Physical Therapy for Headache

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This article was first published in a 2015 edition of HeadWise.

By Denise Schneider, PT, FAAOMPT, COMT, ATC
Headache Program Manager
Athletico Schaumburg South
Schaumburg, IL

A cervicogenic headache stems from the structures in the cervical spine (neck) and radiates into other areas, such as the back of the head, over the top of the head, and/or on the side of the head. This type of headache may occur gradually or occur as a result of an injury. An individual suffering from a cervicogenic headache may report an increase in symptoms with movement of the head or neck and a decreased ability to do so. Symptoms may increase with prolonged positions or postures, such as sitting for extended periods of time at the computer. Other symptoms associated with cervicogenic headache include: neck pain; muscle tenderness; tenderness over the joints in the neck; shoulder/arm pain on the same side of the headache; weakness; and, possible dizziness, nausea, and lightheadedness. Cervicogenic headache and its associated symptoms are typically the result of stiff joints in the neck; soft tissue tightness and/or trigger points; and, possibly nerve irritation.

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Figure 1. Denise Schneider, PT, performs manual therapy on a patient to address upper cervical joint stiffness and decreased range of motion of the head/neck.

Physical therapy is commonly prescribed for individuals who experience cervicogenic headaches. The physical therapist will complete a comprehensive musculoskeletal exam to determine which structures are contributing to the symptoms. The exam includes assessment of: range of motion of the head/neck; joint mobility; musculature tightness, tenderness, and trigger points; strength and endurance of the deep neck flexor muscles; strength and endurance of the axioscapular muscles; and posture. The physical therapist will also include other appropriate tests and measures.

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Figure 2. This is another technique to decrease stress on the upper cervical joints to help decrease pain, improve joint mobility, and increase range of motion.

Based on the results of the examination, the physical therapist will then design a specific treatment plan. The physical therapist will likely perform manual therapy techniques in order to decrease pain and increase the movement of the head/neck. Figure 1 demonstrates a joint mobilization technique for a stiff joint in the upper cervical spine. Figure 2 demonstrates a general manual therapy technique used to decrease stress on the head and neck and promote pain relief.

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Figure 3. Gently nod head by bringing chin towards the throat. This position may be held for up to 10 seconds for 10 repetitions. This exercise helps to strengthen the muscles of the neck that help to keep the head in an upright position which will decrease stress on the head and neck and decrease pain.

In addition to manual therapy techniques, physical therapy treatment will include the performance of exercises to increase the strength and endurance of the deep neck flexor muscles. Figure 3 demonstrates a craniocervical flexion exercise whereby the individual is instructed to gently nod his head, by bringing his chin towards his throat. He is also instructed to relax his shoulders to avoid compensatory patterns of other muscles. He is instructed to hold this position for a certain amount of repetitions. Additional exercises are performed in physical therapy to promote strength and endurance of the neck muscles and upper back muscles.

Other physical therapy interventions used to address cervicogenic headache include, and are not limited to: soft tissue massage; cardiovascular exercise; education on posture and body mechanics stretching; and, pain relieving modalities. Individuals should expect to attend physical therapy sessions 2 to 3 times per week for 3 to 6 weeks. With appropriate treatment for physical therapist who specializes in headache interventions, one can expect a decrease or resolution in cervicogenic headache signs and symptoms.