Headaches, neck pain and restricted neck range of motion? You may be suffering from cervicogenic headaches!
Article too long? Check out this short video with Dr Abbey Davidson (Osteopath) which the best stretches and exercises to help with headaches.
The term cervicogenic headache sounds a little confusing. If we break it down; “cervico” refers to the cervical spine or neck and “genic” comes from genesis or originating from. So a headache which is originates or is caused by the neck.
Because cervicogenic headaches are caused by dysfunction in the bones, joints, nerves, discs and muscles of the neck they are technically classified as a secondary headache (as opposed to a primary which originate from the head itself). For more information on the neck and neck anatomy check out our other blog Neck Complaints.
The term cervicogenic headache is often incorrectly used to describe a headache associated with neck pain. Tension-type headaches and migraines also commonly have associated neck pain. It is important to distinguish that cervicogenic headaches are headaches caused completely by disorder of one or multiple structures within the neck and not just an associated symptom or by-product. Note that cervicogenic headaches can often mimic migraines. Migraines are a primary headache originating in the brain where cervicogenic headaches originate in the neck.
Cervicogenic headaches arise from the neck therefore injury and diseases effecting the neck trigger this type of headache. Some common causes of cervicogenic headache include:
To establish what causes the headache you have to consider what is effecting the structures of the neck.
Some risks factor for cervicogenic headaches include:
If you are experiencing a cervicogenic headache you may experience some or all of the following:
Note that cervicogenic headaches can mimic symptoms similar to migraines. This includes light sensitivity, blurred vision, nausea and sensitivity to sound.
Sudden onset of neck pain/headaches, especially with face pain, slurring, fever, weakness or symptoms effecting the arm should be assessed by a health professional as soon as possible
Gentle range of motion exercises, stretches, avoiding aggravating activities, self-massage, anti-inflammatory gel application, deep neck flexor strengthening, appropriate hydration and maintaining a headache diary may be helpful. Note that what you can do right now for your headaches will vary depending on the specific cause.
Gentle neck range of motion exercises will aim to maintain and improve the movement at each joint within the neck and decrease any restrictions. These exercises should be performed in each plane of movement: side bending right, side bending left, rotating right, rotating left, flexion and extension. They shoulder be performed rhythmically and within pain limits.
Stretches such as those demonstrated in the video at the top of page will aim to decrease muscle tone and spasm within tight muscle potentially contributing to your headaches. Suboccipiatl, trapezius, levator scapulae and scalene muscle stretchs are often usefel. Try doing these stretches on both sides and holding the stretch for 20-30 seconds within pain limits.
Chin tuck exercises (when performed correctly) aim to restrengthen the deep neck flexors or stabilizing muscles of the neck. The video at the top of page demonstrates how to perform these exercises. This is more of a preventative strategy for future cervicogenic headaches by adding strength and stability to the neck region.
Maintaining Headache Diary can be really helpful in someone who suffers regularly from headaches. It can really be useful when you first go to a health practitioner in diagnosis, knowing the timing, how frequent, how long, how intense and any triggers associated with your headaches.
Self-massage just like stretching is aimed at addressing the soft tissues of muscles of the neck. Muscle tightness, spasm or trigger points can refer directly into your head and cause your headache symptoms. Gently use your fingers to rub into tight muscle points and gently release tight muscle fibres.
Hydration is important for headache sufferers. Consumption of 2-3L per days is recommended for an adult. Being hydrated helps the neck structures and therefore cervicogenic headaches by lubricating joints, adding to disc height and improving muscles tone.
Avoiding activities which aggravate your headaches. This may mean changing your set up at work to be more ergonomic, taking regular micro-breaks at work, altering certain duties at work repetitively utilise the neck or changing bad daily habits. It is important to first identify activities which aggravate our neck and headaches and then find a way to avoid or minimise them.
As mentioned before cervicogenic headaches are secondary headaches. This will mean your physiotherapist or osteopath will spend time trying to find the specific cause of your headache. Not only looking at the joints, bones, muscles, nerves and discs in your necks but also investigating the shoulders, mid-back and other necessary regions.
Assessment will also involve orthopaedic and basic neurological testing to assess if any further investigation is required. In some cases, your osteo/physio will send you to get some imaging (X-Ray, MRI or CT) to give you a clear diagnosis and management plan going forward. Your therapist will spend time trying to give you a proper explanation of your condition and how you will both work together to improve your symptoms and underlying causes.
Hands on therapy may involve techniques such as muscle activation, spinal manipulation, dry needling, soft tissue massage, joint articulation, traction, stretching, exercise prescription. These will attempt to address the structures within the neck causing you headaches as well as any other regions contributing in neck stress (e.g. restricted mid-back or shoulders).
Cervicogenic headaches caused by muscles and joint dysfunction may respond to osteopathic or physiotherapy within 2-3 weeks. Whereas cervicogenic headaches with disc and nerve involvement can take much longer (6-12 weeks+). Cases involving osteoarthritis may require ongoing management to keep symptoms as minimal as possible. Under the right care and management practices cervicogenic headaches can be treated effectively.
How long until your headaches improve is heavily dependent on what the cause of the pain is and the changes you are willing to make. Changing habits which are constantly aggravating your neck and headaches is key. This may mean taking regular micro-breaks from your desk, changing your duties at work, altering your sleeping position and/or increasing your exercise participation. Compliance to prescribed treatments and exercises prescribed by your health professional is also of high importance.
In rare cases where there is significant nerve compression in the neck further intervention may be required to relieve cervicogenic headaches. This may include anaesthetic injections (nerve blocks) or surgery. Recovery under these circumstances is expected to be longer.
By Sydney CBD Osteopath Dr Abbey Davidson