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.
