Physical Therapy Management for Cervicogenic Headaches

Cervicogenic headaches are caused by musculoskeletal dysfunction in the upper cervical spine that refers pain to the head, often developing on one side of the head. Cervical spine dysfunction can be caused by irritation or compression of cervical nerves, muscle strains to the neck, shoulder, or upper back, arthritis, poor posture, or from a sports or whiplash injury.  

Physical therapy is often the first line of treatment for cervicogenic headaches and can help manage pain and address the underlying cause of the headache pain through a targeted manual therapy and strengthening exercises program.

Cervicogenic headaches are a type of headache that begins in the upper cervical spine (the top seven vertebrae of the neck) and refers pain to the head, often developing on one side of the head, starting from the back of the head and neck and radiating toward the front

Common symptoms of a cervicogenic headache include: 

• Pain that radiates through the neck to the head with sudden movements or prolonged positions

• Pain that is felt on one side of the head, behind, around, and above the ear and which can radiate to the forehead, temple, or behind the eyes.

• Pain that feels constant rather than throbbing

• Pain in the shoulders or upper back

• Limited range of motion in the neck

• Numbness or tingling in the arms or hands

• Neck stiffness that makes it difficult to move normally

Physical therapy is often the first line of treatment for cervicogenic headaches and can help manage pain and address the underlying cause of the headache pain through a targeted manual therapy and strengthening exercises program. Physical therapy aims to strengthen weakened neck muscles, relieve pinched nerves, relax tight shoulder and upper back muscles, and enhance neck joint mobility.

Physical therapy treatment for a cervicogenic headache can include: 

• Pain management may involve the use of a TENs unit, which uses electrotherapy via a low-voltage electric current to stimulate nerves and treat pain.

• Manual therapy involves soft tissue and upper cervical spine joint manipulations to help soothe muscles and decrease pressure in the region as well as restore range of motion in the neck. Research has shown that SMT (spinal manual therapy) to the cervical spine and upper thoracic spine can lead to a significant reduction in headache frequency and intensity. 

• Dry needling involves the insertion of thin filiform needles into trigger points (taut bands of muscle) in the neck and shoulder muscles to ease tension and reduce referred pain from these trigger points.

• Myofascial release (MFR) involves manual stretching to address adhesions in fascial connections which can restrict normal movement of muscles between fascial planes in the neck and shoulder regions. MFR can restore the length and integrity of fascial tissue, helping alleviate pain by reducing strain on sensitive structures like blood vessels and nerves in the area. 

• Targeted stretching of the neck, upper back, and chest muscles (upper trapezius, levator scapulae, and pectoral muscles) to relieve tight muscles. Stretching can involve alternate cycles of contraction and relaxation to help relax and lengthen tight muscles to improve range of motion in the neck.

• Postural training particularly of the lumbar and thoracic spines to correct any postural deficits contributing to neck pain and headaches. The therapist may guide the patient through sensorimotor exercises, such as progressive exercises on unstable surfaces, to promote reflexive stabilization and postural stability. The therapist also strengthens the core to support proper posture of the spine and neck.

• Muscle strengthening of the deep neck flexor muscles and scapular muscles to reduce neck tension and address weak muscles or muscle imbalances in the neck, shoulders, and upper back. Stronger muscles can reduce the pressure on tight nerves in the neck that may be referring pain to the head and causing headaches. Exercises can include lateral flexion, rotation of neck muscles, chin tucks, and shoulder blade stretching and strengthening.

• Aquatic therapy involves exercising in a heated pool as the water reduces the weight and pressure on the neck, allowing patients to more easily strengthen neck muscles. The hydrostatic pressure of the water also pushed against the body, helping reduce swelling in and around the neck. 

• Cervical traction treatment involves the use of a manual traction table or cervical traction device to gently stretch the spinal muscles and lightly pull on the head to create space between the cervical vertebrae. This helps to reduce pressure and tension in the neck.