Everyone suffers an occasional headache, but do yours last for days at a time? If so, it may be more than just stress. The term cervicogenic headache (CGH) was developed to describe a particular type of headache that derives its origin from the neck. While the causes of CGH's are different from other types of headaches such as migraine, cluster and rebound headaches, the symptoms are strikingly similar.
An excellent first question you might ask is, "How is my neck responsible for my headaches?" The cervical spine possesses a unique set of nerves that travel directly into the brain and join with the trigeminal nerve — the nerve responsible for all of the sensory information of the face, eyes and head. Problems associated with this system encompass everything from toothaches and eye pain to the throbbing feeling you experience with a headache.
Classic signs of CGH include intense, intractable pain that worsens over time (days to weeks), a continuous cycle (no pain-free periods) and the tendency for sleep to have little to no effect. Furthermore, the headache will often intensify with specific, reproducible movements of the head and neck in certain directions.
Unlike migraines, CGH is not triggered by light, smells or hormone levels. CGH is also not associated with illness or vascular problems, and in 90 percent of cases responds minimally if at all to pain medication or to caffeine. I would caution patients against continuing to take medication if it does not provide relief as it may evoke a new type of headache called "rebound headache." The body adapts to the current level of medication and will "hurt" if medication levels drop too low.
A complex series of head and neck movements called "provocation testing" is used to clarify the neck's role in headache generation. This type of testing is the bedrock in establishing which joints in the neck are problematic, and it also lays the vital framework for treatment. Patients will need to be tested in a sitting position, on their backs and on their stomachs to ensure that no symptomatic area is omitted from treatment. Evaluation of CGH is rarely straightforward, so patients should expect a solid hour of dynamic movements during the exam, which often leads to soreness later on.
Despite its complexities and its frequently disabling nature, with the proper workup CGH responds excellently to treatment. With CGH, I find that there is some combination of poor posture, stiffness of certain cervical segments and weakness in selected muscle groups — all things that can be remedied — usually with only minor modifications to daily activities.
Posture is corrected through awareness education and frequent, gentle exercises. Weakness is addressed with a gradual progressive home strengthening regimen. Stiffness poses more of a challenge and rests almost entirely in the hands of your therapist. Through joint mobilization and manipulation, the restrictions in the joint are removed, and the patient will need to follow up with range of motion exercises that mimic clinical treatment.
To date, CGH does not have a documented lifespan or a regular predictability, thus I am unable to draw any firm conclusions on the likelihood that a patient will do well without physical therapy management. Once the nuances of the headache are fully understood, treatment is initiated on a two-times per week basis, usually with at least one rest day between sessions. The frequency reduces to once per week, then to once every few weeks, then monthly to ensure full recovery, as CGH may return if not monitored at regular intervals.
The earlier physical therapy intervenes, the more likely it is that the course of treatment will not stretch too long. If you find your headache is not responding to your typical solutions, ask your doctor if physical therapy is right for you.
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Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly..Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail features@eagletribune.com.
