Treatment of Cervicogenic Headaches

What are Cervicogenic Headaches?

Cervicogenic headaches are headaches that stem from the neck. The pain is perceived in the head but the dysfunction is originating in the neck. Typically, these headaches originate in the upper three vertebrae of the neck (vertebrae are the bones of the spine). Certain movements or sustained postures can cause strain or compression to the joints, muscles, ligaments, discs and/or nerves of the neck. This in turn, can refer pain to the head in the form of a headache.

The reason that upper neck dysfunction refers to the head and face causing headache is because there is a merger of the upper neck spinal nerves (C1, C2, C3) with the trigeminal nerve (which controls the sensation of head, forehead, jaw line, back of eyes and ears). This cross-communication between these nerves is what leads to cervicogenic headache.

What Causes Cervicogenic Headaches?

Cervicogenic headache is caused by any activity or event that puts excessive stress/load on the upper neck. This can occur with one specific event (such as whiplash or blunt trauma) or may build up gradually with sustained poor postures (at the computer or while doing housework for example) .

What are the Signs and Symptoms of Cervicogenic Headache?

The headache itself can feel like a constant dull ache, typically on one side of the head and face but if there is significant injury affecting both sides of the neck, then the headache can occur on both sides. Also, the headache can be accompanied by neck pain or neck stiffness. It usually comes on during the provocative activity or after the activity and even sometimes the next morning following the provocative event.

What Are Some Exercises That Can Help Cervicogenic Headache?

Since posture of the entire spine and specifically the upper neck is a leading contributing factor for developing cervicogenic headache, the goals of exercise will be to improve posture. Keep in mind that an individualized approach to exercise will be more effective in treating cervicogenic headache when compared to a general program. A qualified physiotherapist will be able to assess you and will develop the best exercises for your specific posture and your lifestyle goals.

Here is a list of generalized exercises that may be helpful for this condition. Exercises should not exacerbate symptoms and should be conducted in pain free ranges of motion.

Posture Based Exercises

1. Gentle Chin Tucks while elongating the back of the neck
2. Shoulder Blade Pinching while lengthening and lifting through the spine

Neck Stabilization Exercises

3. Deep Neck Flexor Activation while keeping the spine in neutral
4. Gradually stacking the neck bone by bone into upright alignment (from a flexed position)

Muscle Release/Stretching

5. Myofascial release with two balls at juncture between the head and top of the neck
6. Upper Trapezius stretching
7. Flexion of the neck to stretch all the long muscles on the back of the neck
8. Sternocleidomastoid stretching
9. Scalenes stretching
10. Levator scapulae stretching
11. Pectoralis stretching

Upper Back Stabilization Exercises

12. Lifting spine to neutral from a flexed position over an exercise ball

Functional Exercises

13. Whole body exercises that improve core and postural musculature (such as squats, shoulder press, push up, pull up, deadlift etc)

Physiotherapy for Cervicogenic Headache

It is advisable to visit a trusted physiotherapist at the onset of your symptoms. Your physiotherapist will conduct a thorough assessment and develop an individualized treatment plan. A multi-modal approach to care is the most effective. Your treatment plan may consist of the following strategies and techniques:

1. Hands on Manual Therapies: to mobilize the joints of the neck, upper back, shoulders or other areas of the body that may be contributing to your symptoms
2. Acupuncture: to stimulate the nervous system, release tight bands of muscle and stimulate a physiological response that will activate the bodies’ natural healing process.
3. Gunn IMS: to release tight bands of muscle and re-set the nerve impulse to the associated muscles
4. Prescriptive Exercise: individualized exercises that will address muscle imbalances and postural dysfunctions.
5. Soft Tissue Release: stretching and manipulation of soft tissues and muscles that may be contributing to your symptoms
6. Posture Re-Education and Activity Modifications: to prevent further aggravation and make you more mindful about your posture.

Can Cervicogenic Headache Be Cured?

Yes, of course! The most efficient route would be to see a physiotherapist who can help develop a personalized program that will target your specific issues. Most simple cases will resolve within 1-2 weeks but more complex cases will take weeks to months for full resolution of symptoms. This will all depend on the cause, severity, duration of the pain, your ability to get the proper treatment and your ability to modify any aggravating activities/demands. The key is to stay consistent with your prescriptive exercises and make any necessary lifestyle changes to prevent this condition from recurring (such as adjusting your work station and limiting phone/tablet browsing for instance).

Best Position to Sleep in if you suffer from Cervicogenic Headache?

If you suffer from cervicogenic headaches, it’s important that you try to maintain a neutral neck posture when you are sleeping. This means that the posture that you achieve with your head and neck when you are sitting up straight is the same posture that you want your neck to be in as you lie on your pillow.

If you are a side sleeper, then you must ensure that your pillow is supportive enough to maintain your head and neck alignment.  Your pillow must fill and support the space that is created between the top of your shoulder, neck and head. Otherwise, your head will end up in a side-bent position.

If you are a back sleeper, then you must ensure that your pillow does not prop your head up too high and force you into a flexed position. If you prefer to sleep on your back, you may want to ensure that your pillow can compress down to allow your head to rest in a position that is aligned with the rest of your spine. If you have forward head posture and your bones have adapted to this posture, then you may need some additional pillow support to account for the fact that your head rests a bit forward.

We recommend that you always try a pillow in store before you purchase it. Remember, the fancier and more expensive pillows (with all the bells and whistles) are not always the best. What works for you, will not work for the next person.

If you are suffering from cervicogenic headaches and would like to see one of our experienced physiotherapists, contact us today!