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Headache (Cervicogenic)Injuries > Neck & Head > Cervicogenic Headache
(Also known as Headache, Cervical Headache, Neck Related Headache, Referred Pain from the Neck)
What is cervicogenic headache?Cervicogenic headache is simply another name for a headache which originates from the neck and is one of the most common types of headache. It is important to note, however, that there are many types of headache of which cervicogenic is just one. Another common type is vascular (this includes migraines). The spine (neck) comprises of many bones known as vertebrae. Each vertebra connects with the vertebra above and below via two types of joints: the facet joints on either side of the spine and the disc centrally (figure 1). During certain neck movements or sustained postures, stretching or compression force is placed on the joints, muscles, ligaments and nerves of the neck. This may cause damage to these structures if the forces are beyond what the tissues can withstand and can occur traumatically due to a specific incident or gradually over time. When this occurs pain may be referred to the head causing a headache. This condition is known as cervicogenic headache. Cervicogenic headache typically occurs due to damage to one or more joints, muscles, ligaments or nerves of the top 3 vertebra of the neck. The pain associated with this condition is an example of referred pain (i.e. pain arising from a distant source – in this case the neck). This occurs because the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears. As a result, pain arising from structures of the upper neck may refer pain to any of these regions causing a cervicogenic headache. Although cervicogenic headache can occur at any age, it is commonly seen in patients between the ages of 20 and 60. Causes of cervicogenic headacheCervicogenic headache typically occurs due to activities placing excessive stress on the upper joints of the neck. This may occur traumatically due to a specific incident (e.g. whiplash or heavy lifting) or more commonly, due to repetitive or prolonged activities such as prolonged slouching, poor posture (figure 2), excessive bending or twisting of the neck or working at a computer. Signs and symptoms of cervicogenic headachePatients with this condition usually experience a gradual onset of neck pain and headache during the causative activity. However, it is also common for patients to experience pain and stiffness after the provocative activity, particularly upon waking the next morning. The pain associated with cervicogenic headache can sometimes last days, weeks or even months. Cervicogenic headache usually presents as a constant dull ache, normally situated at the back of the head, although sometimes behind the eyes or temple region, and less commonly, on top of the head, forehead or ear region. Pain is usually felt on one side, but occasionally, both sides of the head and face may be affected. Patients with this condition often experience neck pain, stiffness and difficulty turning their neck, in association with their head symptoms. Pain, pins and needles or numbness may also be felt in the upper back, shoulders, arms or hands, although this is less common. Occasionally patients may experience other symptoms, including: light-headedness, dizziness, nausea, tinnitus, decreased concentration, an inability to function normally, and depression Patients with cervicogenic headache typically experience an increase in symptoms during certain movements of the neck or sustained positions (e.g. driving or sitting at a computer in poor posture). Patients may also experience tenderness on firm palpation of the upper part of the neck just below the base of the skull along with muscle tightness in this region. Diagnosis of cervicogenic headacheA thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose cervicogenic headache. Occasionally, investigations such as an X-ray, MRI or CT scan may be required to assist diagnosis. Prognosis for cervicogenic headacheMost patients with this condition heal quickly and have a full recovery with appropriate physiotherapy treatment. Recovery time varies from patient to patient depending on compliance with treatment and severity of injury. With ideal treatment, patients with minor cases of cervicogenic headache may be pain free in as little as a couple of days, although sometimes it may take 2 – 3 weeks. In severe or chronic cases a full recovery may take weeks to months. Contributing factors to the development of cervicogenic headacheThere are several factors which can predispose patients to developing cervicogenic headache. These need to be assessed and corrected where possible with direction from a physiotherapist. Some of these factors include:
Treatment for cervicogenic headacheMost cases of cervicogenic headache heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain or ache until they are symptom free (a postural support or postural taping may be required). Activities which place large amounts of stress through the upper neck should also be minimized, these include: sitting, standing or lying in poor posture (slouching), head looking down activities, shoulders forward activities and lifting. Resting from aggravating activities allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate treatment for patients with cervicogenic headache is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times. Patients with cervicogenic headache should perform early movement and postural exercises (often "chin tucks" – see below) to prevent stiffness from developing and to ensure the neck is functioning correctly. The treating physiotherapist can advise which exercises are appropriate and when they should be commenced. Patients with this condition should also pay particular attention to maintaining good posture as much as possible to minimize stress on the neck. This is particularly important when sitting or driving. Optimal sitting posture can be obtained by sitting tall on an appropriate chair, with your bottom in the back of the chair and a lumbar support (or a pillow or rolled up towel) in the small of your back. Your shoulders should be back and your chin should be tucked in slightly (figure 3). Physiotherapy for cervicogenic headachePhysiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence. Treatment may comprise:
Other intervention for cervicogenic headacheDespite appropriate physiotherapy management, a small percentage of patients with this condition fail to improve and may require other intervention. This may include pharmaceutical intervention, corticosteroid injection, investigations such as an X-ray, CT scan or MRI, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. Exercises for cervicogenic headacheThe following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 – 5 times daily and only provided they do not cause or increase symptoms. Chin TucksBegin this exercise by sitting or standing tall with your back and neck straight, shoulders should be back slightly. Tuck your chin in until you feel a mild to moderate stretch in your neck pain-free (figure 4). Keep your eyes and nose facing forwards during the movement. Hold for 2 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 4 – Chin Tucks Shoulder Blade SqueezesBegin this exercise by sitting or standing tall with your back straight. Squeeze your shoulder blades together as hard and far as possible pain-free (figure 5). Hold for 5 seconds and repeat 10 times provided there is no increase in symptoms.
Figure 5 – Shoulder Blade Squeezes Rotation in SittingBegin this exercise by sitting with your back and neck straight and your shoulders back slightly. Turn your head looking over one shoulder until you feel a mild to moderate stretch pain-free (figure 6). Keep your neck straight and don't allow your head to poke forwards during the movement. Repeat 5 - 10 times to each side provided there is no increase in symptoms.
Figure 6 – Rotation in Sitting (right side) Physiotherapy products for cervicogenic headacheSome of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
To purchase physiotherapy products for cervicogenic headache, click on one of the above links or visit the PhysioAdvisor Shop.
Other Exercises
Find a Physio for cervicogenic headacheFind a physiotherapist in your local area who can treat this condition.
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Figure 1 - The Spine (neck)
Figure 2 - Poor Posture
Figure 3 - Optimal Sitting Posture
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