cervicogenic headaches:
Cervicogenic headaches are a complex yet common condition seen in clinical practice. Understanding their intricacies, from anatomical causes to effective treatment strategies, is crucial for in aiming to provide optimal care.
Description:
Cervicogenic headaches are characterised by pain perceived in the head, originating from cervical (neck) structures, particularly the upper cervical spine. Unlike other types of headaches, cervicogenic headaches stem from musculoskeletal dysfunction rather than neurological or vascular origins. This condition often presents with unilateral/one-sided pain, typically starting from the neck and radiating towards the back of the head, temples, forehead, or behind the eyes. Neck stiffness and restricted range of motion is also a common complaint.
Anatomical Causes:
- The anatomical origins of cervicogenic headaches lie within the cervical spine and its surrounding structures. Dysfunction or irritation of cervical facet joints, cervical intervertebral discs, cervical muscles, ligaments, or nerves can trigger pain referral to the head.
- Poor posture.
- Trauma (such as whiplash injuries).
- Degenerative changes.
- Prolonged sitting and repetitive movements contribute to the development of these anatomical dysfunctions.
Risk Factors:
- Poor posture.
- Sedentary lifestyle.
- Occupations requiring prolonged sitting or repetitive neck movements.
- Previous neck injuries (such as whiplash), and age-related degenerative changes in the cervical spine.
Symptoms:
- Unilateral head pain, typically starting from the neck.
- Pain radiating towards the back of the head, temples, forehead, or behind the eyes.
- Neck stiffness and reduced range of motion.
- Pain exacerbated by certain neck movements or sustained postures.
Assessment:
- Detailed history-taking to understand the onset, nature, and aggravating factors of headaches.
- Postural analysis.
- Neurological tests.
- Cervical spine mobility.
- Special tests.
Treatment:
Physiotherapy plays a central role in the management of cervicogenic headaches, aiming to address underlying musculoskeletal dysfunctions and alleviate pain. Treatment modalities include:
- Manual therapy techniques such as joint mobilisations, soft tissue mobilisation, and myofascial release to improve cervical spine mobility and alleviate muscle tension.
- Therapeutic exercises targeting cervical spine mobility, stability and strength, including postural correction exercises and neck muscle strengthening exercises.
- Education on ergonomics, posture, and lifestyle modifications to prevent exacerbation of symptoms.
In conclusion, cervicogenic headaches pose a significant burden on individuals’ quality of life, but with the right approach, they can be effectively managed. Physiotherapists equipped with a comprehensive understanding of cervicogenic headaches and a diverse range of treatment modalities can play a pivotal role in relieving pain and restoring function for their patients. Through diligent assessment, targeted interventions, and patient education, physiotherapy offers hope and relief for those suffering from this debilitating condition.
References:
- Biondi, D. M. (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association, 105(4_suppl), 16S-22S.
- Jull, G., Trott, P., Potter, H., Zito, G., Niere, K., Shirley, D., & Emberson, J. (2002). A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 27(17), 1835-1843.
- Fernández-de-las-Peñas, C., Alonso-Blanco, C., Cuadrado, M. L., & Pareja, J. A. (2006). Myofascial trigger points in the suboccipital muscles in episodic tension‐type headache. The journal of headache and pain, 7(3), 203-207.
- Jull, G., Amiri, M., Bullock-Saxton, J., Darnell, R., Lander, C., & O’Leary, S. (2007). Cervical musculoskeletal impairment in frequent intermittent headache: part 1: subjects with single headaches. Cephalalgia, 27(7), 793-802.
- Garcia, J. D., Arnold, S., Tetley, K., Voight, K., Frank, R. A., & Mork, P. J. (2016). Efficacy and safety of manual therapy interventions for cervicogenic headache: a systematic review. Journal of Manual & Manipulative Therapy, 24(4), 183-192.
