What is a cervicogenic headache?

A cervicogenic headache may also be referred to as a tension headache and is a headache that originates from the neck and is one of the most common types of headaches. A tension headache is generally a diffuse, mild to moderate pain that's often described as feeling like a tight band around your head. Sometimes the best expression for this headache is tension and pressure.    

What are the common causes of cervicogenic or tension headaches?

The cervical spine (neck) comprises of several bones known as vertebrae. Each vertebra connects with the vertebra above and below via facet joints and the disc centrally. During certain neck movements or sustained postures, stretching or compression force is placed on the joints, muscles, ligaments and nerves of the neck. With overuse, these forces may stress the structure beyond their normal limits and until the tissue breaks down. The source of pain may be the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears. As a result, pain arising from structures of the upper neck may refer pain to any of these regions causing a cervicogenic headache.    

What is the prognosis of cervicogenic or tension headaches?

Although cervicogenic headache can occur at any age, it is commonly seen in patients between the ages of 20 and 60. Fortunately, effective treatments for cervicogenic headaches are available. Physiotherapy and Massage Therapy may be very helpful. Managing a tension headache is often a balance between fostering healthy habits, finding effective nondrug treatments and using medications appropriately. See your doctor for effective pain management and to rule out potentially serious conditions.   There are several factors which can predispose patients to developing cervicogenic headache. These need to be assessed and corrected where possible with direction from a physiotherapist. Some of these factors include:  
  • Poor posture
  • Stiff joints
  • Tight muscles
  • Restricted fascia
  • Weakness postural muscles
  • Bad habits leading to abnormal and excessive stress
 

What are the common causes of cervicogenic or tension headaches?

Headaches are causes by many factures and there are no definitive tests to differentiate between most of them. Some of these causes may be serious and life threatening such and therefore seeking a medical diagnosis is important for headaches which are out of the norm for us.

   

What are the risk factors associated with cervicogenic headaches?

  • Poor posture at home, at work, or during their activities
  • Neck and upper back stiffness and joint restrictions often as a result of working postures
  • Muscle imbalances often as a result of postural and functional compensations
  • Muscle weakness in those muscles that are responsible for neck flexion
  • Muscle tightness in those muscles which are responsible for neck extension
  • Previous neck trauma (e.g. whiplash)
  • Inappropriate desk setup
  • Inappropriate pillow or sleeping postures
  • A sedentary lifestyle with bad habits of sitting and lounging
  • A lifestyle comprising excessive slouching, bending forwards or shoulders forwards activities.
  • Stress
  • Dehydration
   

When to see a doctor and when to make an appointment with your doctor?

If headache disrupts your life or you find that you need to take medication for your headaches more than twice a week, make an appointment to see your doctor. Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different. Occasionally, headaches may indicate a serious medical condition, such as a brain tumor or rupture of a weakened blood vessel (aneurysm).

   

If you have any of these signs or symptoms, seek emergency care:

  •  Abrupt, severe headache, which may be like a thunderclap
  • Headache with a fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties
  • Headache after a head injury, especially if the headache gets worse
  • Chronic, progressive headache that is precipitated by coughing, exertion, straining or a sudden movement
   

How can physiotherapy and massage do to help tension headaches?

Manual Physiotherapy

Manual therapy treatment is targeted at both joint restrictions and muscle tightness’s around the neck and upper back. Soft tissue release techniques will work to loosen the suboccipital muscles that attach into the base of the head, as well as the larger neck muscles that originate in the upper back and terminate in the upper neck. It is well known that these muscles in particular can refer pain to the head and contribute to headaches. Joint restrictions in the upper 4 vertebral joints of the neck have also been known to cause and/or contribute to headaches. These joints get restrictions due to previous trauma and/or poor postures, so mobilization techniques are gently performed to improve their motion and modulate headache intensity.   Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence. Treatment may comprise:  
  • joint mobilization
  • massage therapy
  • myofascial release
  • muscle energy
  • joint manipulation
  • traction
  • Low Intensity Laser therapy
  • Craniosacral therapy
  • Postural taping
  • Postural training and advice
  • activity modification advice
  • the use of an appropriate pillow for sleeping
  • ergonomic advice
  • exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture
   

Massage Therapy

With tension headaches, massage therapy provides relief of pain and trigger point referral patterns using relaxation, diaphragmatic breathing and moderate Swedish massage techniques. Muscles that are irritated and hypertonic can sometimes refer pain into the head causing a headache. In these incidences, trigger point techniques are used to release the muscles there by decreasing the tone in the muscle and reflex affecting the muscle    

How can physiotherapy and massage therapy help jaw pain?

Temporomandibular joint (TMJ) disorders can be alleviated with self-managed care, physiotherapy and massage therapy. Manual physiotherapist utilize techniques such as joint mobilization, craniosacral therapy, joint traction techniques and focus on postural training to reduce abnormal stress on the TMJ and joints of the neck. Tooth grinding, previous trauma, and poor postural habits, the movement in the jaw joints (TMJ's) can become altered. This will often cause deviation in the normal bite, as well as significant muscular tightness’s in the region. Manual techniques can be performed directly to the TMJ to decompress it for pain relief and gently glide it to restore normal alignment. Also, the vertebral joints of the upper neck are scanned for typical restrictions related to forward head posture and are mobilized as indicated by your assessment. Alignment is the issue when it comes to jaw pain, posture becomes a preventative measure and a proactive approach to good recovery. Massage therapy is effective for TMJ disorders as often this condition is associated with neck and upper back tightness. Massage and myofascial release of the cervical musculature and fascia may reduce tension on the TMJ. Soft tissue and trigger point release techniques are aimed to relieve overuse and tightness in the muscles that move your jaw and seize up with inflammation. Low Intensity Laser Therapy is effective in decreasing inflammation and promoting healing of the damaged tissues.

How can low intensity laser therapy help acute and chronic jaw and fascial pain?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.    

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