What is it?
Cervicogenic headache is simply another name for a headache which originates from the neck and is one of the most common types of headache.
The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally.
During certain neck movements or sustained postures, stretching or compression force is placed on the joints, muscles, ligaments and nerves of the neck. This may cause damage to these structures if the forces are beyond what the tissues can withstand and can occur traumatically due to a specific incident or gradually over time. When this occurs pain may be referred to the head causing a headache. This condition is known as cervicogenic headache.
Cervicogenic headache typically occurs due to damage to one or more joints, muscles, ligaments or nerves of the top 3 vertebra of the neck. The pain associated with this condition is an example of referred pain (i.e. pain arising from a distant source – in this case the neck).
This occurs because the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears. As a result, pain arising from structures of the upper neck may refer pain to any of these regions causing a cervicogenic headache.
Cervicogenic headache typically occurs due to activities placing excessive stress on the upper joints of the neck. This may occur traumatically due to a specific incident (e.g. whiplash or heavy lifting) or more commonly, due to repetitive or prolonged activities such as prolonged slouching, poor posture, excessive bending or twisting of the neck or working at a computer.
Signs and Symptoms
Cervicogenic headache usually presents as a constant dull ache, normally situated at the back of the head, although sometimes behind the eyes or temple region, and less commonly, on top of the head, forehead or ear region. Pain is usually felt on one side, but occasionally, both sides of the head and face may be affected.
Patients with this condition often experience neck pain, stiffness and difficulty turning their neck, in association with their head symptoms. Pain, pins and needles or numbness may also be felt in the upper back, shoulders, arms or hands, although this is less common.
There are several factors which can predispose patients to developing cervicogenic headache. These need to be assessed and corrected where possible with direction from a physiotherapist. Some of these factors include:
- poor posture
- neck and upper back stiffness
- muscle imbalances
- muscle weakness
- muscle tightness
- previous neck trauma (e.g. whiplash)
- inappropriate desk setup
- inappropriate pillow or sleeping postures
- a sedentary lifestyle
- a lifestyle comprising excessive slouching, bending forwards or shoulders forwards activities.
Most cases of cervicogenic headache heal well with appropriate physiotherapy. Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence.
Treatment may comprise:
- joint mobilization
- joint manipulation
- soft tissue massage
- dry needling
- electrotherapy (e.g. ultrasound)
- postural taping
- postural bracing
- the use of a lumbar roll for sitting
- anti-inflammatory advice
- activity modification advice
- the use of an appropriate pillow for sleeping
- ergonomic advice
- exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture
- clinical Pilates
- neural stretches
Jenny Davison (Former Physio)
Central Baldivis Physiotherapy