Treat Headaches with Exercise – Part 1

Treat Headaches with Exercise – Part I

Cervicogenic Headache Exercises – Treat That Killer Headache With These Exercises
Do you see patients with headaches after a whiplash injury? Do they experience pain that seems to start in the neck and then spread to one side of their head or arm? Does moving their head seem to start their headache or exacerbate their pain?

If you answered yes to any of those questions, there’s a high chance they have a type of headache known as a cervicogenic headache. Lucky for them, as an extremely qualified healthcare provider you can help alleviate their pain. In addition, we’ll show you some stellar cervicogenic headache exercises for you to try at home.

Anatomy and Physiology of a Cervicogenic Headache
What distinguishes a cervicogenic headache from your more classic headaches like migraines or tension type headaches are that cervicogenic headaches are actually caused from dysfunction in your neck. Cervicogenic headaches are a form of referred pain – meaning that although the source of the pain is in the cervical spine, the sensation of pain is felt in the head as a headache. This happens because there are nerves in the upper cervical region (C1, C2, and C3) that have connections to nerves of the head (cranial nerve V via the trigeminal nerve spinal tract).

Although some controversy exists, a vast majority of the literature agrees that the most common cause of cervicogenic headaches is dysfunction from the C2-3 zygapophysial joints (facet joints). However, there is also literature to support that cervicogenic headaches can arise from dysfunction in the C2-3 and C3-4 intervertebral discs of facet joints, as well as the atlantoaxial (C1-2) and atlanto-occipital (C0-1) joints. The most common causes of these upper cervical dysfunctions are whiplash associated trauma as well as prolonged neck flexion or poor static postures.

Neck

Anatomy of the Upper Cervical Region
A recent systematic review in 2013 by Racicki et al came to the conclusion that “conservative physical therapy treatment techniques are an effective interventions for decreasing cervicogenic intensity and frequency, as well as neck pain.” In particular, utilizing a combination of mobilization, manipulation, and cervicogenic headache exercises like cervico-scapular strengthening exercises, are the most effective intervention based on the results of that systemic review.

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Manual Therapy
First, identify which specific upper cervical segments are dysfunctional through a segmental motion exam. Typically, palpation of the dysfunctional segment will recreate symptoms similar to the headache, letting the you know you’re on the right segment. From there, you should perform soft tissue mobilization to the suboccipital muscles with the intention of relaxing them. You can’t address the dysfunctional joints if the muscles around them are tense and guarded! From there, you can either employ joint mobilizations or manipulation to the dysfunctional segments. We are advocates of joint manipulations (if the patient is appropriate) because we can quickly “get in and get out” and treat the area of interest without provoking the tissue for too long.

Upper Cervical Soft Tissue Work, Mobilization, and Manipulation

In the video above, I demonstrate a general upper cervical manipulation. While a manual therapist likes to be as specific as possible with their joint mobilizations, it’s difficult to say whether we are gapping  C0-C1 or C1-C2 or even C2-C3 joint. Next, I demonstrate some general soft tissue mobilization to obliquus capitis superior and inferior. Finally, I demonstrate one of many ways to mobilize the C0-C1 joint. The particular technique shown is a mobilization of the occiput, while stabilizing at the transverse process of the atlas.

Cervicogenic Headache Exercise: SNAGs
Following manual therapy, teach your patients how to perform a Sustained Natural Apophyseal Glide, or SNAG, for short. This SNAG cervicogenic headache exercise is a way to provide yourself your own form of manual therapy. Essentially this exercise mimics the manual therapist’s hands and provides a joint mobilization to the dysfunctional joint.

SNAGs

To perform:

Use the EDGE of a towel. Using the edge, and not the middle or folded up towel, is important as you don’t want the towel to slip off of your skin.

Place the edge of the towel on the dysfunctional segment.

Anchor the towel with your the hand on the same side as your dysfunctional segment as shown.

With your opposite hand, reach up and grab the edge of the towel. If you give it a slight tug, you should feel a pulling/stretching sensation behind your neck at the dysfunctional segment. You should not feel any of your symptoms.

While pulling the towel (towards your opposite ear), turn your head towards your hand at the same time and hold this position for 3 seconds. Only turn your head in your pain-free range of motion. Your line of pull should be horizontal, to just below the eye (I said towards the eye in the video on accident)

That’s 1 rep. Now repeat 10 times.

Perform this exercise twice a day.

Give this SNAG cervicogenic headache exercise a try on yourself 1st…but be warned, BE GENTLE! At this point, we don’t know if you’re treating the right segments, or even the right problem in the first place!

In Part II we’ll touch on Neuro and Postural-Re-education exercises to help your patients address their headaches.

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