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Cervicogenic Headaches

Is Neck Stiffness the Real Cause of Your Headaches?

There are many different types of headaches, and many different causes of headaches. However, possibly the more common types of headaches are tension type headaches, migraines, cervicogenic headaches, cluster and TMJ headaches. One particular type of headache that we see regularly in the physiotherapy clinic, is actually caused by neck pain and stiffness. This is the Cervicogenic Headache (CGH).

What are Cervicogenic Headaches?

Cervicogenic Headaches (CGHs) are chronic and are considered a secondary type of headache. This is because they arise secondary to stiffness or pain in the upper joints of the neck – the upper cervical spine.

There is now evidence that suggests that multiple structures in the upper cervical spine can be the source of the pain that refers into the head, generating the headache. Generally, these structures surround the first three spinal levels (C1, C2, & C3). These structures could include joints, discs, ligaments, and muscles.

Differentiating cervicogenic headaches from other types of headaches can be difficult, however common characteristics of CGHs are headaches that are aggravated by neck movement or posture, tenderness of the upper three cervical spine joints, associated neck pain or stiffness, weakness of the deep neck flexors, and increased activity of the superficial neck flexors. Generally, CGHs are one-sided headaches, that start from the back of the head and/or neck and migrate to the front.

How can it be treated?

There are various treatment options that can be used to manage CGHs. Modalities, such as TENS and cryotherapy, are frequently used by sports physical therapists to help reduce pain and facilitate healing, however, evidence suggests they are most effective when used in combination with other therapies. In most evidence found, CGH treatment has focused on joint mobilisation and manipulation, which is found to be an effective treatment option. Evidence also suggests that patients with neck pain, with or without headaches, have more relief when manual therapy is used in combination with exercise.

Quite often a pattern of muscle imbalance called “Upper Crossed Syndrome”, is found in those patients presenting with CGHs. This pattern describes a presentation of weak deep neck flexors, tight sub-occipitals, tight upper trapezius and levator scapulae, tight pectorals, and weak rhomboids and lower trapezius muscles.

Therefore, exercises to improve the weaker muscles in the upper quarter, are important. Several studies on chronic neck pain and CGHs, have utilised a variety of upper quarter strengthening exercises, including; shoulder abduction and retraction; lat pull downs; push ups; chest press; shoulder shrug; arm curls; bent over rows; and chest flies.

Weighted upper limb rows from high plank position - upper quarter strengthing exercise.

If you suffer from headaches, don’t let it go unattended to.

Book an appointment with one of our physiotherapists today to see how we can help you.

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