Characteristics of Cervicogenic Headaches
According to the International Headache Society there are over 230 different classifications of headaches all with different presentations and symptom sets. As physiotherapists, there is one group of headaches that stand out above all the rest for us to influence and change, the Cervicogenic Headache. The Cervicogenic headache characteristics are quite distinct and easy to identify and once assessed, we can definitively determine whether or not musculoskeletal treatment is going to be successful.
The determining characteristics of cervicogenic headaches are:
1. Location of the headache is not symmetrical i.e. unilateral headache or alternating headache swapping sides
2. Always has associated neck pain or stiffness at some point during the presentation
3. The headache comes on after long periods of sitting (i.e. associated with posture)
4. The headache started (or escalated) after a trauma?
5. The Headache is failing to respond to medication like it used to
If your patient has all or some of these symptoms, they need to have their upper cervical spine examined to determine if it is a primary cause of their headache. Our assessment techniques quickly and accurately determine whether the neck is involved and whether our treatment will help. If the patient currently has a headache during assessment, our strategy is to actively reduce (if not clear) the headache in that clinical session and then educate them how to minimise the risk of return. We can assess the neck when the patient has a headache or is totally pain free.
If the patient doesn’t currently have a headache, we can still assess the upper cervical spine and isolate the individual joints to try to reproduce the headache symptoms. This can sound scary for a patient but if we can provoke a response from a cervical segment, we can accurately determine that this structure is the cause of their headache, then educate the patient and treat the section to remove the dysfunction and reduce the headache. Nobody leaves our clinic with a headache if they come in symptom free.
Reducing or temporarily reproducing the patient’s symptoms, determines whether the upper cervical spine is a cause of their headache and we can then set the goal over 3 sessions to reduce their headache symptoms. If treatment is unable to reproduce or reduce their symptoms, their headache is not cervicogenic in origin and we refer them back, or if there is no change by three treatments, we refer them back for further investigation.
Author: Nigel Smith
Optometrists: Your eyes are fine, what now….
Optometrists are front line campaigners in the management of headaches and have a unique skill set that allows them to accurately diagnose whether the visual field is compromised, leading to headaches. They can then provide the necessary visual aids to rectify the problems. It is known to GP's and the general public that we need to eliminate vision as a primary cause of headaches, but what do we do when the optometrist clears the eyes as a factor. Or what do we do when we fix the patient's vision but the headaches don’t clear?
Thinking practically, we ask what is it about staring at computer screens that causes headaches. If you can clear the patient's eyes as a cause of pain, consider the position they are putting their shoulders, neck and head in to maintain their “computer posture”. There are some consistent characteristics of cervicogenic headaches that should be able to give you a clue that it is involved, and when you consider their posture, it becomes clear that the next step to determine the cause of their headaches is a cervical spine examination.
Thinking laterally, we need to consider the afferent inputs in the regions that the patient experiences headache pain. The Trigeminal Nerve (CNV) has three clear divisions, the Opthalmic branch runs along the temple and the brow and has divisions into the back of the eye socket and sinuses, the Maxillary branch innervates the soft palate, muscles of mastication and influences eustachian tube and even the stapes in the ear, and the Mandibular branch is responsible for the jaw and lower teeth. The processing centre for any information that is carried on any of the divisions of the Trigeminal nerve is actually located in the brainstem where there is convergence of nerve fibres from the C0, C1 and C2 Spinal nerves. In a nutshell, an irritation of the cervical spine can lead to referred pain along the Trigeminal nerve pathway and express pain in the temple, brow and eye socket, a grouping of symptoms that is commonly thought of as a result of eye strain.
Cervical Spine assessment to determine or eliminate musculoskeletal origin of headaches is becoming more relevant and the more pathways we have through more health professionals to get the neck assessed, the better chance we have of changing the lives of our patient's.
Author: Nigel Smith
Can Physiotherapy Help Tinnitus?
The Headache Neck & Jaw Clinic was recently asked by a group of audiologists how jaw and neck physiotherapy can help clients with tinnitus. Our Director, Scott Cook, and Senior Associate Physiotherapist, Karri Field, provided a short power point presentation to explain the close associations between the ear, neck and jaw.
Here at the HNJ Clinic we frequently have clients present with combined neck, jaw and tinnitus problems. Assessing and treating the neck and jaw in these cases facilitates reduced mechanical compression and irritation to the soft tissue and nerves around the eustachian tubes and tympanic membranes. Clients receive the most success from physiotherapy if their tinnitus is aggravated by neck and jaw movements.
If you’re interested, have a sneak peek at our powerpoint presentation below. Feel free to contact us if you have any further questions or if you would like us to do a presentation for your business.
Author: Karri Field