Headache Physio Addressing Structures Of The Neck And Upper Back
Aside from being painful, headaches can be tricky to diagnose and even trickier to manage. There are many different causes of headaches, and this blog is focused on a subset that relate to structures in the neck as contributing factors of head pain. If you have severe headaches, or headaches that are unexplained, please consult with your doctor or headache physio to discuss potential causes, investigations and management.
As physios, we mainly work with patients who suffer from headaches where the structures of the neck and upper back
are involved. These structures can be the cause of headaches or secondary to headaches.
Cervicogenic Headaches – a referral from the neck?
Cervicogenic headache refers to head pain that results from irritation to structures in the upper cervical spine. This can be the joints, discs, muscles and nerve tissue, generally around the three top-most vertebra.
Nerves from the C1-3 levels of the neck converge on the Trigeminocervical nucleus with fibers from the Trigeminal nerve (a cranial nerve). This creates an overlap/confusion in messaging from the cervical nerves to the brain.
Drivers of neck pain
These structures of the upper neck are often irritated by prolonged sitting postures. Head-forward postures while sitting at a computer limit the movement allowed at these joints. Over time the joints become less mobile, and can become more sensitive. In some cases, the structures of the upper neck (muscles, joints, nerve tissues) can become sensitised to prolonged sitting and movements. Secondary issues such as muscle spasm, movement inhibition, and a spreading and referred pain can result.
Symptoms of cervicogenic headache
Headaches from this origin often start with a pain at the top of the neck, on one side. The pain often then manifests in the head one-sided, and located around the eye, the back of the head and the side.
Patients experiencing these headaches often have symptoms that overlap with migraines, cluster and tension headaches. For this reason, it is important to identify any contributing factors coming from the neck so that appropriate management can be undertaken.
Neck pain and restrictions
At your physio appointment, we will observe your neck range of motion for any restrictions, pains or asymmetries. When the neck is a major contributing factor in head pain, as in cervicogenic headaches, there will usually be some soreness or restriction in range of motion.
On palpation, cervicogenic headaches will usually have focal tenderness on palpation over the upper joints of the cervical spine. These will usually be one-sided, but can be bilateral.
Cervicogenic headache physio treatment
Treatment is dependent on identifying the contributing positions, postures, movements and structures that are involved.
- Changing sitting position to include more upright postures
- Increasing screen height so eyes are level with top of the monitor
- Regular movement breaks from prolonged sitting
- Neck range of motion exercises
- Chin Tucks – we think these are the bee’s knees for getting the joints and muscles of the upper cervical spine moving
- Strength training for the upper body. Aside from helping out our stabilising and postural muscles, strength work has a great impact on helping posturally overworked muscles to relax.
- Massage of the muscles if the upper back and neck
- Mobilisations of the joints of the upper cervical spine
- Thoracic spine mobilisations and manipulations
- Medications – simple analgesia and anti-inflammatories can be really effective if taken in combination with active management strategies.
If pain isn’t settling, scans and reviews with your GP may be necessary to help get to the bottom of lingering head pains, especially if management of the cervical spine contributors aren’t getting to the bottom of the problem.
At Movement Centre, our physios take pride in getting to the root cause of the problem. We have been helping patients in Sydney’s CBD for years, so we are well versed in the aches afflicting Sydney’s office workers. Come and see our team to get the right diagnosis and the right management for your headaches. We take headache physio seriously.