Physical therapy is often utilized in the comprehensive treatment for headache sufferers. For certain types of headaches, physical therapy has proven to be successful in decreasing and/or resolving the intensity and frequency of symptoms, improving an individual’s function and mobility, and improving an individual’s quality of life. A common type of headache seen in clinical practice that responds well to physical therapy is cervicogenic headache
A Cervicogenic headache stems from the structures in the cervical spine (neck) and radiates into other areas, such as the back of the head, over the top of the head, and/or on the side of the head. This type of headache may occur gradually or occur as a result of an injury.
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An individual suffering from a cervicogenic headache may report an increase in symptoms with movement of the head or neck and a decreased ability to do so. Symptoms may increase with prolonged positions or postures, such as sitting for extended periods of time on the computer.
Cervicogenic headache and associated symptoms are typically the result of stiff joints in the neck, more specifically the upper portion of the neck, soft tissue tightness and/or trigger points, and possibly nerve irritation.
Physical therapy is commonly prescribed for individuals who suffer from cervicogenic headaches. The physical therapist will do a comprehensive musculoskeletal exam to determine which structures are contributing to the symptoms.
The physical therapist will also include other appropriate tests and measures.
A physical therapist will then design a specific treatment plan based on the results of the examination. Manual therapy techniques will most likely be preformed in order to decrease pain and increase the movement of the head/neck. Figure 1 demonstrates a joint mobilization technique for a stiff joint in the upper cervical spine. The goal is to decrease the stiffness of the joint to increase the range of motion of the head/neck. Figure 2 demonstrates a general manual therapy technique to decrease stress on the head and neck and promote pain relief.
In addition to manual therapy techniques, physical therapy treatment will include the performance of exercises to increase the strength and endurance of the deep neck flexor muscles. Figure 3 demonstrates a craniocervical flexion exercise whereby the individual is instructed to gently nod his head, by bringing his chin towards his throat. He is also instructed to relax his shoulders to avoid compensatory patterns of other muscles. Additional exercises are performed in physical therapy to promote strength and endurance of the neck muscles and upper back muscles.
The individual is instructed to gently nod his head by bringing his chin towards his throat. This position may be held for up to 10 seconds for 10 repetitions.
Other physical therapy interventions used to address cervicogenic headache include and are not limited to: soft tissue massage, cardiovascular exercise, education on posture and body mechanics, stretching, and pain relieving modalities. Individuals should expect to attend physical therapy sessions 2-3 times per week for 3 to 6 weeks. With appropriate treatment from a physical therapist who specializes in headache interventions, one can expect a decrease in cervicogenic headache signs and symptoms.
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