If you have tried every medication for your chronic, recurrent headaches but haven’t been able to get any true relief, you may not be targeting the root cause of your symptoms!
Cervicogenic headaches, a subset of secondary headaches, stem from issues in the neck and can be a source of immense discomfort for those who experience them.
Understanding the intricate relationship between neck dysfunction and these headaches is crucial for both individuals grappling with the pain and healthcare providers seeking effective solutions.
In this article, we'll look into the underlying causes of cervicogenic headaches, explore the benefits of joint mobilization and manual manipulation of the cervical spine, soft tissue mobilization, specific postural exercises, dry needling, potential treatment risks, and provide you with a well-rounded perspective on this often-overlooked issue.
What is a cervicogenic headache?
The first step to treating this type of headache is to understand its origin. Unlike primary headaches like tension-type or migraine, cervicogenic headaches arise from abnormalities in the joints of the neck and so are considered a type of secondary headache.
According to Bogduk et al., structures innervated by C1-C3 have been shown to be capable of causing headaches. When the segments don’t move well, the nerve endings that innervate those segments can send pain signals to the brain triggering referred pain that usually manifests as headache symptoms.
These issues can include pain of mild to moderate intensity, usually involve one side of the head and neck, are tender to pressure in affected areas, and can limit range of motion of the neck.
Poor posture, prolonged periods of static positioning like slouching at a desk, repetitive neck motions, emotional stress and anxiety, and even past injuries from motor vehicle accidents can contribute to the development of neck dysfunction and cause further issues.
Let’s dive a little bit deeper into how I treat cervicogenic headaches!
Decrease joint stiffness with mobilization and manipulation.
Because one of the main causes of these headaches is hypomobile or stiff joints in the cervical spine, the first line of treatment is to decrease that joint stiffness.
Through gentle and controlled movements with their hands, physical therapists strategically mobilize the joints of the cervical spine. Alternatively, a high-velocity low-amplitude thrust (HVLAT) manipulation can be used to achieve similar results in a shorter time period. Thrust maneuvers typically result in a cavitation or “pop” in the target joints.
Bronfort et al. 2010 have reported that both joint mobilization and spinal manipulation were effective in treatment of cervicogenic headaches.
These interventions boast a spectrum of benefits: enhanced range of motion, relief from muscle tension, and a reduction in pain perception. These improvements, achieved through joint mobilization, contribute significantly to alleviating the pain associated with cervicogenic headaches.
Relieve muscle tension with soft tissue mobilization.
When we have dysfunction that leads to pain, the body will try to hunker down and protect itself by causing the nearby muscles to guard, making them tight, firm, and painful. When some of the muscles aren’t functioning properly, other muscles can tend to take over which leads to muscle dysfunction.
Muscles like the upper trapezius, levator scapulae, paraspinals, and suboccipital muscles play a role in normal neck function and can contribute to headache development when tense or restricted.
By focusing on specific muscles linked to the head and neck, these therapeutic techniques work to release tension, improve blood circulation, and promote relaxation. Soft tissue mobilization and massage can alleviate muscular imbalances, enhance flexibility, and ultimately reduce the frequency and intensity of cervicogenic headaches.
Improve strength, function and independence with exercise.
While hands-on treatment can be beneficial for restoring motion and relieving pain, we can’t ignore the importance of promoting independent management of symptoms with the use of exercise. It is important to make sure you are challenging your body with strengthening and postural re-education exercises to make the treatment stick!
We have this term in physical therapy called regional interdependence, or put simply, one dysfunctional area of our body can impact several other areas. Not only is it important to target the head and neck, we also have to take into consideration the shoulders and thoracic spine since they are all connected!
Some examples include:
motor control exercises for the deep neck flexors
stretching and mobility drills for the thoracic spine
strengthening periscapular stabilizers
diaphragmatic breathing to relax hypertonic muscles
Stay tuned for a future post with various exercises and progressions!
Is dry needling beneficial for headaches?
Dry needling can offer benefits like reduced muscle tension, increased blood flow, and most importantly pain relief. In the realm of headache management, dry needling can harmonize with joint mobilization, manual manipulation, and therapeutic exercise. When it comes to normal function of the head and neck, the intricate network of muscles plays a pivotal role.
Dry needling aims to release tension and decrease pain within these muscles. This can indirectly contribute to reducing the headache-inducing tension originating from the affected soft tissues. Dunning et al. (2021) found a significant difference in reduction of headache intensity, frequency, and disability in those who received dry needling with e-stim and spinal manipulation over those who only received non-thrust mobilization and traditional exercise.
If you want to know more about dry needling and what it can treat, I wrote a separate article that you can take a look at here!
What are the risks and side effects of treatment?
As with any medical intervention, it's essential to address potential risks and side effects transparently. While manual manipulation can yield remarkable results, temporary soreness, discomfort, and, in rare cases, adverse reactions are possible outcomes.
It's crucial to emphasize that these potential downsides are significantly minimized when a skilled and qualified physical therapist conducts a thorough assessment, tailoring the treatment to the patient's specific needs. Ensuring open communication and informed consent can further mitigate these risks, making manual therapy a safe and effective option for managing cervicogenic headaches.
For a more in depth discussion about the risks and side effects of different manual therapy interventions, check out the "Risks and Side Effects of Manual Therapy" section in this article.
Conclusion
The dynamics between neck dysfunction and headaches are often overlooked in the diagnosis and treatment of cervicogenic headaches.
By working with a Doctor of Physical Therapy who has the necessary understanding of anatomy and physiology of the head and neck, it’s possible for those who suffer chronic headaches to take the steps toward noticeable relief. The bridge between effective management lies in comprehensive care that encompasses joint mobilization, manual manipulation, therapeutic exercise and lifestyle adjustments.
If you experience chronic headaches or neck pain, or have any specific questions about how your condition can benefit from physical therapy, schedule a free phone consultation with me by clicking here and filling out the form with your information!
**Disclaimer: The information provided in this article is intended for educational and entertainment purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for personalized guidance and recommendations regarding your specific health concerns. The content presented here is based on general knowledge and research available up to the date of this article's publication. Any reliance on the information provided is at your own discretion and risk. The author and publisher do not assume any liability for any actions taken based on the information presented in this article.
References:
Bogduk N. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther. 1992 Jan;15(1):67-70. PMID: 1740655.
Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 2010;18:3.
Dunning, J., Butts, R., Zacharko, N., Fandry, K., Young, I., Wheeler, K., Day, J., & Fernández-de-las-Peñas, C. (2021, February). Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. The Spine Journal, 21(2), 284–295. https://doi.org/10.1016/j.spinee.2020.10.008
What Is Cervicogenic Headache? (2022, July 28). American Migraine Foundation. Retrieved October 12, 2022, from https://americanmigrainefoundation.org/resource-library/cervicogenic-headache/
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