Excessive strain caused by poor working postures (prolonged sitting, working in awkward neck postures) can irritate the upper joints of the neck and cause a headache. The joints can also be injured by trauma. This could be a sporting or recreational injury or a motor vehicle crash. In the late middle-aged to older age groups, osteoarthritis of the upper neck joints is another common cause of cervicogenic headache.
Neck pain and headaches are typically made worse by sitting or working for a long time in one (often poor) posture, and are typically aggravated by neck movements. The neck is tender and movements are often slightly restricted or stiff. About one-third of people with cervicogenic headache also report some light-headedness, unsteadiness or visual disturbances.
It can sometimes be confusing to know if you have a cervicogenic headache, as the symptoms of different types of headaches are often quite similar. Neck pain and tenderness are common symptoms of migraine, tension-type and cervicogenic headache. In migraine and tension-type headache, this neck pain is often a spread of the headache into the neck. In cervicogenic headache, it is the opposite. The neck pain starts and then spreads into the head. This headache is from a local cause in the neck. Likewise, neck movements are stiff and painful in cervicogenic headache.
Correct diagnosis is important, as each headache type requires a different treatment method. GPs, neurologists and physiotherapists may all play a role in diagnosis.
Your physiotherapist will first undertake a full examination to determine if the headache symptoms fit the pattern for cervicogenic headache, and if there are problems with the joints and muscles, particularly in the upper part of the neck.
There are several possible results of this examination.
- The clinical examination might indicate that the headache is coming from the neck (cervicogenic headache), and physiotherapy treatment is the best management.
- The examination might suggest the headache is another type (eg, migraine or tension-type headache)—that is, the neck joints and muscles were found to be normal. In these cases, management by your GP is the primary treatment, and some physiotherapy methods such as relaxation therapy and soft tissue therapy may assist in management as part of a multidisciplinary approach.
- People with migraine and tension-type headaches may have problems in their neck that are independent of their headache. In these cases, physiotherapy treatment of the neck may offer some help in conjunction with treatment from the GP.
Physiotherapists use a variety of treatment methods for best practice management of cervicogenic headache.
Education, advice and assurance
This is to ensure the person understands the nature of their headache, is assured of its benign nature, and has the knowledge to actively participate in the care of their neck.
Manual therapy
This is an effective treatment method used to help ease the headache, neck pain and any associated symptoms.
Exercise
The exercises are prescribed depending on your requirements, and are designed to:
- ease pain
- improve posture and postural habits
- improve movement and flexibility of the neck
- train the supporting muscles of the neck and shoulder girdle
- train strength and endurance of the neck muscles
- train balance, movement accuracy, as well as head and eye movement control when light-headedness or unsteadiness are symptoms of the headache disorder.
Advice for work and home
Prolonged and awkward postures, as well as poor lifting and carrying techniques will aggravate the neck pain and headache. Your physiotherapist works with you to develop best work, activity and lifestyle habits to relieve unnecessary strain on the neck.
Self-management program
It is important to care for your neck to help prevent recurrent headaches. Your physiotherapist will work with you to devise a program of simple and convenient exercises and lifestyle habits relevant to your needs. It is best to try to include them into daily routines so that good neck postures and movement become normal habits. A plan will be developed to help manage and rapidly settle any future flares of headache and neck pain rapidly.
There is an increasing body of evidence supporting the treatments offered by physiotherapists for the treatment of cervicogenic headache, particularly manual therapy and exercise. A comprehensive management program will include education, manual therapy, exercise therapy and work practice advice. Self-management strategies are vital to help you look after your neck, and adopt best work and lifestyle habits as well as a simple exercise regime.
There is no convincing evidence that methods used by physiotherapists help migraine headache. However, some people with tension-type headache may gain some relief with relaxation, massage and other soft tissue techniques.
Be aware of neck postures, and try to avoid prolonged sitting and slouched postures at work or at home that can aggravate your neck pain and headache. Regularly sit upright and tall, and hold the posture for 10 seconds, to relieve strain on joints and muscles. Correct posture at least twice an hour for waking hours. Move regularly. Other exercises can be performed two to three times per week to ensure all muscles are working well and are supporting your neck and the weight of your head.
The descriptions of a full range of exercises for neck have been published on the websites of the Motor Accident Insurance Commission (Queensland) and Motor Accident Authority (NSW). The advice and exercises are suitable for people with recurrent and chronic neck pain as well as for persons who have neck pain as a result of a whiplash injury.
The time for improvement varies between people, and clinical trials indicate there can be relief within 2–6 weeks of beginning management. Some people take longer and this will often depend on the nature of your neck disorder.
