by Dr. Erik Heinlein, PT, DPT, Cert DN, TPI Certified
Cervicogenic headaches are a common condition that often gets overlooked or misdiagnosed in healthcare. Medical doctors often don’t know how to recognize this condition and will diagnoses people with cervicogenic headaches as people with “migraines”. Often, cervicogenic headache and migraines can look somewhat similar, they have defining differences. The good news is; if you have cervicogenic headache, usually you can achieve a highly successful outcome in physical therapy without medications or imaging studies!
What is a Cervicogenic Headache?
Cervicogenic Headache (CGH) is a type of headache experienced due to a problem with the upper neck. Often in the form of neck muscle tightness or joint irritation of the top 2 or 3 joints of the neck. CGH is often confused for other types of headache such as migraine or tension type headaches. I recommend consulting with a spine specialized physical therapist to determine if you are experiencing cervicogenic headaches vs other headache types. However, there are some defining characteristics of cervicogenic headaches that help us diagnose the condition. Let’s discuss a little cervical spine anatomy prior to discussing the condition.
The cervical spine consists of 7 vertebrae, C1 to C7, the cervical nerves from C1 to C8, muscles and ligaments. The first two vertebrae have a unique shape and function. They form the upper cervical spine. The upper vertebrae supports the skull (C1), articulates superiorly with the back of the skull This joint is responsible for 33% of flexion and extension. The design of C1 allows forward and backward movement of the head. Below C1 is C2 that allows rotation. The C1-2 joint is responsible for 60% of all cervical rotation.
The C1-C3 nerves relay pain signals to the nociceptive nucleus of the head and neck, the trigeminocervical nucleus. This connection is thought to be the cause for referred pain to the occiput and/or eyes. A common pattern of cervicogenic headache is that the pain radiates from the back of the skull up and over the ear to behind or above the eye sometimes referred to as a “Ram’s horn” pattern due to the shape of the pain distribution.
Irritation of the nerve fibers, muscles, or joint tissue at the C1-3 level sends signals through a nerve pathway that overlaps with the nerves in our head and face causing us to experience pain in this region. Oftentimes, repetitive trauma such as sustained postures can lead to irritation of these regions and begin to cause pain. Usually the condition is on one side, but it can affect both. It is brought on through. Computer work or prolonged driving tend to be associated with these cases and adjustment of the spine ergonomics is necessary to prevent this.
How is it treated?
Successful treatment requires skilled care to reduce the muscle tightness across the region; dry needling or manual trigger point therapy, or cupping can be utilized. Also the joint motion loss needs to be restored through various forms of manipulative or non-manipulative therapies. And postural corrections and ergonomic changes will need to be implemented to sustain corrections to the cervical spine by your therapist.
There are often exercises that will need to be prescribed to address cervical postural muscle weakness, which is also a common trait of people suffering from CGH.
Each person is unique in their own condition, and discovering what specific issues are at play for you can only be determined through an exam with an experienced spine based provider. I was lucky to have received great mentorship and undergo ongoing training to further my knowledge and skill with this condition and would love to meet you if you or someone you know might be suffering from this type of condition!
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