Headaches are a complex type of pain and there is evidence that a high percentage of headaches are due to problems in the neck structure. Physiotherapy can help solve these problems and put a stop to the associated headaches.

The common headache that responds well with physiotherapy is known as a cervicogenic headache.

What is cervicogenic headache?
A cervicogenic headache is a syndrome characterised by one sided head pain, referred from either bony structures or soft tissues of the neck.

What are the features of cervicogenic headache?
Sufferers usually complain of single sided headache which is side locked (meaning it does not change position between sides of the head). It can extend from the neck to the base of the skull and around to the front of the head. The symptoms are generally provoked by neck movements and sustained postures, usually being described as dull or moderate in intensity and worse in the mornings.

On examination, sufferers tend to have reduced neck range of motion, sore and tender neck muscles, reduced joint mobility with poor motor control of the deep neck flexors (stabilising endurance muscles).
It is important you are assessed by a physiotherapist to differentiate if your headache is of a cervicogenic nature and therefore easily treatable by physiotherapy, or in actual fact, other forms of headache such as migraine.

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How can cervicogenic headache be treated?
A physiotherapist is able to treat cervicogenic headache by addressing the causing factors and develop an individualised treatment plan.
Management techniques include the following:

 €¢ Postural assessment: Adopted poor positions and sustaining them for long periods of time can result in a  poked neck   posture. This posture typically results in upper cervical spine joint stiffness, contributing directly to neck dysfunction and as a result cervicogenic headache. A physiotherapist is able to assess posture and give the most effective advice on correction.

 €¢ Joint mobilisation/ manipulation: Stiffened and dysfunctional neck joints can be gently mobilised and manipulated to provide normalised joint mobility.

 €¢ Massage: Typically patients with cervicogenic headache tend to exhibit muscle tenderness and spasm under the base of the skull in the sub-occipital muscles. Local massage and trigger point therapy can provide significant relief.

 €¢ Exercise program and self management techniques: Patients with cervicogenic headache usually have inhibition of the deep stabilising neck muscles and over activity of the superficial neck muscles. An individualised basic exercise program can be prescribed which can target re-activation of deep neck muscles and relaxation of the superficial muscles to restore balance. Furthermore, simple and effective exercises can be given which help to provide immediate relief of headaches.

What is the evidence saying?
There is current strong evidence which shows the effectiveness of physiotherapy intervention in the management of cervicogenic headache. It has been shown that a simple incorporation of manipulative and exercise therapy spanning over a 6 week period has the ability to reduce both the intensity and frequency of cervicogenic headache. The most important outcomes however are that these benefits are maintained in the long term and do not return once the treatment period has ceased.

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