapy, exercise therapy and work practice advice. Self-management strategies are vital to help you look after your neck, and adopt best work and lifestyle habits as well as a simple exercise regime.
There is no convincing evidence that methods used by physiotherapists help migraine headache. However, some people with tension-type headache may gain some relief with relaxation, massage and other soft tissue techniques.
What can I do at home?
The descriptions of a full range of exercises for neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.
How long until I feel better?
The time for improvement varies between people, and clinical trials indicate there can be relief within 2–6 weeks of beginning management. Some people take longer and this will often depend on the nature of your neck disorder.