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Best Treatment for Cervicogenic Headaches

Ah…..Headache. Probably the most common type of ache a human knows from early on in life. There are many reasons for having a headache and sources are so varied that regrouping the different type of headaches under one umbrella would be counterproductive.
Today, I want to discuss Cervicogenic Headaches, a common type of headaches and how to address them on your own…and maybe also with a little help from a specialist.

Cervicogenic headaches? What Is It?

You probably have once find yourself reaching for the bottle of ibuprofen because of pounding inside your skull…
Well, you ‘re not alone and you are part of the statistics as it is the most common reason for reaching for over-the-counter meds.
One common origin for headaches is the neck, or cervical spine…which define the term cervicogenic headaches.
In this type of headaches, the cause originate in the neck itself and the symptoms can sometimes resemble the other common migraines, tension or cluster headaches, to name a few.

Symptoms can present such  as:

  1. A very stiff neck limiting your range of motion and making neck and head movement painful
  2. One sided neck or shoulder/arm pain along with the headaches itself,
  3. Pain following sustained pressure to the sub occipital area, your upper neck region where the neck meets with your skull, possibly from sleeping with a poorly supported neck, forward head posture or sustaining awkward posture like painting a ceiling or crawling under a sink for plumbing repair…
  4. Tenderness in the upper 3 vertebra in your neck and tightness and trigger points in the superficial muscles of the neck, base of neck and shoulder blades area. They can also lead to nausea.
  5. Headaches felt in any of the location as seen on the picture below, including around your eye, side or top of your head
Cervicogenic headaches can last for a short periods of time like an hour to a much longer and uncomfortable weeks. They represent 2-18% of all type of headaches, according to different studies. The incidence is equal in male and female and they are characterized as non-throbbing and milder or equal to a migraine, with the first symptoms felt in the neck then progressing to face, head/ skull. They often(53% of time) occur in victims of whiplash injury, such as in a motor vehicle accident. But also without any specific trauma. They can be chronic, recurrent , and episodic.

But the single most important descriptor to remember for a correct diagnosis of a cervico-genic headache is that ​the symptoms and pain only occur on one side, and the symptoms remains on that side.

What create Cervicogenic Headaches?

Picture

In this type of headaches, it is believed various structure(ligaments, discs, joints, muscles and/or blood vessels) in the upper neck, between the skull and the third cervical vertebrae, could be the source of the pain that is then referred to various places in head, skull, neck and even to the base of your clavicle, or collarbone. 
Recent studies revealed that facet joints (the joints on the sides of each vertebrae that articulates with the vertebrae above and below) are the main source of cervicogenic headaches. Especially the facet joints at
C2-C3. And even more likely following a trauma, like a whiplash.

Of course, some other studies ruled out that without trauma, the facet joints were not  the source of pain.

Imaging, like MRI, have not been helpful in diagnosing Cervicogenic headaches as normal variations and changes like disc herniation(bulge) are seen equally in people suffering from cervicogenic headaches and people that do not. 

Medical treatment have consisted of steroidal injections at the C2-C3 facet with some benefit for some patients.
The most common observable findings in patient with these headaches is the limitations in head and neck movement, particularly rotation (head turns), involving moving of facet joints. So an injection to these joints would in theory helped in decreasing the pain since facet joint are known to referring pain to the head.

​Over-the-counter medications like you would take for a common headache have been for the most part ineffective in helping people when considered as the main treatment.

As you can see on the illustration to the right, the upper cervical region is a hotbed for nerve activity as cervical sensory nerve roots, and two of the 12 cranial nerves( the trigeminal and spinal accessory nerves) are present in this fairly small area and refers sensation and pain to the face and the head.  Any of these nerves can send nociceptive( pain) signals that create a cervicogenic headache.


Best Treatment For Cervicogenic Headaches

Treating cervicogenic headaches from a classic western medicine standpoint is often limited to steroid injections or over-the-counter non steroidal anti inflammatories. The effects of the two can be effective but also often limited to temporary relief, and sometimes with adverse side effects.
In regards to non invasive treatments, a combination of exercises and manual (hands-on) therapy has been shown to be beneficial.

Manual therapy can blend many different techniques, including soft tissue and joint mobilizations. Adding manual therapy to exercises can also be beneficial, although some studies shows no significant difference in results vs using either exercises or manual therapy alone to treat cervicogenic headaches.

The benefit of exercises, as it is true with many condition, cannot be ignored in the treatment of Cervicogenic headaches.
Exercises and especially being taught by a therapist how to perform self mobilization of the neck  is invaluable as it blend both the manual therapy and the exercises aspects.  It also decrease the need to rely on a practitioner on a regular basis to address the mobility limitations that leads to this type of heachaches and empower the patient with self treatment at home or work.
Jull G, Trott P, Potter H, et al. demonstrated  in their studies (A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27: 1835–43) that specific exercises helps > 75% of sufferers decrease their symptoms by more than 50% and  with a complete resolution at 7 weeks in 35% of cervicogenic headaches patients.

​When it comes to exercises for cervicogenic headaches, strengthening the neck and shoulder blade musculature that will prevent excessive pulling and loading of the upper cervical/ neck region is key, as well as keeping the mobility of the upper cervical spine joints.
In the following videos, I demonstrate several techniques that will do just that.  Some of them, the techniques using the edge of a towel, could also help cervicogenic headaches symptoms right away. I would start with these as they could provide immediate relief.

I hope these exercises and techniques are helpful for you in your recovery from cervicogenic headaches.  Don’t hesitate to leave any comments or questions below and don’t forget to consult a physical therapist if you symptoms persist.

Disclaimer: this blog is provided for information and education purposes. In no instance the author guarantees results nor is responsible for aggravation of symptoms when techniques are performed inappropriately. Please consult a physical therapist for a comprehensive assessment and treatment of cervicogenic headaches symptoms.


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