Cervicogenic Headaches

Cervicogenic headache is when the problem in the neck leads to referred pain up the head unilaterally.

Some of the common causes are linked to problems with nerves, bones, muscles:

  1. Whiplash injury
  2. Strained or sprained neck
  3. Poor forward head posture
  4. Poor ergonomics
  5. Disc bulges leading to a pinched nerve
  6. Arthritis/degenerative disc disease
  7. Fractures

Types of Headaches:

  1. Primary Headaches: When there is no underlying disease causing headaches. Less dangerous.
    1. Migraine: Main difference between migraine and cervicogenic headaches is that migraine is rooted in the brain while cervicogenic headaches are from the neck and base of the skull. Pain is mainly throbbing, pulsating with migraines.
    2. Tension headaches: Diffuse bilateral, dull aches.
    3. Hypnic
    4. Cluster
  2. Secondary Headaches: When something else causes pain in the head/neck area. More dangerous.
    1. Brain tumors
    2. Meningitis
    3. Aneurysm
    4. Neck injury

Symptoms: Cervicogenic headaches are normally triggered by movements of the neck with stiffness around the neck leading to limited ROM in the cervical spine. Mostly the pain which is non throbbing/pulsating is on one side and gets worst when pressure applied ta certain spots along the neck. Pain may last for hours or days.

Diagnosis: Since there are multiple types of headaches, its hard to diagnose cervicogenic headaches.

  1. Frequency, severity, and location of headaches
  2. Blood test: To detect any inflammation
  3. X Ray/ MRI/CT scan: To detect movement abnormality with flexion/extension, abnormal posture, disc bulges, arthritis, tumors or other abnormality

Treatments:

  1. Physical Therapy
  2. Nerve Blocks
  3. Corticosteroid/epidural injections
  4. Medications

PHYSICAL THERAPY
– Manipulative and therapeutic exercises including the following:

  1. To improve mobility/flexibility in the neck and upper back with the help of stretches, manual spinal mobilization, thoracic spine thrust manipulation.
  2. To increase the muscle strength in deep cervical flexors/extensors, scapular stabilizers and hence help correcting the posture.
  3. SNAGS(Self sustained Natural apophyseal glide): Movement with mobilization technique to improve joint hypomobility and reduce the symptoms originating from headaches.
  4. Spinal mobilizations
  5. Active and passive mobilization with movements
  6. Work related ergonomic training/postural reeducation: To strengthen scapular retractors and external rotators and allow lower trapezius to slightly depress the medial border of scapula and stretch the levator scapulae and upper trapezius muscles to lengthen them and allow the correct orientation of the scapula and repeat this so the correct postural alignment becomes a habit. Scapular control along with cervicothoracic postural position can be trained for functional activities such as lifting weights. Unstable surfaces such as exercise balls or foam pads can be used to add challenge to the cervical spine as well as the whole-body for stabilization exercises. These final stages of the rehabilitation program for CGH patients can be progressed toward functional activities to return the patient to full participation.
  7. Trigger point release: to release the tight/taut bands and hence release the pressure causing headaches.

Nerve blocks: Helps with temporary relief to help you work better

Steroid shots: Steroids can be advised by your doctor with the theory that the pain continues sensitizing the cervical nerve roots and initiates a pain-producing loop involving nerve root and microvascular inflammation as well as mechanically induced micro-injury.

Medicines: Your doctor may recommend you pain killers, muscle relaxants, NSAIDS to help the pain and muscle spasms.

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