CERVICOGENIC HEADACHE.

According to the American Migraine Foundation, a Cervicogenic headache is a refer headache from the neck area. Cervicogenic Headache is a secondary headache because it is the result of another origin like the upper neck or the back of the head. Cervicogenic Headache is one of the most common headaches in weight-lifting athletes ( Rifat S.F., Moeller J.L. Sports Med Rep, 2003 ). 

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Types of Headache Disorder: ( Cephalalgia, 2004)

There are basically 2 categories of headache Primary and Secondary.

  1. Primary headache includes cluster and migraine headaches as well as also tension-type headache.
  2. Secondary headaches are the result of another source of head and neck injury.

Prevalence :

Approximately  47% of the global population suffers from a headache and 15-20% of that headache are cervicogenic headaches. (Phila Pa 1976). A higher prevalence of headache in adults with neck pain. Females are more prone to Cervicogenic Headache affecting 4 times as many women as men. Since Cervicogenic Headache commonly affects women, it is important to consider menstruation and hormonal shifts as a contributor to headaches. (Hagen K., et al. Eur J Neurol, 2002. Lieba-Samal D. et.al. Miziara L., et al.)

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Cause: 

  1. Postural: Forward Head Posture ( Watson DH, Trott PH Cephalalgia. 1993 Aug )
  2. Active Range of motion: There is a significant decrease in range of motion in the neck. ( Dumas J.P., Jull G., et al.)
  3. Muscle Length: Upper Crossed Syndrome (Jull G, Barrett C, Zito G )
  4. Soft Tissue: Myofascial Trigger point in the muscle. (Simons D.G., Travell J.G.et.al. Philadelphia: Lippincott Williams & Wilkins )

 Treatment:

Electrotherapy: There are some studies suggested that TENS are Cryotherapy effective in Cervicogenic Headache patient. (Haldeman S, Dagenais SSpine J. 2001). 

In a recent systematic review, Chow et alconcluded that LLLT reduces pain immediately after treatment in acute mechanical neck pain and up to 22 weeks after treatment in patients with chronic neck pain, while Leaver et al. suggested LLLT is more effective in the intermediate and long-term than short term. ( Leaver A.M., et al. J Physiother, 2010 )

Manual Therapy: Several Studies shows that spinal manipulation is effective for cervicogenic headache patients especially those focused on the upper cervical region. (Haas M, Group E et. al. J Manipulative Physiol Ther. 2004). Both mobilization and manipulation are effective for the treatment of patients with cervical pain, although manipulation appears superior to mobilization in the short term. (Gross A, Miller J, Man Ther. 2010 Aug)

Muscle Stretching: Patients with cervicogenic headache present tightness in various neck muscles (Jull G, Barrett C, Treleaven J, et. al. Cephalalgia. 1999 Apr). The post-isometric relaxation (PIR) technique is useful in helping reduce tightness and trigger point pain. (Lewit K, Simons DG Arch Phys Med Rehabil. 1984 Aug). 

Posture Correction Exercise: The patient with cervicogenic headache has a forward head and rounded shoulder posture.  A good ‘proprioceptive posture’ begins from the core, ensuring the patient knows how to activate the transverse abdominus and brace the entire core. In addition, patients should be instructed in proper diaphragmatic breathing to reduce activation of accessory respiratory muscles ( Simons D.G., Travell J, et. al.  Lippincott Williams & Wilkins )

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Active Exercise: (Phil PageInt J Sports Phys Ther. 2011 Sep)

  1. Active ROM exercise of neck and shoulder
  2. Shoulder shrugging and retraction
  3. Push-up
  4. Chest press
  5. Strengthening exercise of neck

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