|Everyone has suffered a headache at some time. The International Headache Society is an august scientific body that has been researching headache causes, types and treatments for many years.|
Detailed analysis has identified and codified many different type of headache. It is important to make sense of different headaches and treat each one as appropriate. For example, from research into migraine, new drug treatments have been developed that can be dramatically effective in dealing with severe migraine.
One particular headache is suitable for physiotherapy intervention: cervicogenic headache. Cervicogenic is the medical tern meaning ‘coming from the neck region’. In this case, it is structures within the upper neck that produce pain.
Cervicogenic headache is actually a pain carried by nerves and joints in the upper neck. Somewhat like sciatic pain where pain down the leg is actually from the lower back, in neck based headache the pain is referred so that it is felt around the skull.
The features of cervicogenic headache are relatively easily recognised. Pain always occurs on the same side of the head, so pain does not occur on the right hand side on one day and move to the left side the next time. It tends to concentrate either at the base of the skull or on the temple, just above the eye. It can vary in intensity but does not tend to occur 24 hours a day.
In true neck based headache, a clear association between posture or movement of the neck must be present. What this means is that as a mechanically caused pain, there must be a movement based, on/off factor aggravating the pain. Do something with the head and neck in one position and the pain starts. Get out of the position and the headache will disappear.
Most commonly the mechanical factor relates to holding the head in a sustained posture that is straining the joints, muscles and ligaments of the upper neck. This can occur from less than ideal head-on-neck posture for example sitting at a computer, or reading with the head dropped onto the chest.
Equally cervicogenic headache pain can come on from cumulatively repeating an incorrect movement. In the work environment perhaps the head is being constantly turned to talk to work colleagues, or reaching to a filing cabinet behind the chair repeatedly throughout the day. Another aggravating factor can be something simple, like slumping in the same chair every evening to watch television, where the TV is off at an angle to the chair. Sitting like this once or twice is fine, but if you do it for a couple of hours most evenings, over months and years this off-centre angle can irritate the neck and cause headache pain.
Sometimes the headache can also occur because of sleeping position. In this case the headache will be most obvious on wakening, often settling during the day, but there again the following morning. Often neck discomfort in bed presents as pillow problems, ‘playing’ with pillows for weeks, trying combinations of no pillow, one, two or even three as nothing feels comfortable. This may bring broken sleep. During the night the neck feels stiff or painful.
So how can an individual deal with a headache such as this? Well, the first thing to do is to become aware of the specific mechanical on/off pattern. The easiest way to do this is that once the headache comes on, think back over the preceding few hours. Picture exactly what you were doing and where your head and neck were in relation to the rest of the body. Look either for sustained positions or repeated activities. Once you have identified them, the next step is to alter what you do to avoid repeating whatever brings the pain on.
This allows a person to subconsciously tune into the pain and become aware of the warning signs. The adage ‘forewarned is forearmed’ comes to mind.
Chartered Physiotherapists treat cervicogenic headache by identifying mechanical factors and suggesting ways to improve posture or poison. Detailed assessment of bony posture or the spine and upper neck region will bring the actual pain sources to light.
On clinical examination in cervicogenic headache one or two small spinal joints will be found to be restricted in movement. A new clinical test developed at Curtin University in Australia has found 100% success in identifying which joints are amiss, without the need for x-rays or other medical tests.
Joint restriction is usually accompanied by muscle problems. Small muscles that attach the head to the back of the neck will be tight, more so on the side of the headache. Supporting muscles deep in the neck may have become inhibited by pain so they are ineffective in carrying the weight of the head. Ligaments can be stretched or shortened in response to incorrect head position.
Rehabilitation will address each of the clinical findings. Manual therapy is highly effective in freeing up tight or restricted joints. With manual therapy the headache pain must be accurately reproduced. The patient will be able to say ‘yes, that’s my headache exactly’. This is tremendously helpful both for Physiotherapist and the patient as it confirms the headache as a true cervicogenic headache. This gives both parties confidence that the treatment is appropriate and will work. Stretching exercises are given for tight tissues. Strengthening exercises will address weak muscles. Posture correction is a very significant component of dealing with headache symptoms in the long term.
Cervicogenic headache is not life-threatening but can be disruptive and debilitating if it goes on long term. It can be clearly and simply diagnosed. Appropriate treatment is available, with excellent results.