Cervicogenic Headaches

Do you suffer from ongoing or repetitive headaches? Could it be helped by physiotherapy?

There are many types of headaches, with different causes and therefore different solutions. There are several types of headache that physiotherapy can assist with. One of these is the cervicogenic headache¹.

What is a cervicogenic headache?

Cervical – relating to the neck. Genic – causing, forming, producing ².

The International Headache Society describes a cervicogenic headache as being a “headache caused by a disorder of the cervcial spine…. usually but not invariable accompanied by neck pain”³.

A physiotherapist is trained in determining whether a headache originates in the neck. There are some features specific to a cervicogenic headache³, such as:

• Presentation equal in males and females.
• Pain on one side of the head. Always the same side of the head.
• Pain may be located around the eye, the temple, the crown of the head, the back of the head or the base of the skull.
• May be constant or intermittent, but persists over a long period. An hour to weeks.
• Moderate to severe intensity. Steady, deep pain.
• Triggered by neck movements, a certain posture or pressure on the neck. Not always easily identified.
• Often accompanied by a reduced range of movement of the neck. May be accompanied by nausea or visual changes, but this is unusual.

What can a physiotherapist do to help?

It is important for a physiotherapist to assess your headache and determine what therapy is likely to be appropriate¹. The source of a cervicogenic headache is usually the top of the neck, it may involve joints disc, ligaments, and muscles⁴. Your physiotherapist will also eliminate other causes for your discomfort.

Physiotherapy may include:

• Joint mobilisation^5,6,7
• Strengthening exercises^5,8
• Soft tissue massage⁹.

Summary

A cervicogenic headache is a headache resulting from mechanical trouble at the top of your neck. You may or may not feel pain in the neck. A physiotherapist will diagnose your type of headache and through manual therapy, exercises and education, will help you to resolve or reduce your pain and to correct the dysfunction that caused the headache.

References

https://www.physio-pedia.com/Cervicogenic_Headache

1. Goodman, C, Fuller, K. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis: Saunders Elsevier, 2009.
2. https://medical-dictionary.thefreedictionary.com/-genic
3. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders.2nd edition. Cephalalgia 2004;24:suppl 1.
4. Becker WJ. Cervicogenic Headache: Evidence that the neck is a pain generator. Headache. 2010;4 699-705
5. Fritz JM, Brennan GP. Preliminary Examination of a Proposed Treatment-Based Classification System for Patients Receiving Physical Therapy Interventions for Neck Pain. Physical Therapy. 2007;87:513-524.
6. Cleland et al. Examination of a Clinical Prediction Rule to Identify Patients with Neck Pain Likely to Benefit from Thoracic Spine Thrust Manipulation and a General Cervical Range of Motion Exercise: Muti-Center Randomized Clinical Trial. Physical Therapy. 2010;90:1239-1253.
7. Hal T et al. Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache JOSPT 2007;37:100-107.
8. Jull G, Stanton W. Predictors of responsiveness to physiotherapy management of cervicogenic headache. Cephalalgia. 2005;25:101-108
9. Gema Bodes-Pardo et al.; Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial; Journal of Manipulative and Physiological Therapeutics Volume 36, Number 7; 2013

Cover photo by Matteo Vistocco