Headaches are an extremely common ailment. It is estimated that at least half of the world’s population experiences at least one headache each year. In the United States, that number is even higher, where close to 90% of the population reports having at least one headache annually.
There are many different types of headaches. In fact, some neurologists estimate there are more than 150 distinct types. Some of the most common include tension headaches, migraines, cluster headaches, cervicogenic headaches, sinus headaches, exertion headaches, and medication-induced headaches.
I will be focusing on cervicogenic headaches, one of the most common types I see as a physical therapist.
What Is a Cervicogenic Headache?
A cervicogenic headache is pain in the head and/or neck that originates from the structures of the cervical spine, including the joints, muscles, and other soft tissues. Pain in the head resulting from something in the spinal area is known as referred pain, meaning the discomfort is felt in a different location than its source.
Common Causes of Cervicogenic Headaches
While cervicogenic headaches can develop after a trauma, such as a motor vehicle accident, fall, or assault, they often occur without any clear injury. Many individuals who experience these headaches have sedentary lifestyles or jobs that involve prolonged sitting, particularly at a desk or computer.
It’s also important to note that individuals can experience multiple types of headaches simultaneously, which can make diagnosis more complex. Various types of headaches may occur on their own or alongside other types of headaches, such as migraines. Different headache types may also influence one another. For example, cervicogenic headaches can exacerbate migraines or vice versa.
Symptoms Physical Therapists Can Help Address
Common symptoms of cervicogenic headaches include:
- Pain at the base, side, or front of the skull
- Pain behind or above the eye, or in the jaw/ear region
- Head or neck pain that is intermittent and can last from hours to days
- Pain that worsens with head or neck movement, or with sustained or awkward positions (often accompanied by limited range of motion)
- In some cases, symptoms may also include nausea or visual disturbances
How to Prevent or Minimize Cervicogenic Headaches
Many individuals who suffer from cervicogenic headaches spend a significant portion of their day sitting or leaning forward. This often leads to forward head posture, rounded shoulders, and overall poor alignment. Over time, this can cause muscle imbalances, including tightness and weakness in the neck and upper back.
Below are strategies to help prevent or reduce symptoms:
Posture
- Sit upright with proper spinal alignment
- Gently pull your shoulder blades back and down
- Take breaks to stand or move every 30 minutes
Massage
- Soft tissue massage from the neck down to the mid-back
Exercises
- Chin tucks: Sitting up tall, tuck chin back and hold for 5 seconds, repeat 5x. This helps stretch the often tight muscles at the base of the skull, and also strengthens the deep muscles along the front of your spine which are responsible for keeping your head upright.
- Neck stretches: Gently bring your ear toward your shoulder, hold for 20 sec, repeat 2x. Also, rotate your chin toward your shoulder, hold for 20 sec, repeat 2x. These exercises stretch the muscles along the back and sides of your neck.
- Rows: Focus on pulling the shoulder blades back; perform 2 sets of 10 repetitions. This strengthens the muscles along your shoulder blades that help keep you upright.
How Physical Therapists Evaluate Cervicogenic Headaches
When evaluating a patient with cervicogenic headaches, a physical therapist will assess:
- Posture of the head, neck, shoulder blades, and mid-back
- Range of motion in the neck, thoracic spine, and shoulders
- Flexibility of soft tissues surrounding the neck, shoulders, and spine
- Strength of muscles supporting the neck and shoulder girdle
- Joint mobility of the spine, ribs, and shoulders
How Physical Therapy Can Help
After a thorough evaluation, a physical therapist will develop a personalized treatment plan based on the patient’s specific needs. Treatment may include:
- Modalities: Such as ultrasound, electrical stimulation to promote circulation, reduce inflammation, and support healing. Dry needling can be effective in relaxing tight muscles and reducing pain as well.
- Therapeutic exercise: Strengthening and stretching programs for the neck, mid back, shoulders, and other postural muscles.
- Education: Guidance on proper body mechanics for sitting, standing, lifting, and sleeping (including pillow positioning).
- Manual therapy: Hands on techniques such as joint mobilization and soft tissue work to improve mobility and flexibility.
- Home exercise program: Customized exercises to reinforce progress between sessions.
Physical therapy can be highly effective in reducing, and often completely resolving, cervicogenic headaches. If you’re unsure whether physical therapy is appropriate for your symptoms, the team at ReThrive Physical Therapy and Wellness can help determine the best course of action.
If you’re experiencing headaches and would like to explore treatment options, contact ReThrive to schedule an evaluation.
Eric Ullman, PT, DPT
Physical Therapist
Owner of ReThrive Wellness, PLLC
ericullman@rethrivewellness.com
www.rethrivewellness.com