Let’s talk about the possible treatment and exercises for cervicogenic headache which comes from atlanto occipital, c1 and c2 vertebrae and how can you prevent it?
What is the characteristic that makes me doubt that the headache in the upcoming case is from her neck?
- The headache will be on one side of the brain.
- Pain in the head when moving the neck in certain positions
- It may be a pain in the shoulder that is on the same side.
- Pain and stiffness in the neck.
- Inability to move the neck within its normal range of motion.
- In addition to the fact that the pain will start from the back to the front.
Well, since we said that the source has a problem in c1 w c2, what is the test that allows me to determine this type of headache?
We have such a test, and the most important one is: Flexion Rotation test, and this works as follows:
- Patient supine therapist take patient head into full passive flexion
- Then rotate it toward right and left
- The kinematic range is compared in both directions
- And the test remains ve + if there is a difference of more than 15 degrees between the right and left, or that the pain that the eye complains of appears
Why these two movements in particular?
The idea is that the upper cervical is responsible for the largest range of rotation about 45. So when I do a complete flexion, I isolate the rest of the cervical spine. And rotation will be pure from upper cervical
Now we will talk about the treatment and exercises
Treatment for cervicogenic headache is the next step after the clinical diagnosis is made. It is super important that we seek adequate help, where the physical therapist can assess movement, especially in the upper cervical spine, a region we call the cervical skull. There are important tests in addition to clinical exams that we can observe this rotation measure as we mentioned before.
In a second moment, when the pain is more relieved, it may be necessary to correct the patient’s posture, especially if it is altered by the pain crises.
Some techniques are used quite effectively in the case of cervicogenic headache, such as thermotherapy, laser, digital pressure, therapeutic ultrasound or other physical means. The important thing at this stage of the treatment is to get the muscles of the patient’s cervical region, which involves neck, neck and shoulders, to relax again.
For this, currently, acupuncture can be an important ally in cervical muscle relaxation and in the control of predisposing factors, such as anxiety, insomnia and stress. Acupuncture has been used more and more in parallel with traditional treatments, bringing great benefits and enhancing results. Manual relaxations such as shiatsu device can also be used in parallel.
What types of exercises does it include?
Some types of exercises for cervicogenic headache include resistance and muscle strengthening exercises, postural exercises that involve the cervical spine, acupuncture and stretching exercises if there is not any contraindication, for example. In addition, muscle relaxant medications, preventative medications, and neuro-modulators may also be used.
Also, exercises for cervicogenic headache such as Pilates and/or RPG are recommended, which help to reorganize posture and musculature. For this, we use very effective techniques of orthopedic manual physiotherapy associated with specific exercises and a progression to general exercises for cervicogenic headache.
1- Headache SNAG for Mulligan
Mulligan assumes that if a headache stops cervical technique involving the upper spine then, this must be diagnostically significant as to the site of the lesion causing the problem and the fact that there is a mechanical component.
Technique of this exercise:
- Patient sitting: It is very important that the patient straightens his back
- Therapist stabilize the patient head by rt elbow. While his rt little finger on C2 Spinous process
- Therapist use his left base of the thumb to apply the mobilization with direction 90 degree
- Sustain for 10 to 30 seconds
- If this technique relief headache, It repeated 6 to 10 times.
In addition to these exercises for cervicogenic headache that the physiotherapist does, there are also exercises that can be done at home on the advice of the physiotherapist. For example:
This exercise is done seated and aims to improve posture and not to assume incorrect postures.
- It is necessary to sit at the tip of the chair or well seated with the back supported.
- And as soon as this position is reached, it is necessary to straighten the sternum.
- Open the shoulders and bring out the pelvis.
- The position should be maintained for about 10 seconds.
- The exercise should be repeated 10 times at least twice a day.
3- Exercise of yes:
- It can be done lying on your back with a towel or pillow under your neck, or standing up against the wall.
- If you are in the supine position, the exercise consists of bending the chin forward as if to say yes.
- Keeping the head and neck in contact with the towel or pillow.
- The same movement must be performed if you are in an upright position leaning against the wall.
- Taking care to open your shoulders towards the wall when making the movement.
- The exercise must be repeated 10 times, maintaining the position for 10 seconds and must be repeated twice a day.
4- Stretching exercises if there is not contraindication:
- It is to be carried out in a sitting position, or in an upright position leaning against a wall.
- In a sitting position, the ear must be brought towards the shoulder.
- Tilting the head laterally and maintaining the position for 10 – 15 seconds.
- In an upright position you must lean with your arms at the level of a corner of the wall.
- Keeping your elbows at shoulder height.
- Once in position, take small steps forward until a stretch is felt.
- Once you have reached the stretch, hold the position for 10 – 15 seconds.
- The exercise must be repeated at least three times.
5- Scapular retraction:
- In a seated position with the back straight and well placed against the back of the chair.
- The arms and hands are opened, spreading them slightly towards the back and the position is maintained for about 5 seconds.
- To be repeated 10 times.
6- Cervico thorathic mobilization:
- In a sitting position, place your hands at the base of the skull just below the ears.
- Close the elbows forward and then move them away by opening the chest outwards, while doing the movement the position of the back must remain erect.
7- Isometric Reinforcement of the neck:
- In a sitting position, place the hand on the forehead. Push the head against the hand and hold a little.
- Put your hand behind your neck. Push your head against your hand and hold a little.
- Put the hand sideways against the head and push with the temple against it.
- Hold a little and then, repeat on the other side.
My Diagnostic and Exercises for Cervicogenic Headache
This patient came to me a while ago with chronic neck pain, TMJ and cervicogenic headache. And often he had tried everything in the literal sense, starting with medicines to all methods of physical therapy, and also went to physical education centers for the gym.
I started hearing complaining of pain for two years continuously, as he was complaining of a terrible headache, especially in the morning, with pain and tingling in the ears. But the biggest problem for him is that all the doctors say that he is healthy and that the issue is psychological (of course there was a psychological part in it, but not the basis). Ordinary, MRI and CT scans are very healthy and there is nothing to cause this pain.
I started doing the assessment and it was very clear that it had hyper-mobility of C5, C6. I asked him for dynamic x ray for cervical and sent him to a neurologist, whom I knew well. The doctor said that there are some problems in the neck, and the issue is not worth a surgical fixation and that we start a physical therapy with him.
Watch Video To Know More Exercises
Let us see the intended part of this case:
This patient’s chief problem was instability of middle cervical. Of course, he was going to the doctors for mobilization and manipulation for cervical spine. This is very wrong exercises for this case.. why?
You must know that:
You must do an assessment before you do mobilization and see if it really contains a hypomoible segment and does it really need mobilization or does it contain hypermobility and therefore contraindicated for mobilization and manipulation.
This is the main program of exercises for cervicogenic headache that I was working with special case:
- Mobilization and manipulation for upper thoracic
- Strength for middle and upper traps, deep flexor and extensor of neck
- Strength for sub occipital muscles
- Craniocervical flexion Ex
- TMJ pt program
- No stretching ex
- No mobilization for cervical