Suffering from Headaches?

It's the end of the work day and you can feel it coming on: the pounding starting at the back of your skull and reaching over your head into your eyes and temples. You try to stretch your neck out side to side with no avail, the headache stays. In an article published in the journal Cephalagia, Stovnern et. al. found that upwards of two-thirds of the world's population suffers from headaches.

There are many different types of headache, and may be caused from a number of different issues. Some of the more common headaches are migraines, tension headaches, and cervicogenic headaches (CGH).

I'd like to write about the latter of that group today, as this is a kind of headache that physiotherapy can have the greatest impact on (although tension headaches, we can also help with!).

Cervicogenic put simply means that the pain originates in the neck, typically the area from the bottom of the occiput (skull) to the third cervical spine. The actual definition of a cervicogenic headache is published by the International Headache Society (IHS) and is explained as pain, referred from a source in the neck and perceived in 1 or more regions of the head and/or face.

Diagnosis of cervicogenic headaches can be done by your physiotherapist through an assessment method known as the flexion-rotation test, or FRT. This test checks for rotational mobility between the first (atlas) and second (axis) cervical vertebrae - the atlanto-axis joint or AA joint (the motion at these joints contribute almost half of our total neck rotation). If there is marked loss of rotation to one side, it there is a very good probably of having restriction in the  AA joint that is leading to your headaches. The restriction is often on only one side, and thus headaches are also predominantly on that same side.

Okay, great. My physiotherapist has given me a diagnosis of having a restriction in my AA joint leading to headaches, now what the heck can I do about it??

With proper diagnosis, we can give a very specific exercise to help mobility of this joint. The exercise can then be used when you have your headaches, and diminish or abolish your symptoms!

This image was taken from the research article of Hall et. al. in JOSPT (see reference below).

The image above shows the patient working on a restriction on the left side of her neck. She is using a custom strap, but this can also be done with a towel. Pressure is applied by the right hand on the left atlas (C/1) while looking forward. Pressure is maintained on the atlas as you rotate as far to the right you can without pain. End-range is then held for a few seconds, and then you return to the start position, while again maintaining the forward pressure on the atlas.

 

This is an image of Jack Miller performing a Mulligan technique in one of their DVDs. 

This technique was first shown to me by Jack Miller (PT, FCAMPT), who is a great physiotherapist based out of London, during a lecture of CANZED seminars: Mulligan Concept - Upper Quadrant Procedures. This exercise takes the name of a self-SNAG aka self-sustained natural apophyseal glide, meaning we are maintaining pressure on the joint through normal pain-free motion.

A study published by Toby Call, MSc. in 2007 show the efficacy of this self-SNAG technique with those clients that have AA joint restriction leading to headaches. The study took 32 subjects with CGH and FRT limitation. The study was double-blinded and placebo controlled (aka: a wonderful study!). After the first visit, those in the self-SNAG group already had marked improvement in range of motion (mean: 15 degrees), and had a lower self-reported headache index questionnaire than their control counterparts at 4 weeks and at 12 months.

If you are suffering from headaches, and you are not sure where the pain may be coming from, or you are certain it is coming from the neck, I suggest that you go for an assessment of your neck by an orthopaedic physiotherapist. We will be able to properly assess your condition to see if you may benefit from physiotherapy, and whether this technique may be ideal to help you self-manage your pain. Call in for an appointment today at 204-421-9177!

Hall, T. et. al. (2008). Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. The Journal of Manual and Manipulative Therapy. 16(2), 73-80.

Hall, T. et. al. (2007). Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache. Journal of Orthopaedic & Sports Physical Therapy. 37(3), 100-107