1.1 Introduction
Headache is the most common health complaints seen by General practitioners. Most headaches aren’t serious and can be treated with medication, physiotherapy and lifestyle changes. Many of us will be able to relate to the constant pounding, the inability to concentrate and sleep, the severe impact it has on our daily activities. Headache is a pain that occurs in the head and upper neck region of the body. It can affect a small portion of the head, such as the eyes or temples, or it can affect the entire head.
1.2 Symptoms
A cervical headache starts as a steady, non-throbbing pain at the back and base of the skull, sometimes extending downward into the neck and between the shoulder blades. Pain may be felt behind the brow and forehead, even though the problem originates from the cervical spine. Pain usually begins after a sudden neck movement, such as a sneeze.
Along with head and / or neck pain, symptoms may include:
Stiff neck
Nausea and/or vomiting
Dizziness
Blurred vision
Sensitivity to light or sound
Pain in one or both arms
Mobility difficulties
1.3 Risk Factors
Risk factors that may be involved in headache onset or aggravate cervical headaches include:
Fatigue
Sleep difficulties
Cervical disc problems
Current or prior neck injuries
Poor posture
Muscular stress
2.1 Causes
Headaches have many different causes but can generally be split into two types:
Primary headaches are a result of abnormalities in the brain or head. These include tension headaches, cluster headaches, and migraine which are all fairly common.
Secondary headaches are caused by a disease or medical condition. These include inflammatory disorders and injuries to the head and neck and require careful and accurate diagnosis.
2.2 Cervical headache is classified as a secondary headache.
Cervical headache (CGH) is usually characterized by pain that is referred to the head from the cervical spine (the neck region). Cervical headaches are side- specific and do not fluctuate from side to side like a migraine headache can. The cause of a cervical headache is often related to excessive stress to the neck. The headache may result from cervical osteoarthritis, a damaged disc, whiplash-type movement or poor sitting posture that irritates or compresses a cervical nerve. There are as many as 20 muscles in the neck region and a dysfunction in these muscles can often cause significant problems. Whiplash injury can mean motor vehicle accidents, common falls – that cause this motion of the head.
3.1 Diagnosis
Determining the origin of the headache is one of the most challenging task in cervical headache. The diagnosis of a cervical headache begins with a thorough medical history with a physical and neurological examination. A proper diagnosis should include:
A medical history and a physical examination
A series of plain cervical spine x-rays, including flexion/extension views of the joints in the upper three cervical spinal segments
An open-mouth view of the skull and a lateral skull x-ray may be necessary
One or more diagnostic nerve blocks in the neck will need to be performed
Although not mandatory, a CT or MRI may be of interest
3.2 Treatment
The type of treatment a patient receives should be dependent on the type of headache they have.
3.3 Medication
Medication alone seldom serves as an adequate treatment for cervical headache although medication can sometimes provide a measure of relief. Inflammatory drugs, anti-seizure agents, anti-depressants, and migraine prescriptions are given for pain relief. If pain medications prove unsuccessful, then injections may be considered, including occipital nerve blocks, atlantoaxial joint block administered at C1-C2, and/or facet joint blocks administered at C2-C3. Other treatment options, listed in order of from non-invasive to invasive, include:
Spinal manipulation or other manual therapies
Behavioral approaches
Acupuncture
Trigger point injections
Prolotherapy
Facet joint blocks (a type of spinal joint injection)
Nerve blocks (this is usually of the medial branches of the nerves that supply the facet joints)
Radiofrequency pulse ganglionotomy of the nerve root (eg, C2, C3)
Spine surgery to relieve nerve or vascular compression (this is rarely necessary)
4.1 Physiotherapy for Cervical Headaches
A patient’s history and clinical presentation is vital for the physiotherapist to know whether their symptoms are consistent with cervical headache. It is important to know about the location, severity, frequency and duration of headache symptoms. Qualified physiotherapists recognize these findings and employ appropriate manual therapy techniques to the cervical spine. Physiotherapy also assists the associated soft tissue structures to regain range of motion and restore normal joint mechanics to the cervical spine. The physiotherapists instruct patients on some exercises that addresses the deep neck flexors and the stabilizing muscles of the scapular area. This will also help to stimulate the process of healing and repair by facilitating normal movement and loading stresses around the symptomatic joints.
5.1 Prevention
Maintain a good sitting posture
Avoid prolonged periods of sitting or static postures in general
Avoid getting overtired to the point of exhaustion
Keep yourself well hydrated throughout the day
Exercise regularly to stimulate the circulation of blood to the head and to maintain neuro-musculoskeletal flexibility.