What is Cervicogenic headache?
As the name might suggest a cervicogenic headache is pain in the head that starts in or is referred from the neck. Cervicogenic headache is common after whiplash injury, with up to 53% of headache after accident related to the neck.
How can I tell if I have cervicogenic headache? How is this different than a migraine headache?
A cervicogenic headache usually has the following qualities:
- One sided symptoms that don’t shift from side to side
- Symptoms are brought on by neck motion, awkward neck positions or posture, or from pressure on the back of the head
- Movement of the arm and shoulder on the same side may cause a headache
- There may be a loss of range of motion of the neck
- Pain is usually moderate (non-excruciating), usually non-throbbing
- Pain will usually start in the neck and go up
- into the head and around the ear
- Cervicogenic headache affects men and women equally and is often triggered by a trauma to the head or neck
Migraine usually has the following qualities:
- Women are 3 times more likely to suffer from migraine
- Usually symptoms are on one side, but can shift to the other side
- Pain is described as throbbing or pulsating with moderate to severe quality
- Pain is usually located around the eye, face, forehead, and sometimes the top or side of the head, but not associated with neck pain
- Associated symptoms of light, sound, or movement sensitivity; visual changes; and nausea or vomiting often accompany migraines
When should I seek help from my doctor?
In physical therapy we talk about red flags. These are signs and symptoms that may mean something more serious is going on. If any of the following are true, you should see a health care provider before trying to treat your headache at home. A doctor should see you if you experience any of the following red flags after a trauma to your head or neck. A trauma to the head or neck could be a fall, a car accident, a spinal manipulation, or any situation where your head is moved forcefully in a direction.
The 5 D’s And 3 N’s
- Diplopia – double vision
- Dizziness – vertigo, lightheadedness
- Drop Attacks – a sudden fall that is not associated with a loss of consciousness and not caused by a stimulus (like tripping)
- Disarthria – slurred speech
- Disphagia – difficulty swallowing
- Ataxia – loss of coordination that will often present as difficulty walking because of balance problems
- Nausea – queasy sensation, often with the urge to vomit
- Numbness – especially in the face
- Nystagmus – uncontrollable eye movements that will sometimes affect vision or balance
Other red flags to consider
- Sudden onset of SEVERE headache
- Worsening pattern of pre-existing headache without an event that should trigger worsening pain
- Headache associated with fever, stiffness in the neck, rash, history of cancer or HIV or other illness
- Moderate or severe headache that is triggered by cough or sneeze or bearing down
- New onset of headache during or following pregnancy
What exercises can help with my headache?
If you are not concerned about red flags then these exercises are often helpful when dealing with headache that is related to the neck.
Check out your posture!
Posture affects the position of the spine and often can contribute to headaches related to the neck. Forward head position can cause shortening of the muscles at the base of the skull (the subocciptal muscles) which can pull on the nerves in that area and contribute to headache. Posture starts at your pelvis, which means you need to tilt the pelvis forward and back until you find the middle and then stack your body segments on top of a flat pelvis. If you are unsure of your resting posture have a friend or co-worker take a picture of you from the side when you are sitting and when you are standing.
Ergonomics:
Desk fit can make a big difference. You should be able to sit upright with your feet on the floor. Your hips and knees should be at about 90 degrees. When you are sitting in good posture your shoulders should feel relaxed, your hands should rest on the desk and your elbows should be at about 90 degrees. The top of your computer screen should be at about eye height (in the photo the computer could be slightly higher). If you work on a laptop, get a stand to elevate your computer and use a separate keyboard and mouse. Posture can be fluid, consider setting a timer to remind you frequently to check your posture and return to neutral.
Shoulder blade position:
Forward head position often is accompanied by forward shoulder position and weakness of the muscles between the spine and the shoulder blades. A good place to start is to work on shoulder blade squeezes. Sit up in a tall spine posture and gently squeeze your shoulder blades together. Make sure your shoulders are not shrugging up toward your ears. Hold for 3-5 seconds and repeat up to 10 times. This can be a good exercise to use as a postural break.
Deep Neck Flexor Training for the longus coli
Longus coli is a muscle at the front of the neck, behind your throat, that helps with stability of your spine. You can think about it as a core muscle of your neck.
Lay on your back with a towel roll under your neck and possibly a towel roll under your head (your face should be parallel to the horizon). Imagine an axis of motion through at the position of your ears. Make a nodding “yes” motion by bringing your chin toward your voice box. Your head should not lift and the muscles in the front of the neck should stay relaxed. To monitor this place an open hand gently across the base of the neck to be sure the muscle that are superficial stay relaxed. Try to hold this “tuck” position for 10 seconds, 10 repetitions. You may need to work up to this. There should not be pain with this exercise if it is done correctly.
Review the red flag section of this post. If you have had a recent trauma to the head or neck with accompanying headache and any of the other red flags or a severe headache that has come on without trauma you should see a medical provider immediately. If you have made some changes to your posture and have been trying some of the exercises listed in the post, but are still struggling with headache it may be time to see a physical therapist. The PTs at Union Physical Therapy can evaluate your spine to determine what might be driving your headache condition.
Author: Amanda Benson has been practicing physical therapy in Seattle since 2005 with advanced training and certification in manual therapy and orthopedics. She, along with Mitch Owens, is a founding member of the Whiplash Injury Treatment Center. Mitch, along with his wife Elisa Owens, are the owners of Union Physical Therapy. Union Physical Therapy and the Whiplash Injury Treatment Center are located in the Wallingford neighborhood of Seattle, Washington.