Pain in the Neck

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Physical Therapy Treatment for Cervicogenic Headaches

What is a Cervicogenic Headache?

A “headache” is one of the most far-reaching and non-discriminatory patient complaints, affecting people of all etiologies and medical backgrounds. About 47% of the population suffers from chronic headaches. While many headaches are categorized as the “tension-type,” about 15-20% are considered cervicogenic. Diagnostically, cervicogenic headaches are associated with neck pain and stiffness and typically occur more on one side, originating from the back of the head and neck and extending to the front. Shoulder and arm discomfort can also be experienced on that same side. Cervicogenic headaches are considered “secondary,” meaning that the pain experienced is actually be referred and caused by deficits elsewhere. Some of the most common sources of cervicogenic headaches are considered to be the upper cervical spine facets (or joints), upper cervical (head and neck) muscles, and degeneration of the intervertebral disc between the second and third cervical vertebrae. Cervicogenic headaches are often aggravated by abnormal posture and certain head or neck movements.

Contributing Factors to Cervicogenic Headaches

When a patients present to a physical therapist with a medical diagnosis of “cervicogenic headaches,” there are several areas the clinician may focus on in regards to his or her assessment.

1) Posture: “Forward head” posture increases stress on the upper cervical spine.
2) Cervical Range of Motion: Many patients exhibit reduced ability to perform full range of motion with their neck; this may be due to joint restriction, muscle tightness, or guarding due to pain.
3) Muscle Length and Soft Tissue Assessment: Increased tightness and stiffness are often noted in the sternocleidomastoid (SCM), upper trapezius, levator scapulae, scalenes, suboccipitals, and pectoralis major and minor muscles. Myofascial “trigger points” are commonly found in the SCM, upper trapezius, and temporalis muscles.
4) Muscle Strength: Frequently weakness is found in the deep neck flexors.
5) Manual Joint Assessment: Hypomobility (decreased motion) is exhibited in the cervical spine segments/vertebrae
6) Breathing Patterns: Diaphragmatic breathing allows the lungs to fill to their maximum capacity. Poor diaphragmatic activation or control causes accessory respiratory muscles, typically the scalenes and SCM, to become over-activated, tight, and restricted.

Treatment Techniques You Can Perform At Home!

Below are techniques and exercises that you can perform at home to reduce the symptoms of cervicogenic headaches.

1) Improving your posture with these exercises :

a. Cervical retraction with chin tucks to help reduce forward head posturing
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b. Scapular retraction and depression with or without shoulder movement to reduce forward rounded shoulder and increased kyphotic posturing:
Scapular retraction, No Money
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2) Increasing cervical Range of Motion
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3) Increasing muscle length
a. Stretching:
Upper trap stretch, Levator scap stretch
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b. Using a tennis ball/theracane/hammer to release tissue restrictions
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c. Subocciptial release – tape 2 tennis balls together, or put in a sock and tie a knot. Then lay on your back putting the tennis balls at the base of your skull. Lay until headache subsides.
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4) Improving your breathing patterns by performing diaphragmatic breathing.
a. Inhale through your nose and allow the air to expand your ribcage/abdominal region, then exhale out of your mouth. You DO NOT want your chest to raise when inhaling

This article was written by Christy Saunders DPT and Megan Edwards PTA/Clinical Director of our Millsboro Office.

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