When it's more than a pain in the neck!

Headaches... we've all had one and they can really be debilitating. There are many causes of headaches. Three common causes are tension related headaches, migraines and neck related headaches. The neck related headache is also known as a cervicogenic headache.

A cervicogenic headache is due to a disorder in one of the top 3-4 joints in the neck. The pain is usually felt on one side of the head - the same side as the neck dysfunction. The pain in the head is usually accompanied by neck pain and the pain increases with neck movements or postural changes. Migraines and tension related headaches may have associated neck pain, however this is often secondary to the headache. Correct diagnosis is important as the management of each headache cause differs significantly.

Cervicogenic headaches respond very well to physiotherapy management. Some migraine and tension headache sufferers will get benefit from physiotherapy treatment as there may be a elements of cervicogenic headaches involved. The goals of physiotherapy management are:

• ease the pain

• improve posture

• improve movement

• strengthen the supporting muscles of the neck and shoulder blades

• train balance, movement control and head/eye movements.

Headaches can be recurrent and long lasting. Management needs to be comprehensive and directed to your needs.

Posture, posture, posture! We know we should sit and stand with "good" posture but it is hard. Posture is an indirect measure of the functional status of the neuromuscular system. We need strength to maintain "good" posture and awareness of what that is. Good posture means sitting upright with shoulder blades back and shoulders over a neutral pelvis. Having a physiotherapist show you what good posture looks like can really help. Take a photo of yourself in your resting posture and then get your physio to take a photo in a more optimal position.

Good posture can help offload your neck joints and muscles assisting in reducing your headaches. It can help in a number of other musculoskeletal aches and pain too.

There are certain patterns of muscle tightness and weakness that go with cervicogenic headaches and they have been known as the "upper crossed syndrome". Cervicogenic headache sufferers often have tightness in their pectoral muscles, rounding their chest in. They also have tightness of their upper traps, levator scap, lifting their shoulder blades up. They also have tight suboccipitals contributing to the compression of the upper cervical vertebrae and a forward head posture.

On the opposing arm of the quadrant you have weakness. Weak deep neck flexors, which are the core muscles of the neck. Weak rhomboids and lower traps, which are help stabilise the shoulder blades and assist in arm function. Addressing both the tightness and weakness areas can help normalise movement and prevent headaches.

The principals for training both the deep neck flexors and the scapula stability muscles are similar. First you need to learn how to use them. Learning how to switch on these muscles will help switch off ones that might be tight and overused. Secondly these muscles need to be trained in endurance. They are postural muscles and need to work at a low level for long periods. Thirdly they need to work in various positions, including against gravity, and be integrated into your usual strength training.

Cervicogenic headaches are treatable. You don't need to experience these headaches. You need to learn how to use your postural muscles!

Visit our Physios at The Movement Workshop for personalised, long-lasting Cervicogenic headache relief. Our clinic in South Melbourne is conveniently located close to the Melbourne CBD for any office workers!