Physical Therapy For Cervicogenic Headaches

Have you ever had a headache that didn’t get better with the use of medication? Have you wondered why you sometimes wake up in the morning with a headache or feel a headache coming on after working in front of a computer screen or even after being on your cell phone for a prolonged period?

Common Headache Types

Migraine or Cluster Headache
Many possible factors can produce headache symptoms and they can be diagnosed based on their presentation and location of the headache. The most widely known headache is caused by vascular issues, meaning a constriction of the blood vessels in the head, thus causing a headache often diagnosed as a migraine or cluster headache.

Sinus Headache
Another common headache is a sinus headache, the symptoms of which are primarily located at the front of the head, with patients having palpable tenderness through the forehead and face.

Cervicogenic Headache
A cervicogenic headache, however, will likely originate at the back of the head/neck travel up the head, and may even cause pain in the eye. The pain is usually on one side and may accompany neck pain, stiffness, or symptoms intensified when applying pressure to the neck. Imaging to include an X-ray or MRI will often be inconclusive.

Physical Therapy Intervention
What are the options for treating a headache if you suspect it is cervical in nature? This is a common diagnosis treated through physical therapy intervention as the headache is musculoskeletal in nature, meaning arising from the muscles or bones. A licensed physical therapist will perform a thorough evaluation of the mobility in the cervical region to assess any limitations in active movement of the neck and or any limitations of the facet joints (a joint where one vertebra joins another). The most commonly involved area is the top three cervical vertebrae. A therapist will also assess the integrity of the muscle groups through the neck as well as the muscle groups along the front of the chest/shoulder and into the middle back or shoulder blade region. This assessment is critical in correcting any posture changes that cause undue stress through the upper cervical region and thus triggering a cerviogenic headache. These posture changes can occur following sustained positions such as prolonged computer work, prolonged sitting, or prolonged work with arms in an overhead position.

Treatment Techniques
Once a physical therapist has identified the structures involved and the exact origin, various treatment techniques can be utilized to provide symptom reduction.  Mobilizations of the cervical facet joints are critical to restore normal movement and reduce inflammation and pain arising from this area. A joint mobilization is when direct pressure is rhythmically applied to a joint surface. The goal of mobilization is to reduce pain and inflammation and gradually restore movement by varying the amount of pressure applied.

Soft tissue release, or massage, is also utilized to address the tightness through the neck musculature that has occurred either due to holding the neck in a sustained position to avoid pain or from sitting with improper posture for prolonged periods. In conjunction with the manual techniques of mobilizations and soft tissue release, exercises will be implemented to correct any postural changes due to muscle weakness through the neck and scapular stabilizing musculature and with flexibility exercises given to address tightness due to adaptive posture changes.

Treatment would not be complete without thorough education provided on how to maintain proper postures and prevent exacerbation of symptoms and reoccurrence of headache pain.