Experience regular headaches?
If so, you’re not alone.
In fact, nearly 47% of the global population experiences headaches [1]. That’s no small number of people. Still, despite headaches being so common, there’s no simple answer for how to best treat and address this type of pain.
As we’ll explore in this article, often times headaches resulting from problems in your neck can be effectively treated by physical therapy.
Connection between headaches and neck dysfunction
In many cases, headaches can stem from cervical spine & neck issues. These types of headaches are also known as Cervicogenic Headaches (CGH). In fact, evidence suggests a higher prevalence of headaches in adults with neck pain [1]. Basically, neck problems often lead to headaches. Women appear more predisposed to CGH, as they are 4 times more likely to experience a CGH [1]. However, men can also be affected.
Cervical osteoarthritis (or arthritis of the neck), which is common in many older adults may be associated with headaches and cervical muscle pain [2]. Diagnosis & treatment of CGH should be made by carefully examining the etiology of the headaches, not just the symptoms. This means it’s important to see a clinician that has experience with neck & headache assessments.
Physical & Occupational therapy treatment has been shown to improve pain from headaches by addressing muscle spasms, trigger points, range of motion (ROM), and the postural components of cervicogenic headaches [4].
What the Research Shows
When it comes to treating headaches, many people overlook physical or occupational therapy treatment techniques. This is probably due to the fact that when most people get a headache, they may take something like Tylenol or ibuprofen and go about their day.
However, for people who experience regular headaches, which may result from neck problems, physical and occupational therapy treatment can be an effective option. In fact, check out what one research article said about it:
“A randomized controlled trial of high methodological quality showed that manual therapy was an effective form of management for cervicogenic headaches (CGH).” [1]
When an occupational or physical therapist treats a patients neck with manual therapy, they may use techniques like pin and stretch, soft tissue mobilizations, isometric stretching, or trigger point release. These treatment techniques aim to reduce muscle tension, which can lead to decreased neck pain and headaches.
But, before you go running to a PT or OT for treatment, you need to first figure out whether the pain you’re experiencing is coming from your neck.
How to determine whether it is a cervicogenic headache (CGH)?
Temporomandibular Disorders (TMDs) and headache are closely related pathologies [5]. Which means many people who experience a TMD may also experience frequent headaches. According to several studies, there is a strong correlation between headache and other dysfunctional symptoms, such as joint noise, pain during mandibular movement (opening or closing the mouth), pain in the temporomandibular area, depression, anxiety, and poor sleep quality [3][5].
Pain and dysfunction at the temporomadibular joint (TMJ) is associated with higher instances of headaches and neck dysfunction, and as a result, cervicogenic headaches [6]. Simply put: if a patient has a TMD or experiences pain attheir TMJ, it would not be surprising to learn that they also experience frequent neck or headaches.
Other diagnostic criteria for cervicogenic headaches (CGH) include: 1) Symptoms and signs of neck involvement including comparable symptoms such as: neck movement and/or sustained, awkward head positioning, and/or external pressure over the upper cervical or occipital region, 2) Restriction of range of motion in the neck, 3) Ipsilateral neck, shoulder or arm pain, and 4) Unilaterality of the head pain, without sideshift [2].
So basically, if a patient experiences pain on only one side of their head or neck (unilateral), or if they experience a headache on one side and neck and/or shoulder pain on that same side, it may be a CGH. Again, that’s why it’s important to talk with your doctor and to seek out a physical or occupational therapist who has experience assessing and treating neck dysfunction & headaches.
What may therapy treatment for cervicogenic headaches include?
So, understanding the qualifiers for cervicogenic headaches (CGH), what can patients expect to experience in conservative treatment programs like physical or occupational therapy? Manual therapy is one type of recommended treatment for cervicogenic dizziness & headaches. In these cases the manual therapy treatment is directed at decreasing muscle spasms and trigger points of pain in the cervical (neck) muscles [1].
Evidence shows the use of manual therapy for CGH & dizziness results in improvement in postural stability, ROM, muscle tenderness and neck pain. Therefore manual therapy combined with vestibular rehab yielded good treatment outcomes [4]. Treatment may also include postural exercises & stretches as well.
Summary
I can’t stress this enough: headaches are a big deal. If you experience frequent and regular headaches, you should see your primary care physician to make sure that it’s not something more serious than muscle joint-related pain. For example, blood pressure issues can also lead to headaches. These headaches typically don’t involve pain at the TMD or on only one side of your head, but it’s still worth looking into to make sure you’ve got your bases covered.
If you and your doctor determine that the cause of your headaches is not something more serious like blood pressure issues, then it’s very possible that physical or occupational therapy can help you address and treat those headaches —especially if your pain follows some of the patterns listed above. In that case, make sure you see a clinician that understands cervicogenic headaches and how to assess & treat them effectively.
References
[1] Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201065/
[2] Hall, T., Briffa, K., & Hopper, D. (2008). Clinical evaluation of cervicogenic headache: a clinical perspective. The Journal of manual & manipulative therapy, 16(2), 73–80. https://doi.org/10.1179/106698108790818422
[3] Romero-Reyes, M., & Uyanik, J. M. (2014). Orofacial pain management: current perspectives. Journal of pain research, 7, 99–115. https://doi.org/10.2147/JPR.S37593
[4] Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther. 2005 Feb;10(1):4-13. doi: 10.1016/j.math.2004.03.006. PMID: 15681263.
[5] Di Paolo C, D’Urso A, Papi P, Di Sabato F, Rosella D, Pompa G, Polimeni A. Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients. Pain Res Manag. 2017;2017:3203027. doi: 10.1155/2017/3203027. Epub 2017 Mar 21. PMID: 28420942; PMCID: PMC5379086.
[6] Greenbaum T, Dvir Z, Emodi-Perlman A, Reiter S, Rubin P, Winocur E. The association between specific temporomandibular disorders and cervicogenic headache. Musculoskelet Sci Pract. 2021 Apr;52:102321. doi: 10.1016/j.msksp.2021.102321. Epub 2021 Jan 12. PMID: 33482538.
