Cervicogenic Headaches

Prime Physiotherapy

Headaches caused by neck problems are called cervical (ie neck) headaches or "cervicogenic headache" (CGH).

These affect about 25% of the adult population, females being about 4 times more affected than males. A systematic review of physiotherapy for CGH* found that of 6 good quality randomized trials, 5 of those studies showed improvement in headache pain and recovery of function from therapy.

In 1988 the International Headache Society (IHS) published diagnostic criteria for headaches, including cervicogenic headache.

Cervicogenic headache is considered a secondary headache and falls under the ICD-10 code of G44.841, with the key component being pain in the head or face that can be attributed to the neck dysfunction.

In 1998 the Cervicogenic Headache International Study Group (CHISG) published its own set of criteria.

In simple terms, your neck joints can cause neck headache or pain if they are either too stiff or too loose (& unsupported by weak muscles) or are in an abnormal joint position eg. locked facet joint or poor posture.

Other tissues in the neck such as nerve, muscle or ligament may be the source.

Once your neck becomes stressed and painful, regardless of which anatomical tissue, the pain signals are referred to the trigeminocervical nucleus in your brainstem... and you start to feel a neck headache or face pain.

Most commonly the cervical tissues that are triggering the headache are located within the upper 3 or 4 cervical spinal levels.

In many cases the headache can occur without the sufferer being aware that they have a neck problem, but it has been shown that in 73% of cases the symptoms will begin in the neck before spreading to the head or face, eyes lips, tongue, ear, etc.

Typically CGH is unilateral ie one-sided but can be bilateral (both sides).

Other associated symptoms may be dizziness, nausea, vomiting, blurred vision, red or sore eye/s, photophobia &/or phonophobia

The physiotherapy examination will typically involve:
- Taking a history, behaviour of symptoms and aggravating factors,
- Physical examination including
  •  Vertebral Artery insufficiency testing
  •  Upper cervical spine stability testing
  •  Cervical Spine ROM testing:

Gross movements: Flexion, Extension, Side Flexion & Rotation, Protraction, Retraction, Quadrants

- Palpation
  •  Soft tissues for muscle bulk, tone, spasm, pain or trigger points
  •  Bony anatomy including spinous processes, transverse processes, articular pillar & facet joints for swelling, excrescences, gross postural and segmental alignment & other abnormalities

- Passive movements
  •  Testing of physiological and accessory translation movements of individual spinal levels.

Xrays and scans are infrequently helpful, but can indicate potentially related issues such as the extent of degenerative changes or spinal instability.

Based on the findings from the examination a practitioner should be able to determine whether the neck is the likely source of a patient’s headache.

Physiotherapy Treatments

- Manual Therapy (Manipulation and/or Mobilization)
  •  Massage
  •  Trigger point therapy
  •  Dry needling or acupuncture
  •  Transcutaneous Electrical Nerve Stimulation (TENS)
  •  Other physical modalities

- Self Administered
  •  Postural re-education
  •  Exercise training
  •  Stretching
  •  Strengthening
  •  Biofeedback & Relaxation Training

As with most musculoskeletal conditions, the number of treatments required cannot be anticipated, and there is no “typical” number. Many cases can be resolved in around 4 consultations with the physiotherapist, some sooner: as quickly as one or two, and others longer.

Factors affecting the speed of recovery include the historical duration of symptoms and the severity of abnormalities in the neck.

Cervical headaches that can be considered chronic may qualify for up to 5 physiotherapy consultations per annum at little or no cost to the patient under Medicare’s "Enhanced Primary Care" (EPC) scheme. Your doctor would need to confirm this and complete a "Care Plan" in order to qualify.

In cases where the physiotherapist does not believe therapy will be successful, we promptly refer elsewhere.

TREATMENTS other than physiotherapy could include medication, injection, or nerve blocks including radiofrequency.

If you or someone you know suffers a lingering headache that has not been accurately diagnosed and well managed, a visit to Prime Physiotherapy may get it sorted, no matter how long it has existed. We have treated hundreds of cases and have resolved cases that had dogged sufferers for 20 years and more. You can imagine the joy of finding a solution after such protracted suffering.

*Reference: Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Racicki et al, Journal of Manual & Manipulative Therapy Volume 21 Issue 2 (May 2013), pp. 113-124.