The main issue at play is the nerves that carry information from the upper 3 segments of the cervical spine (C1-3) converge on the same point in the brain that informs it of head pain. Due to the anatomy of the nerves the brain essentially is confused about where the pain is coming from and therefore neck pain is instead interpreted as a headache. 

For some people this is one sided, for example their right neck joints and muscles will refer pain to the right side of the head causing a right sided headache. This is often reflected in the examination performed by the physiotherapist where the right side of the neck will be much more tender to touch than the left. 

Can physiotherapy help?

For people with cervicogenic headaches, physiotherapy can therefore be of great benefit as we can find the cause of the neck pain and work to release and strengthen the neck. Reducing the tension on the neck therefore reduces the neural input to the brain that signifies pain that is then interpreted as a headache. This includes a thorough assessment to identify what activities or postures are placing additional strain on your neck. For example some desk workers who spend long time sitting and use a mouse in their right hand will find that they fatigue the right side of their shoulder and neck muscles. The physiotherapist will then work to find strategies to reduce this tension via actions taken at work while also using soft tissue and mobilisation techniques, followed by a strengthening program. 

Consider other factors

It is also important to note that most headaches are multifactorial and other factors include hormonal, blood pressure, stress, mental health and medication. Each of these factors will need to be explored to varying levels in different people. This may involve consultation with other health professionals. 

See also this blog by the Australian Physiotherapy Association for more information:

https://choose.physio/your-body/neck/neck-related-cervicogenic-headache

References:

Biondi, D. M. (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association, 105(4_suppl), 16S-22S.

Bogduk, N. (2001). Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Current pain and headache reports, 5(4), 382-386.

Image source: https://postpt.com/web/headaches-we-all-get-them-cherie-is-here-to-educate-us/

Sophie Woodhouse

Physiotherapist Shepparton, GV Sportscare

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