Cervicogenic Headache

by: Physiotherapist Jordan Coffey.

Do you suffer from headache that primarily originates from pain in the neck?

Cervicogenic headache (CH) is the most common cause of chronic headache that often goes misdiagnosed! CH is caused by the upper three neck bone nerve root afferents merging to the same brain region as trigeminal afferents.

Afferent nerve fibres bring messages in towards the central nervous system think of sensation, pain, vibration, temperature. The trigeminal cranial nerve is the largest of the 12 cranial nerves and its main function is relaying information about the sinuses, skin, and mucosal membranes in the face! Cervical nerve roots are responsible for carrying sensory and motor information to different parts of the body. In particular, the upper three cervical nerves supply sensory and motor information to the head and neck; including movements forward, backwards, and to the sides. This convergence of afferents misinterprets information of the cervical afferent, resulting in neck pain and headache.

Symptoms that are commonly seen in patients with cervicogenic headache are unilateral headache symptoms, ipsilateral neck and arm pain, pain episodes of varying duration, pain originating in the neck and eventually spreading to the head, sustained neck trauma prior to the onset of headaches, pain triggered by neck movement or sustained poor positions, and autonomic symptoms (blurred vision, nausea, vomiting, sensitivity to light and sound, e.g.).

Different forms of headache respond to different forms of intervention. For example, evidence suggests that migraine does not respond well to physical intervention compared to cervicogenic headache. The management of cervicogenic headache depends on the information gained from the physical examination. The physical examination should include a systematic examination of myofascial, neural, and articular structures in the cervical spine. Common evidence-based techniques used to treat cervicogenic headache are as follows:

• General Exercise: strengthening, stretching, endurance
• Specific exercise: posture, motor control
• Neuroscience education
• Mobilization and manipulation
• Sleep
• Drug management
• Myofascial: trigger point therapy, massage
• Psychological management

In treatment of cervicogenic headache, a comprehensive exercise program should be prescribed to the patient and include motor control exercises. Exercises should be aimed at improving postural control, particularly in the functional position of complaint.

If you are currently suffering from or have recently suffered from neck pain and headache, book an appointment with one of our Physiotherapists at 4Lane Physiotherapy to help alleviate your symptoms and devise an individualised rehabilitation program.

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