Guide to Cervicogenic Headache Osteopathy and Prescriptive Exercise by Osteopaths

What is a Cervicogenic Headache?

A cervicogenic headache is a headache that comes from a problem with neck. The pain is referred from one of these structures in the neck and can spread from the back of the head to the forehead and even to the area around the eyes. Women are four times more likely from these headaches than men.

What are the symptoms of a Cervicogenic Headache?

Cervicogenic Headaches are usually on one side of the head but can occur on both sides. The pain tends to be dull, not throbbing and can become moderate to severe in intensity. The pain is usually caused by awkward or sustained neck positions and can usually be reproduced by applying pressure to the back of the head or neck.

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.

Cervicogenic Headache Pain Distribution

cervicogenic headache

What Causes a Cervicogenic Headache?

People suffering with Cervicogenic headaches tend have a forward neck posture with high muscular tone and fatigue in superficial muscles to
keep unstable head from gravity, which easily induces postural disorder and pain. Consequently in an effort to keep upright postur (Yang and Kang, 2017).

Exercise For Cervicogenic Headache

The application of craniocervical flexion exercise and suboccipitalis relaxation in cervicogenic headache patient is effective in decreasing fatigue of cervical muscles, tone of SCM, and headache intensity and craniocervical flexion that can directly influence postural sustainment is considered to be more effective in reduction of SCM fatigue and headache intensit (Yang and Kang, 2017).

Manual Therapies for Cervicogenic Headaches

Cervicogenic headache treatment should be targeted where the peripheral input is mainly dominant, can benefit from a multimodal manual therapy management including upper cervical spine joint mobilization and/or manipulation, thoracic spine manipulation, and deep cervical flexors endurance exercises. Clinicians should remember that the aim of these techniques is the restoration of the function by limiting the chance of sustained central nervous system facilitation for preventing the development of central sensitization (Fernández-de-Las-Peñas et Courtney, 2014).

Effects of Spinal Manipulation on Cervicogenic Headaches

A study by Dunning et al. (2016) demonstrated that patients with cervicogenic headaches who received cervical and thoracic manipulation (to the neck and mid back) experienced significantly greater reductions in headache intensity, disability, headache frequency, headache duration, and medication intake as compared to the group that received mobilization and exercise; furthermore, the effects were maintained at 3 months follow-up.

Effects of Spinal Mobilization on Cervicogenic Headaches

Patients can experience dizziness associated with cervicogenic headaches. Manual therapy is effective for reducing cervicogenic dizziness, a disabling and persistent problem, in the short term. A study by Reid et al. (2015) found that applying sustained natural apophyseal glides (SNAGs) and passive joint mobilisations (PJMs) for cervicogenic dizziness have long-term beneficial effects in the treatment of chronic cervicogenic dizziness.

Combining Manual Therapy with Physiotherapy for Cervicogenic Headache

In a systemic review by Chaibi et Russell (2012), they concluded that physiotherapy and spinal manipulative therapy might be an effective treatment in the management of cervicogenic headaches.

Evidence base for Manual Therapy as an intervention for Cervicogenic Headache

Clar et al. (2014) summarises that there was moderate (positive) evidence for mobilisation techniques in cervicogenic headache (change from inconclusive (unclear) evidence in the UK evidence report). But inconclusive (non-favourable) evidence for friction based massage and trigger points in cervicogenic headache. Whereas, a systematic review by Garcia et al. (2016) suggested that mobilization or manipulation of the cervical spine may be beneficial for individuals who suffer from cervicogenic headaches.

One systematic review suggests that Osteopathic Manual Therapy can reduce future pain episodes and related disability in adults with headache (Cerritelli et al. 2017).

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Reference List

Cerritelli F, Lacorte E, Ruffini N, Vanacore N (2017). Osteopathy for primary headache patients: a systematic review. J Pain Res  Mar 14;10:601-611

Chaibi A, Russell MB (2012). Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. Jul; 13(5):351-9.

Clar C, Tsertsvadze A, Court R, Hundt GL, Clarke A, Sutcliffe P (2014). Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropr Man Therap. Mar 28; 22(1):12.

Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA (2016). Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: multi-center randomized clinical trial. BMC Musculoskelet Disord. Feb 6; 17:64.

Fernández-de-Las-Peñas C, Courtney CA (2014). Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. Feb;22(1):44-50.

Garcia JD, Arnold S, Tetley K, Voight K, Frank RA (2016). Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence? Front Neurol. Mar 21; 7:40.

Mesa-Jiménez JA, Lozano-López C, Angulo-Díaz-Parreño S, Rodríguez-Fernández ÁL, De-la-Hoz-Aizpurua JL, Fernández-de-Las-Peñas C (2015). Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials. Cephalalgia. Dec; 35 (14):1323-32.

Reid SA, Callister R, Snodgrass SJ, Katekar MG, Rivett DA (2015) Manual therapy for cervicogenic dizziness: Long-term outcomes of a randomised trial. Man Ther. Feb; 20(1):148-56.

Yang DJ, Kang DH (2017). Comparison of muscular fatigue and tone of neck according to craniocervical flexion exercise and suboccipital relaxation in cervicogenic headache patients. J Phys Ther Sci. May;29(5):869-873

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