Headaches affect almost two thirds of the population. There is significant clinical evidence and research to confirm that many headaches arise from stiffness in the joints of the upper neck.

Anatomy of the Cervical Spine (Neck)

The cervical spine is made up of 7 vertebrae in the spine, stacked on top of each other, starting just below the skull and ending at the base of the neck. The cervical spine has a lordotic curve (a backward “C”-shape), with its inherent structure providing a large degree of movement in all directions. Successive vertebra are ‘linked together’ via a pair of facet joints, one on each side of the neck, with an intervertebral disc in between each vertebra. The atlas (first cervical vertebra - C1) sits on top of the axis (second cervical vertebra - C2), with their unique arrangement and its associated ligaments, provide the neck with its high degree of rotation.

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What causes a Cervicogenic Headache?

The joints most commonly causing headaches are the upper facet joints (the joints formed by ‘side links’ between the vertebra), that under normal circumstances should glide freely to allow neck movements. If the joint, surrounding ligaments or muscles are injured, the joints can become stiff and the associated spinal nerves become irritated, acting as a trigger for referred pain into the head and behind the eyes. Misdiagnosis is common.

What Are The Symptoms?

If you have any of the following symptoms, it could suggest the headache has originated in the neck, and can therefore be relieved by physiotherapy treatment:

• History of trauma to the neck (i.e. acute: whiplash, chronic: repetitive work / sporting activity)
• Often appears as a slow, insidious onset
• Described as a constant, steady, dull ache, 
• Maybe present for days / weeks / months
• Stiffness and restricted movement of the neck
• The headache seems to radiate from the back to the front of the head and often appears worse on one side.
• Headache is brought on by certain neck movements or sustained postures eg. sleeping face down with the head turned to one side.
• Headache appears to ease when pressure is applied to the neck or the base of the skull.
• Often involves light-headedness and nausea

What To Do?

Physiotherapy management will involve a thorough clinical history related to the headache qualities and a physical assessment of the movements of the neck. This will usually provide sufficient information for a diagnosis, however if the physiotherapist isn’t satisfied that the injury is ‘mechanical’ in nature (i.e. abnormalities in the cervical joints, fascia and neural structures), then the individual needs to be referred to a sports physician / neurosurgeon for further investigations (i.e. neurological testing, CT scans) and the exclusion of more sinister causes of headaches.

What Can Be Done?

The individual with upper neck stiffness will usually respond very well to physiotherapy, with treatment based on an abundance of scientific research led by physiotherapists and is concentrated on immediate correction of the neck stiffness and any precipitating factors that may be present. This program includes:

• Massage: plays an important role with releasing the ‘tension’ in cervical muscles, in particular the cervical extensors at the back of the neck / upper back. By massaging these muscles and their associated fascia, the local blood flow is improved and any muscle spasm present is released by ‘breaking up’ the adhesions between the muscle fibres.
  
  
• Joint Mobilisations: passive movement techniques applied to the vertebral / facet joints of the upper cervical spine (C1, C2, C3 and C4 levels), in order to restore full pain-free range of motion in each of the cervical joints. To help prevent the recurrence of your headaches you will be shown maintenance exercises for your neck to assist you to maintain your ‘new’ mobility and movement.
  
  
• Stretching: poor cervical extensor muscle flexibility can ‘overload’ the upper cervical joints and associated structures. Hence, a regular stretching program to maximize their length is essential for correct neck function.
  
  
• Strength: Research performed by physiotherapists has found that ongoing neck problems may be due to weakness in the muscles supporting the neck. Specific postural muscles help maintain stability of the neck during activity. Loss of this control leads to the neck poking forward and the shoulders / back to become round and ‘slouch’. This loads the neck joints and other soft tissue structures around the neck. Muscle strengthening and training can be advised by your physiotherapist, which will prevent long-term problems.
  
  
• Stress: is often a large precipitating factor associated with cervicogenic headaches. As such, these need to be identified and addressed as part of the rehabilitation program, as it will significantly lower the occurrence of the headaches.
  
  

Published by Balmain Sports Physiotherapy

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