Are you currently experiencing neck pain when looking over your shoulder and frequent headaches? Cervicogenic headaches are estimated to be the cause of 18% of chronic headaches and affect women 4 times more than men. These headaches are of musculoskeletal origin and are directly correlated with upper cervical joint limitations and soft tissue restrictions. Patients typically report a headache on one side that goes around the ear from the forehead to the posterior part of the neck. Headaches of this nature can limit a person’s work efficiency and pharmaceutical interventions may not be effective. Patients also report having difficulty with rotating their head to look over the shoulder, and pain in the neck that is attributed to increase in stress or cervical tension.  If you are experiencing these symptoms you should set up a consult with your musculoskeletal experts at Performance Plus Physical Therapy to be evaluated for potential cervicogenic headaches. 

Your next question should be, what can I expect from a Physical Therapist to help resolve my headaches? Here at PPPT, we will first perform an hour-long evaluation to help determine if the symptoms are true to cervicogenic headaches. To treat the symptoms, we combine manual therapy with postural specific exercises, since evidence seems to best support these interventions in managing cervicogenic headaches. Manual therapy will focus on suboccipital muscles extensibility, thrust joint manipulations and non-thrust joint mobilizations in order to increase cervical range of motion. Along with manual therapy, postural instructions will be provided throughout all exercises performed in clinic. 

Due to COVID-19, more people are working from home and have found themselves working with poor posture since they do not have the proper ergonomic set up at home. At PPPT, we can review simple tips like elevating a monitor to eye height or even suggest sitting on a large swiss ball to help correct posture. Correcting work desk ergonomics can help decrease cervical and shoulder tension that may help alleviate symptoms. 

Therapeutic postural exercises are commonly prescribed by doctors and physical therapist but can often be performed improperly. Besides tactile and verbal cues, physical therapists at PPPT utilize biofeedback tools that help with isolating deep neck flexor recruitment. Deep neck flexor exercises have been found to be a crucial component to treating cervicogenic headaches and for providing cervical stability post whiplash associated neck injuries. 

Patients with true cervicogenic headaches typically respond better to heat in cervical spine post treatment since it helps alleviate muscle tension in the suboccipital region. A patient’s vision can also affect the suboccipital muscle tension because if visual acuity is impaired the patient typically squints and sticks out their chin.  This posture causes suboccipital flexion and increases tension, ultimately leading to a tight feeling at the base of your skull. Vision is always overlooked by physical therapists since it is out of the scope of practice for physical therapy, but a physical therapist can educate the patient on how visual acuity can affect their posture and may suggest scheduling an appointment with their optometrist if necessary. 

If you have questions about cervicogenic headaches, contact us at Performance Plus Physical Therapy for help. A physical therapist can help modify and prescribe exercises specific to your needs, to help you get back to the activities you enjoy!

By Giovanni Villanueva PT, DPT