Have you ever had a headache that didn’t get better with use of medication? Have you wondered why you sometimes wake in the morning with a headache or feel a headache coming on after working in front of a computer screen or even after being on your cell phone for a prolonged time period?
Common Headache Types
Migraine or Cluster Headache
There are many possible factors which can produce headache symptoms and they can be diagnosed based off of their presentation and location of the headache. The most widely known headache is one caused by vascular issues, meaning a constriction of the blood vessels in the head, thus causing a headache which is often diagnosed as a migraine or cluster headache.
Another common headache is a sinus headache in which the symptoms are primarily located at the front of the head, with patients having palpable tenderness through the forehead and face.
A cervicogenic headache, however, will likely originate at the back of the head/neck and travel up the head and may even cause pain into the eye. The pain is usually on one side and may have accompanying neck pain, stiffness, or have symptoms intensified when applying pressure at the neck. Imaging to include an X-ray or MRI will often be inconclusive.
Physical Therapy Intervention
What are the options for treating a headache if you suspect it is cervical in nature? This is a common diagnosis treated through physical therapy intervention as the headache is musculoskeletal in nature, meaning arising from the muscles or bones. A licensed physical therapist will perform a thorough evaluation of the mobility in the cervical region to assess any limitations in active movement of the neck and or any limitations of the facet joints (a joint where one vertebra joins another). The most commonly involved area is the top three cervical vertebrae. A therapist will also assess the integrity of the muscle groups through the neck as well as the muscle groups along the front of the chest/shoulder and into the middle back or shoulder blade region. This assessment is critical in correcting any posture changes which cause undue stress through the upper cervical region and thus triggering a cerviogenic headache. These posture changes can occur following sustained positions such as prolonged computer work, prolonged sitting, or prolonged work with arms in an overhead position.
Once a physical therapist has identified the structures involved and the exact origin, various treatment techniques can be utilized to provide symptom reduction. Mobilizations of the cervical facet joints are critical to restore the normal movement and to reduce inflammation and pain arising from this area. A joint mobilization is when direct pressure is applied to a joint surface in a rhythmical manner. The goal of a mobilization is to reduce pain and inflammation and gradually restore movement by varying the amount of pressure applied.
Soft tissue release, or massage, is also utilized to address the tightness through the neck musculature that has occurred either due to holding the neck in a sustained position to avoid pain or from sitting with improper posture for prolonged time periods. In conjunction with the manual techniques of mobilizations and soft tissue release, exercises will be implemented to correct any postural changes due to muscle weakness through the neck and scapular stabilizing musculature and with flexibility exercises given to address tightness due to adaptive posture changes.
Treatment would not be complete without thorough education provided in how to maintain proper postures and prevent exacerbation of symptoms and reoccurrence of headache pain.
Amy Morris, PT, DPT, COMT
STAR Physical Therapy, Tullahoma, TN
Amy Morris has been working in outpatient physical therapy for the last 13 years serving the Tullahoma community. She graduated from The University of Alabama in 2000 with her bachelors in biology and went on to pursue her doctorate in physical therapy from Belmont University where she graduated in 2003. Since graduation, she has focused her continuing education in the realm of manual therapy, receiving her certified orthopedic manual therapy (COMT) certification in 2009, completing the curriculum for McKenzie and Mulligan manual therapy approaches as well. Amy joined the STAR team in 2010.