Headache Be Gone: How Physiotherapy Tackles Cervicogenic Pain - Fighting Fit Physiotherapy Nerang Gold Coast

Do you ever get a really bad throbbing headache at times that starts at the neck and goes up to the head?

Do you want to get rid of this headache? If so, read this blog and take action on it!

This type of headache is classified as a cervicogenic headache.

Guess what, physiotherapy will definitely help to relieve this and stop it coming back.

Let’s dive into how we can help.

First, it’s important to understand how it can present and how a physiotherapist at Fighting Fit will properly diagnose it. Cervicogenic headaches are classified as referred pain arising from irritation caused by the cervical ‘neck’ structures innervated by spinal nerves C1, C2, and C3.

C1, C2, C3 spinal nerves innervate these areas.

This headache generally originates from the atlanto-occipital and upper cervical joints in the neck which lies between vertebrae in your neck. Cervicogenic headaches generally present in people between the age of 30-44 years old.

The common symptoms of a cervicogenic headache are unilateral or same side pain in the head, and may radiate into the shoulder, and arm. It will have reduced neck range of motion, one side worse than the other along with muscle tenderness in the neck, base of the skull, upper trap, or side of the neck.

Atlanto-occipital connect the skull to the atlas (C1)

Many people with cervicogenic headaches experience referred pain in the back of their head over into their eyes. This is because the C1-C3 nerves relay pain signals to the trigeminocervical nucleus which is a structure in the brainstem that relays sensory information to the head, face, and neck to the brain.

It is a key part of how pain from the neck can be felt as a headache or migraine, even jaw pain. It should also be noted that the neck trauma, whiplash, neck strains, or chronic spasm of the scalp, neck, and shoulder muscles may increase the sensitivity of this area and worsen symptoms of a cervicogenic headache.

Now that we understand the anatomy and the common symptoms of cervicogenic headaches, how can physiotherapy help?

Now I write this as you may have seen a physio before for headache and not got relief. Often this is because they have missed key areas in assessment and treatment. Not all physio is the same, there are good builders, great builders and average ones or worse. Physio is no different.

So when reading this if you have tried physio, think did they do all of this? Or if you are searching for a physio for your headache, read this as what to expect from us!

Physiotherapy should always begin with a thorough history and physical examination.

Clinicians should palpate for tenderness, tightness, and localised pain in the neck and occiput (back of skull) and see if this pain can spread to areas like the forehead, orbital region, temple, ears and see if the symptoms are one-sided. They also need to look at active and passive neck movement as well as sustained postures to see if pain is aggravated by any of them.

Clinicians will expect to see resistance or limitation in neck movements in patients with cervicogenic headache. Also changes in muscle tone, or a response to stretch of the neck muscles is common.

Physiotherapists should perform the flexion-rotation test as it has proven to be extremely reliable and there is a high specificity and sensitivity relationship between cervicogenic headaches and range of motion towards the restricted side. If this is positive and symptoms are provoked, this is a positive sign for cervicogenic headaches.

Now that we have assessed it is a cervicogenic headache, physiotherapists should create an individualized treatment plan that is specific to the patient’s pain and where their symptoms are coming from.

The aim of any form of treatment should be to ease the pain, improve postural habits, improve movement and mobility of the neck, train the supporting neck and shoulder muscles, and improve balance/head and eye movement when symptoms of unsteadiness or lightheadedness occur.

From evidence by Jull et al., physiotherapists who used a six week physiotherapy program including manual therapy and exercise interventions are effective in reducing cervicogenic headache symptoms. They also decrease medication intake for short term relief which is sustained at one year follow-up.

The treatment in this study consisted of:

Cervical spine mobilisations or manipulation
C1-C2 self sustained natural apophyseal glide also known as a SNAG
Strengthening exercises including deep neck flexor and upper quarter muscles
Thoracic spine mobilisation, manipulation and exercise (scapular muscles, middle and lower trapezius)

Here is what some of these look like below:

Deep neck flexor exercise

C1-C2 SNAG into cervical neck rotation

Scapular squeezes

Never forget the importance of education!

It is also important that the physiotherapist provides great education on how best manage the neck for yourself such as adopting better work and lifestyle habits along with everything mention above.

Small changes like being aware of neck posture and avoiding prolonged sitting and slouched postures can help with regularly sitting upright and tall for 10 seconds can relieve strain on joints and muscles.

Simple lifestyle changes can make a huge difference. Sleep, nutrition, caffeine intake or reduction, smoking or alcohol, beginning aerobic exercise, stress and managing your mental health. Headache is not always as straight forward as push a joint, exercise it this way and it’s nice smelling roses and pretty unicorns.

Overall, relief should be expected within 2-6 weeks of beginning physiotherapy management, but it can differ person to person based on the nature of their neck disorder and the lifestyle of the individual.

Here at Fightging Fit Physiotherapy we make sure to assess, test, measure, monitor and use the best evidence in our treatment to prove to you that you are improving and heading in the direction you want from the treatment you seek.

If you think you may have cervicogenic headaches or symptoms related to it, give us a call or book a headache assessment with one of our physiotherapists using the online booking below

Dean Phelps

Dean is a registered Gold Coast Physiotherapist with undergraduate and postgraduate studies in Human Movement and Exercise Science. His background has developed his vision for Fighting Fit Physiotherapy to focus on optimal health and peak physical performance for every single patient. Utilising his many qualifications, in depth knowledge of the body and passion for exercise he can provide a holistic approach to your treatment and exercise prescription to get the best outcome.

Brenda Samosa

05:52 07 Nov 24

I had a really bad shoulder and had been seeing a different physio for 3 months (from a different place) I got told Tyson was good. After just a few sessions the movement was coming back. I’m 66 and was worried I would have to stop surfing. But with a lot of help from Tyson I’m back in the waves ( thank you so so much)

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08:16 30 Oct 24

Steve Harris

22:33 15 Oct 24

Great team, all friendly, super helpful and first class clinical advice and a big shout out to my Physio Noah with my shoulder issue

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05:33 19 Sep 24

These guys are the best in the biz 🎉

Ryan Brockett

04:20 18 Sep 24

Shout out to Max from fighting fit physio. He helped me out massively straight after shoulder surgery and back into work and sports in no time. Couldn’t recommend anyone better!

Scotty

08:31 31 Jul 24

Five star service from Max & the team!
Professional & very thorough, you know that patient outcomes are of the highest priority.
I highly recommend this business.

Riley Wilson

08:27 14 Jul 24

Be AWARE they’ll immediately try to commit you to multiple follow up sessions after your initial consultation. This happened to me and then I later found out that as it just so happens, they have a cancellation policy that says you have to pay 100% of the consultation fee for cancelling. They failed to tell me this when they were pushy in committing me to 6 sessions after my consult, so that was a really nice little surprise.

I was already uncomfortable with how pushy they were in having me commit to so many sessions, so when I heard about the policy I just cancelled all together. So, I can’t speak further to the quality of their service throughout therapy phase. FYI this was also a few months ago now, it’s possible (though unlikely) they may have changed the policy. Just ask the question.

Megan Shelley

06:51 03 May 24

Fighting Fit Physiotherapy is hands down the best physio I've encountered. Having tried multiple physios for various injuries, I always find myself coming back to them. Their expertise consistently exceeds expectations, helping me get back to my sport faster than I thought possible. Their personalized approach and attention to detail make all the difference. I could not recommend a better or more exceptional physio team!

Gina Matthews

08:41 24 Mar 23

Can't recommend this place high enough. I was in so much pain with my knee an had been for months through advise an exercises I'm now looking forward to returning to gym an back riding my horses in endurance thank you so much

Courtney Halse

01:36 29 Nov 22

Kyle was knowledgeable, personable and professional. He saw me through my second pregnancy and continued to work with me until 6 months post partum on issues with my back. Would recommend anyone to go and see him.

Also shout out to Georgia on the front desk. She makes you feel welcome and brings a sense of warmth to the place!

Alli Davenport

08:07 04 Nov 22

After hip replacement surgery in February I wanted toget back into weight training legs, I started with Mitch 18 weeks ago and after a lot of hard work and sweat I am able to safely train again, I cannot thank Mitch enough for his support,encouragement and knowledge. The staff are friendly and helpful and I always looked forward to my session's

Robert Parkinson

10:50 15 Aug 22

This is the second time I have been treated by the team at FFP.
As a health professional myself I have been impressed with the level of care I have received from all members of the team.
The personalised treatment and rehabilitation programs have produced excellent results and I have completed both programs pain free and feeling stronger than before my injuries.
During the program there was constant communication and follow up and they were very accommodating with my work schedule.
All in all it was a very holistic experience and I would highly recommend the service.

Kiri Canavan

07:30 08 Jun 22

Tyson was amazing! We came up with an 8 week plan at my first consultation with weekly check ins and updates to exercises. 8 weeks later, I am pain free and able to train harder than ever. Highly recommend and the staff are all fantastic and super accomodating!

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