Have you ever had the feeling that your headache is somehow related to the pain in your neck? How that it is such a coincidence that every time your headache is preceded by the stiff neck that you are experiencing? You are not imagining it! It is what the medical community calls cervicogenic headaches, which means headaches originating from the neck
What are the usual complaints from people who suffer from cervicogenic headaches?
Most sufferers complain of a deep dull ache starting from the base of the skull to the top of the head, usually over just one side of the head. It may be present on both sides if the neck pain and stiffness are on both sides of the neck. Other complaints include feeling pressure at the back of the eye and discomfort in the jaw.
Another symptom that confirms the diagnosis is the presence of tenderness when pressure is applied over area of the cervical spine immediately under the skull. In some cases, when pressure is applied for long enough, sufferers feel some relief from the headache.
What are some of the activities that aggravate this condition?
Typically, activities that require the neck to be in a sustained strained position for a prolonged period of time will aggravate this problem. The neck posture is often faulty, the head is turned or tilted to one side or sufferer is adopting the “poke chin” position.
Example of such activities including reading, using the computer especially the laptop, putting on make up, looking up for too long or watching movies or theatre when seated on the side of the hall.
Why do these activities aggravate the headache?
When we adopt the “poke chin” posture, we apply compressive stress to the upper part of the cervical spine, namely, C1 and C2 levels (C1/C2 refers to the first two cervical vertebrae in the spine). Similarly, when we turn our head to one side, we compress the C1-2 level on the same side. This happens as most of the movement of the head occurs at these 2 spinal levels. So if we sustained these postures or repetitively perform them, these 2 levels will start to degenerate and the cartilage wears out over time. This in turn results in stiffness of the upper cervical spine.
What is relevance between the C1-2 levels and headaches?
The nerves that exit C1-2 and sometimes C3 supply sensation to the back of the skull to the top of the head and in some people to the jaw area. The nerves that exit from the right side of the neck will supply only the right side of the head, likewise for the left.
When these joints are stiff or mal-aligned, the nerves at the affected levels will be irritated causing pain. So when one has a right-sided upper neck pain or stiffness, the pain is always referred to the right side of the head.
What can we do?
We need to improve the cervical joint alignment and mobility at the C1-2 levels and to remove the compressive forces, which is to adopt good posture. This will reduce the irritation to the nerves.
If the cervical facet joints are slightly rotated due to contractile forces of tight muscles surrounding the neck, the affected joints are already in some amount of compression and may not allow full functional or physiological range. In this situation, physiotherapists can apply the “MUSCLE ENERGY TECHNIQUE” to realign the joint position. This technique uses the muscles to reposition the joint.
Once the joint is in a neutral position, the actual stiffness (hypomobility) can then be accurately assessed. Stiffness can be treated by various techniques, such as passive mobilization through the MAITLAND technique or with the clients’ active movement with the MULLIGAN SNAG technique. If the joints remain stiff even after a few sessions of mobilization, MANIPULATION can be applied. Once the ideal mobility has been achieved, the client will be expected to maintain it by self mobilization with a strap.
Once the mobility is improved, the headache will be resolved. The client can remain pain free for a long time provided the original cause of poor posture is solved. Good ergonomics here is paramount.