Cervicogenic Headache

What is Cervicogenic Headahce?

Cervicogenic headache is a secondary type of headache that is caused by disorders or lesions involving the bony structure, soft tissue or neural structure in the cervical region.

It is a relatively common cause of chronic headache that is often misdiagnosed or unrecognized as its presenting symptoms can be similar to that of the more commonly encountered primary type headache such as migraine or tension type headache. Below is the pain pattern of common types of headaches.

Tension Type Headache Migraine

Cervicogenic headache

Sign and Symptoms

A “cervicogenic episode” can last for one hour to one week. Pain is on one side of the head, often correlating with the side of the neck where there is increased in muscle tightness. Almost certainly, range of motion of the neck will be compromised.

Cervicogenic headache can be caused by poor posture or cervical arthritis. They can also be traumatic as the result of sudden and forceful movement of the skull and neck as with whiplash caused by like a car accident, a fall, or an athletic collision. Headache that develops three or more months after a concussion, generally is not caused by brain injury. It is highly related to the cervical spine issue.

Diagnosis

Diagnostic criteria as described by International Headache Society (IHS) with at least two of the following:

1. Headache developed after onset of the cervical disorder/ lesion.

2. Headache improves or resolves in parallel with improvement or resolution of the cervical disorder/ lesion.

3. Reduced cervical range of motion, movement or posture dependent pain, worsened by provocative tests.

4. Headache is abolished after diagnostic blockade of the cervical structure or its nerve supply.

Management

Physiotherapy is recommended as a first line management for the cervicogenic headache. There has been an emphasis placed on the manual therapy treatment of cervical joint dysfunction for its management.

Besides, strength and endurance exercises accompanied by stretching exercises were shown to be an effective treatment for headache and arm pain associated with neck pain.

On the other hand, a new program of specific low load exercise was introduced to reeducate muscle control of the cervicoscapular region instead of muscle strengthening. The exercises as below directly addressed the muscle impairments found in the cervicogenic headache patients.

Exercise for Cervicogenic Headahce

1. Craniocervical flexion exercise

(a) Lay on your back, place a towel underneath the neck.

(b) Gently and slowly nod the head as if saying “yes”.

(c) Hold it for 5 seconds then relax and return to the neutral position.

(d) Repeat it for 10 times.

2. Prone scapula stabilization

(a) Lay on your stomach, with your arms and legs fully extended.

(b) Gently exhale and slowly lift your arms off the floor, moving your arms into the “T” formation (90˚ to form the letter “T”) as illustrated with palms facing forward. 

(c) Maintain your head alignment with your thoracic spine (upper back). 

(d) Focus on generating most of your lift through your shoulders.

(e) Hold this position for 5 seconds then relax and return to your starting position. 

(f) Perform 10 repetitions.

3. Postural correction exercise

(a) Sit in front of a mirror.

(b) Sit upright with a natural lordosis curve on lumbar area (lower back) while gently putting the chin in tuck in position and squeezing the shoulder blades.

(c) Hold it for 10 seconds then relax.

(d) Repeat it for 10 times.

The craniocervical flexion exercise emphasized motor control rather than muscle strength was equally as effective as manipulative therapy in improving physical outcomes (includingperformance in the craniocervical muscle test) and relieving neck pain and headache. At the 1 year follow-up, a reduction of 50% or more in headache frequency was achieved by 76% of the exercise group compared with 29% of the control group. The intensity of headache measured by the pain scale VAS decreased by 52% in the exercise group and by 25% in the control group.

References

1. Jari Ylinen, Riku Nikander, Matti Nykänen, Hannu Kautiainen and Arja Häkkinen. 2010. Effect of Neck Exercises on Cervicogenic Headache: A Randomized Controlled Trial. J Rehabil Med 42: 344–349.

2. Gwendolen Jull, Patricia Trott, Helen Potter, Guy Zito, Ken Niere, Debra Shirley, Jonathan Emberson, Ian Marschner, and Carolyn Richardson. 2002. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache.Spine 27(17): 1835–1843.