All About Cervicogenic Tension HeadachesBy Nigel Chua
With the pace of life, work, and societal demands moving at breakneck speed, we notice that there is an increasing trend of people reporting and suffering from headaches.
These patients often report two reasons for their headaches:
- The mental, emotional and physical stress from the type of lifestyle they have or want to pursue
- The nature of work that requires an individual to be in a prolonged static position, working on devices such as computers and smart phones.
NOT ALL HEADACHES ARE MIGRAINES
Sometimes patients naturally call their headache a migraine, but it can be inaccurate because there are a few types of headaches.
We recommend that patients who often suffer from headaches should understand and identify the type of headache that they have, so it will help them to:
- identify the specific triggers
- be able to sense if there is a headache coming soon
- be able to seek appropriate management.
This can help to reduce the intensity and duration of headaches.
The cervicogenic headache is one of the common type of headaches. The good news is that it can be treated with physiotherapy, whereas the main treatment for migraines is medication.
CERVICOGENIC HEADACHE VERSUS MIGRAINE
Migraine refers to a neurovascular disorder with signs of
- mostly one-sided (half) throbbing head pain
- lasting 4-72 hours and
- a group of neurological symptoms including increased sensitivity to light, sound and smell, nausea, and a variety of autonomic, cognitive, emotional and motor disturbances.
Triggers of a migraine attack are frequently associated with a wide variety of internal and external triggers such as
- hormonal fluctuations
- sleep disturbances
- skipping meals
- sensory overload.
Cervicogenic headache refers specifically to pain referred from a source in the neck that presents itself higher up, in the head. It is caused by another illness or physical issue, usually due to a neck disorder or lesion.
In the upper neck area there is a region called the trigeminocervical nucleus, which interacts with the sensory fibers from the upper cervical neck.
This allows pain referral between the neck, face and head. This explains why the source of pain from a headache may actually be in the neck.
SIGNS AND SYMPTOMS OF CERVICOGENIC HEADACHE
Common signs of people with cervicogenic headache:
- Altered neck posture
- Restricted cervical range of motion
- Upper cervical joint dysfunction assessed by manual examination.
This cervicogenic tension headache can be reproduced or triggered by active and/or passive neck positioning and/or movement, or by pressure applied to the affected regions.
Trigger points (tight and sometimes sensitive knots in muscles) are usually found in the suboccipital, cervical, or shoulder musculature, which can cause headaches when manually or physically stimulated.
PHYSIOTHERAPY TREATMENT FOR CERVICOGENIC HEADACHE
There are a variety of treatments including
- nerve blocks
- physiotherapy and exercise
- Botox injections
The most common treatment for cervicogenic headache should target the neck, as it is the cause of the pain. Treatment varies from patient to patient.
Physiotherapy interventions depend on the outcomes and conclusions our senior physios reach after assessing your cervicogenic headache, and understanding your pain, work and exercise history, before creating a physio program specific to you.
Physiotherapy and an ongoing exercise regimen often produce the best outcomes, with low recurrence rate of tension headaches. However, we still recommend that patients have medications or anesthetic injections for temporary pain reduction, especially at times when the pains seems very intense.
This will allow you to:
- have short term pain relief so you can be still functional, e.g. go to work, participate in life events.
- be able to participate effectively with physiotherapy for even more positive long term pain relief.
Physiotherapy treatment involves three main components:
Pain relieving physiotherapy treatments
Manual therapy can be done, such as low-velocity cervical joint mobilization techniques (in which the cervical segment is moved passively with rhythmical movements), and high-velocity cervical manipulation techniques (cracking of the joint in a controlled, clinical and safe manner for the relief of tight joints).
This approach encourages the body to modulate pain levels.
Next, we will always work on soft tissue. Joint manipulations are quick and effective, but short term. Soft tissue treatment, though slower in outcomes, gives medium to long term benefits - hence combining these two treatments is ideal.
Soft tissue release is an essential tool to help relieve tight connective tissues or muscle knots that can be irritating the nerves, causing headache.
Physiotherapy modalities such as
- electrical therapy
- ultrasound therapy to accelerate soft tissue healing
- heat therapy to increase circulation as well as joint and soft tissue flexibility
- cold therapy
are also commonly used to complement the hands-on techniques for pain relief and to facilitate recovery.
Reconditioning of muscular imbalances
Reconditioning of muscular imbalance includes low load endurance exercises to train muscle control of the cervicoscapular region.
The first stage consists of specific exercises to address the impairment in neck flexor synergy found in cervicogenic headache and other neck pain disorders.
Neck flexors have an important supporting function for the cervical region. Shoulder blade muscles, particularly the lower trapezius and serratus anterior, are also trained for better postural control.
Subsequently, co-contraction of the neck flexors and extensors is performed to increase general strength at the cervical region. Muscle stretching exercises are also taught as necessary to optimize loading at the cervicoscapular region.
Postural and ergonomic correction
Postural correction of daily activities is crucial to optimize loading on the spine and overlaying muscles, preventing unnecessary fatigue or stress on the supporting muscles. Use of a mirror for visual feedback and tactile feedback, such as tape application, may be used to aid posture correction.
Rearrangement of layouts and work processes are recommended to minimize undue strain from prolonged postures, especially for people who have desk-bound jobs.