Cervicogenic HEADACHES

Headaches are painful, disabling, and common. Nearly everyone has a headache occasionally. When headaches occur repeatedly, they become a disorder.?Headache disorders and anxiety about the next one, can affect all aspects of a person’s life.?

?Most headaches are easily treated when properly diagnosed.

The most common cause of headaches results from a problem in the upper part of the neck, known as a Cervicogenic Headache.?

What is Cervicogenic headache?

Cervicogenic headaches begin at the base of neck (sub occipital region) and radiate up and around the head in shape of a ramshorn.?The symptoms usually occur only on one side of the head (unilateral), but often are also associated with neck pain/stiffness.?Occasionally they are also associated symptoms of dizziness, visual disturbances and pain referred to the arm/face/jaw/ear.?

These headaches are the result of sustained stress on tissues in the upper part of the neck.?Forward head posture is the main mechanical cause of cervicogenic headaches, a posture that is common while working at a computer, sleeping in an awkward position, and doing sustained close eye activity.

Sign and symptoms of?Cervicogenic headaches:

• gradual onset of a dull headache beginning at the base of the head
• pain that is brought on after 15 minutes of forward head posture (reading, working at a computer or performing close-eye activities)
• pain that stays at the base of the head or radiates up and around to the temple in the shape of a ramshorn
• usually unilateral but can be bilateral
• neck pain and stiffness
• occasionally extends into arm, face, jaw, ear
• pain surrounding the eye
• coughing/sneezing can cause discomfort
• pain attacks can last for hours or days
• stress/tension can also trigger as they often lead to the poor postural position of forward head

How do Migraines Differ from Cervicogenic Headaches?

Cervicogenic are the most common type of headache, but they are often misdiagnosed as migraines because they have many of the same signs and symptoms.?The main difference is cervicogenic are caused by a mechanical stress, while migraines are the result of a vascular or chemical imbalance in the brain.?

1.????Both have similar location of pain and symptoms

Migraines and cervicogenic headaches both have pain located in overlapping regions of the head.?That is why mechanical headaches are often misdiagnosed as migraines.?The associated symptoms that are common with migraines such as sensitivity to light/sound, nausea and vomiting - may also occur with cervicogenic headaches but are much less frequent.

2.????Type of pain differs

Pain from a migraine is throbbing or pulsating while cervicogenic is a constant dull pain and is often combined with neck pain and stiffness.?Migraine headaches do not usually have associated neck pain and stiffness.

3.????Cause of pain differs

Cervicogenic headaches are also known as mechanical headaches because they are produced by a mechanical stress and relieved by exercise and/or change in position.?Whereas migraines are triggered by chemical, hormonal, or a vascular cause.

4.????Treatment is completely different

Because cervicogenic or mechanical headaches have a mechanical cause they therefore need a mechanical treatment.?Migraines on the other hand are the result of a chemical disorder and therefore need a chemical treatment. It is critical to determine the type of headache to render proper treatment.

**A mechanical assessment can clearly differentiate between a migraine and a cervicogenic headache.**

Triggers for a migraine can include:

a.????Hormonal changes

b.????Emotional stress (sets of your “fight or flight” response)

c.????Certain foods

d.????Caffeine & Alcohol

e.????Skipping meals / low blood sugar

f.?????Sensory overload (bright lights, loud sounds, strong smells)

g.????Changes in sleep patterns or being overly tired

h.????Intense workouts

i.?????Changes in weather

What are the Mechanical Causes of Cervicogenic Headache?

1.????Sustained neck protraction

When we bring our heads forward to look closer at an object this motion is called protraction. Most cervicogenic headaches are caused by maintaining our head forward in this protracted position for more than 15 minutes. This sustained position causes stress to the tissues in the upper part of the neck particularly at C23.?When these tissues are stressed over a period of time, pain develops in the suboccipital region and will increase and radiate if this pressure continues. ??

Those with prior whiplash injuries have a higher incidence of suffering from mechanical headaches due to stress on tight tissues in protraction.?The initial force of whiplash propels the head forcibly forward and backwards straining and tearing the tissues that attach the head to the upper neck.?Often these tissues heal in a tightened position because of poor postures and when proper rehabilitation is not provided. ?If the tissue healed in a shortened position, then less stress is required to cause pain at it shortened end range.

2.????Sustained Upper Neck Flexion

A headache can also be triggered when we have our heads protracted and then look up for an extended period.?This places the upper part of your neck/ cervical spine in a flexed position.?Repetitive and sustained postures of looking up cause stress to this upper cervical spine (C23) triggering headaches.?

How Does a Mechanical Assessment Differentiate Between a Migraine and a Cervicogenic Headache?

A mechanical assessment starts with a history: when did the headaches start, is there an apparent initial cause and factors/positions that cause or aggravate the headache and relieving factors/positions. ?The history will begin to establish if the headaches appear be of a mechanical or chemical origin.?

The clinician then performs a postural analysis, followed by neck range of motion to see if there is any loss in motion or any discomfort with movement. (Mechanical/cervicogenic headache are often associated with neck pain and stiffness and a loss of rotation and cervical retraction range of motion.)?The clinician may even place the individual in a causative position to see if a headache is produced.?If a headache is produced or the patient already has a headache then the clinician will look for a position or movement that will reduce the headache.?If the clinician is unable to alter the headache symptoms, then they are unable to give a clear diagnosis of mechanical origin.?The patient will then be given an exercise to perform over the next 24 hrs. to allow further confirmation.?If positions/movements have no effect on the headache symptoms, then mechanical cause can be ruled out.

Only when movement/positions can produce or reduce a headache can the cause by attributed to mechanical.

What is the Proper Treatment for Cervicogenic Headaches?

Cervicogenic headaches have a mechanical cause.?The treatment will be to remove the mechanical stress or move in the opposite direction of what causes the problem.?If a headache initiates after sustaining a protracted position (such as working at the computer, reading, ) then the treatment is to perform retraction (bringing your head straight back over your shoulder. ?Mechanical headaches usually take about 15 minutes in the stressful position to initiate.?Because of this the treatment usually needs to be sustained as well.?Therefore, the exercise position is held for a longer time:?1 minute. 3 times. ?After approximately 15 minutes the headache will dissipated!?

If the headache remains, then the clinician will add more force or over pressure as well as testing over a longer period.?If the headache continues or reduces only partially, the clinician will explore upper cervical flexion and rotation to change the mechanical force.

If you are attempting to reduce your own headache, perform neck retractions: 1 minute hold x 3.? (See video link) https://www.youtube.com/watch?v=l57ZCdKqltg

If your headache does not resolve, please seek medical assistance by scheduling with your physician or schedule with one of our specialists:

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