Headaches are a common complaint and are often very debilitating.  From a clinical viewpoint, ‘headache’ is literally an ache in the head, rather than a diagnosis.  The international Headache Society details a long list of types of headache: from migraine and tension-type headache, through to a subtype of headache that Physios are uniquely qualified to treat – the ‘cervicogenic headache’.  This type of headache is caused by dysfunction of the upper neck joints, which can then refer pain to the base of the skull and eye region. 

How is a Cervicogenic Headache diagnosed?

 The symptoms described by a patient with cervicogenic headache follows a typical pattern: pain starts in the upper neck or base of the base of the skull and is then often felt into the eye region.  It is also usually one-sided.  

 From a clinical perspective, diagnosis is confirmed by during a Physio assessment:

1.     Reduced range of motion of the upper neck joints

2.     Stiffness on palpation of the upper neck joints

3.     Weakness of a group of muscles called the Deep Neck Flexors.  These muscles are important in providing strength and stability to the neck.  

Why is pain from a neck joint felt as a headache?

 The upper neck joints (C0-3) have nerve endings that end in a part of the brain called the trigeminocervical nucleus.  The trigeminal nerve (which innervates the eyes and front part of the head) also converges in this part of the brain.  The pain distribution of cervicogenic headache is as if the brain is a little confused – mixing up the pain signals of the upper neck and trigeminal nerve. 

How is cervicogenic headache treated?

 The most effective way to treat a cervicogenic headache is by addressing 3 things:

1.    Neck joint stiffness:  there is very good evidence to show that mobilisation of the affected neck joints reduces pain and disability caused by cervicogenic headaches.

2.    Strengthen weak neck muscles: we mentioned above that deep neck flexors are an important muscle group in the neck.  Addressing strength deficits in this muscle group, and any others in the neck or shoulders are important not only for improving neck strength and stability, but also for reducing pain.  

3.    Address why the neck joints were irritated in the first place: often this means adjusting desk set-up, sitting posture and/or sleeping posture.  

If you’re experiencing headaches or upper neck pain book an assessment with your Restore Function Physiotherapist to reduce pain and address the contributing factors of your headaches.

References

•  Garcia JD, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Frontiers in Neurology. 2016;7:40.

• Hall T, Briffa K, Hopper D. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. The Journal of manual & manipulative therapy. 2008;16(2):73-80.

• Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurgical focus. 2015;38(4):E2.

• Sterling M, Jull G, Wright A. Cervical mobilisation: concurrent effects on pain, sympathetic nervous system activity and motor activity. Manual therapy. 2001;6(2):72-81.