This is a question that I get from many of my patients. There are several options fore cervicogenic headache treatment at home. First, let’s review the basics of cervicogenic headaches.
A cervicogenic headache is a headache that originates in the cervical spine and refers pain into the head. The cervical spine is the part of the spine that comprises the neck.
The cervical spine is made up of 7 bones, nerves, and many different muscles and ligaments. This type of headache is very common and tends to reoccur. It can be confused with a migraine or tension headache. Cervicogenic headaches tend to respond very well to physical therapy.
What is a cervicogenic headache?
A cervicogenic headache is a headache caused by referred pain from the spinal nerves C1, C2, and C3. So, what are spinal nerves? Spinal nerves are nerves that come off of the spinal cord at each segment of the spine. The neck or cervical spine has 7 spinal segments or vertebra, the thoracic region (midback) has 12, and the lumbar (low back) has 5. These spinal nerves innervate the structures around them including the muscles, ligaments, joints, and discs. The spinal nerves C1, C2, and C3 come out at the spinal segments C1, C2, and C3. These are at the very top of the spine. C1 forms a joint with the back of the skull (an area called the occiput) to connect the spine to the head.
The spinal segments C1 and C2 are shaped differently than the other cervical segmental bones. These form the upper cervical spine and perform a significant portion of neck movement. This area has many smaller muscles around it to help control these movements. These are called the suboccipital muscles. This is because they are right below the occiput.
Poor posture is the culprit in many cases of cervicogenic headaches. More specifically forward head, or chin poke, posture is the one that gets people in trouble. This occurs when the midback and shoulders are more rounded, and the neck is more curved inward or forward flexed. However, in order to be able to see what is in front of us, the upper cervical spine will be extended. This can cause stiffness in the joints, especially around C2 and C3. It can also create tightness in the suboccipital muscles. This will eventually cause pain in the neck area and refer to the head.
So, what is referred pain?
Referred pain is when pain is felt in a place that is not the source of the pain. Cervicogenic headaches tend to refer in a ram’s horn distribution up the neck, skull, and around the eye. The pain will be on the side of the cervical dysfunction. The reason that upper neck pain refers to the head has to do with the nerves. Nerves C1, C2, and C3 relay their pain signals to the trigeminocervical nucleus. This area also receives pain signals from the trigeminal nerve which innervates the face. This causes the pain to be felt from the back of the head and around the eye.
What does it feel like?
A cervicogenic headache is uncomfortable as are all headaches but it is important to be able to distinguish which type of headache one has. This allows for successful treatment. The distinguishing characteristics of cervicogenic headaches include:
- It is unilateral or on one side of the head.
- It takes a ram’s horn pain distribution.
- Increases with neck movements.
- Postural changes can change the pain.
- Tenderness in the upper cervical spine
How can I treat it?
As I mentioned earlier, physical therapy has good success with treating cervicogenic headaches. A physical therapist can help improve mobility in the upper cervical spine with mobilization and manipulation techniques. Also releasing some of the musculature including the suboccipital muscles, scalenes, the upper trapezius, and levator scapula with soft tissue mobilization or dry needling will help decrease the pain and prevalence of cervicogenic headaches. Physical therapy can also help strengthen the neck muscles and improve posture.
There are several exercises that one can do at home to help alleviate the pain and improve the mechanics of the cervical spine. These include chin tucks, upper trapezius/serratus anterior stretches, and levator scapula stretches. Also, postural strengthening plays a big role in treating and preventing cervicogenic headaches. A rounded shoulders and rounded mid back posture also contribute to these headaches so strengthening between the shoulder blades is also very beneficial. This is called scapular strengthening or stabilization. Resistance bands are nice to have for additional difficulty. Having the shoulders and thoracic spine in a good position makes it much easier to have the neck in proper alignment.
How can I prevent it?
I became very good at treating the upper cervical spine during the pandemic. This was because I got so much practice doing it. People were sent home from their office, which probably had a more ergonomic setup, to their home offices. Many of these had very poor ergonomics. Some had laptops on coffee tables. Others had them on card tables. Some just had their laptops literally on their laps while lounging on the couch. All of these setups won’t do damage in the short term but if you are sitting with poor posture for hours at a time, it will lead to problems. And it will do it quickly. The pandemic started in March. By May and June, my schedule was full of neck pain and cervicogenic headaches.
I had one patient which stumped me for a second or two. She had all the makings of cervicogenic headaches including poor workplace setup, forward head/rounded shoulders posture, and neck pain/stiffness. However, her pain referred mostly to one side of her jaw. The trigimenal nerve does provide sensation to the jaw so this is not out of the realm of possibilities that her referred pain would be to the jaw instead of around the head and eye. After a couple of weeks of physical therapy using common treatment methods aimed at cervicogenic headaches, she improved by 80-90% and no longer had pain in her head, face, or jaw.
The moral of this story is that the best way to prevent cervicogenic headaches is through proper posture. The shoulders should be back so that they are in line with the hips. The shoulders should also be held down the back so that the upper trapezius and levator scapula do not become overly tight. To prevent the chin from jutting out, the ears should be in line with the shoulders. This will automatically bring the chin in.
Because proper posture might feel very abnormal and will be difficult to maintain, especially at first, it is important to have a good setup at your work area. This could include an ergonomically designed chair. This type of chair will help support proper posture. These chairs can be expensive so one could improve the ergonomics of most chairs with pillows and towel rolls. Having a lumbar support (this could be a lumbar pillow or just a towel roll) will prompt one to sit up straight. The chair back should be high enough to support the shoulders and upper back. All of this can aid in maintaining good posture with little muscle energy.
Also ensuring that your desktop is not too high is important. The work area should be low enough for the shoulders to relax down the back and allow a 90-degree angle at the elbow. This can be done by lowering or raising your chair or workspace.
In review
- Cervicogenic headaches are referred pain from spinal nerves C1, C2, and C3.
- They are caused by dysfunction in the upper cervical spine.
- Physical therapy is very successful in treating this condition.
- Improving posture is key in treatment and prevention.
- Postural strengthening exercises
- Stretching tight muscles
- Creating an ergonomic workspace
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.statpearls.com/articlelibrary/viewarticle/19263/
https://www.physio-pedia.com/Cervicogenic_Headache
https://www.choosept.com/guide/physical-therapy-guide-headaches