When your headache feels like a real ‘pain in the neck’
Whether a lack of sleep, a stressful day, or one too many drinks, most of us have experienced a headache at some point or another. In fact, headaches are a leading cause of disability, emergency-room visits, and work and school days missed. According the the World Health Organization (WHO), nearly all people will have a headache at some point in their lives and about 50% of adults report experiencing a headache at least once every year.(1) Despite these numbers, head pain is still widely misunderstood and poorly managed. To help guide practitioners, the International Headache Society (IHS) classifies headaches into two basic categories— primary and secondary. Primary refer to those not caused by another disorder (such as migraine or cluster headaches), while secondary are those originating from other causes, like the one you might have when sick with the flu.(2) But for 4.1% of headaches suffers, their pain may be another secondary type, known as a cervicogenic headache.(3)
Cervicogenic headaches arise from irritation to structures in the neck and are ‘perceived in one or more regions of the head and/or face.’ These structures include muscles, joints, and ligaments and involvement is often contributed to neck trauma, whiplash, strains, or chronic muscle spasms of the neck and shoulders. (2,4) Sometimes referred to as ‘occipital headaches’ they are the most common persistent symptom reported following neck trauma.(5) Individuals usually report varied or continuous, unilateral head pain stemming at the neck or base of skull that spreads to the forehead and eye. Pain can also be associated with diffuse shoulder pain, arm pain, or dizziness, though typically lack symptoms such as sensitivity to light, sensitivity to sound, nausea, and vomiting.(3)
Due to this unusual presentation, cervicogenic headaches are often misdiagnosed. Sufferers usually report having seen a number of providers including their primary care, neurologists, and manual therapists, but report mixed or only intermittent relief. Since these symptoms arise from musculoskeletal dysfunctions of the neck, physical therapy should be considered a first line of defense. Multiple studies support that conservative physical therapy techniques such as mobilization, manipulation, and strengthening may be the most effective medical interventions to improve quality of life and decrease headache intensity and frequency.(6) In fact, researchers found that just a six-week physical therapy program was effective for symptom management and decreasing medication intake, both in short and long term.(7) Not sure if this headache sounds like yours, contact me today for a FREE 10-15 minute consultation to discuss your symptoms and what can help.
References:
Headache disorders. https://www.who.int/news-room/fact-sheets/detail/headache-disorders. Accessed September 16, 2020.
The International Classification of Headache Disorders (2013) 3rd edition (beta version) ICHD-3 beta. Cephalalgia 33:629–808
Sjaastad O, Bakketeig L (2008) Prevalence of cervicogenic headache. Vågå study of headache epidemiology. Acta Neurol Scand 117:173–180
Becker WJ. Cervicogenic Headache: Evidence that the neck is a pain generator. Headache. 2010;4 699-705
Schoensee SK, Jenson G, Nicholson G, Gossman M, Katholi C. The effect of mobilization on cervical headaches. JOSPT. 1995;21:184–96.
Falsiroli Maistrello, L., Rafanelli, M. & Turolla, A. Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomized Controlled Trials. Curr Pain Headache Rep 23, 78 (2019). https://doi.org/10.1007/s11916-019-0815-8
Jull G, Trott P, Potter H et al., A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache: The cervical therapeutic exercise programme, Spine 2002.