Your physical therapist can assess your spine and offer treatments that help improve your mobility and decrease your pain.
Anatomy of the Cervical Spine
Your neck is comprised of seven cervical vertebrae that are stacked one upon another. In between those bones are soft, spongy intervertebral discs. There are joints on either side of your neck where one bone articulates with another. The cervical vertebrae protect your spinal cord and allow your neck to move through flexion, extension, rotation, and side bending.
Your upper cervical vertebrae help support your skull. There is a joint on either side of cervical level one that connects to the occiput of your skull and allows for motion to occur.
This suboccipital area is home to several muscles that support and move your head, and nerves travel from your neck, through the suboccipital area, into your head. The nerves and muscles in this area may be a source of neck pain or headaches.
Symptoms of Cervicogenic Migraine
There are several symptoms of cervicogenic migraine headache. These may include:
Pain on one side of your upper neck that radiates to your temple, forehead, or eye Reduced range of motion in your neck Pain on both sides of the back of your head Pain in the back of your head that radiates to one shoulder Nausea Sensitivity to light or sound Dizziness or vertigo Pain in one side of your face or cheek
Sudden motions often trigger symptoms of cervicogenic migraine, or they may come on during sustained postures of your neck. The symptoms are often described as dull and nonthrobbing, and they may last for several hours to days.
If you are having headaches and suspect you are having cervicogenic headaches, you should check with your physician. They can assess you and help make an accurate diagnosis of your condition.
Diagnosis
There are tools your physician may use to diagnose your cervicogenic headaches. These may include:
Physical examination including neck range of motion and palpation of your neck and skull Diagnostic nerve blocks and injections X-ray Computed tomography (CT) scan Magnetic resonance imaging (MRI)
A diagnosis of cervicogenic headache is usually made when there is one-sided nonthrobbing headache pain coupled with a loss of neck range of motion. There should also be a known lesion seen on your neck imaging studies; a bulging or herniated disc, disc degeneration, or arthritic changes in your cervical spine may be present.
Your healthcare provider may refer you to physical therapy to treat cervicogenic headache once it is diagnosed.
Physical Therapy
When first visiting your physical therapist for headaches, they will interview you and take a thorough history of your condition. Questions will be asked about the onset of your pain, symptom behavior, medications tried, and diagnostic studies that have been obtained.
Your therapist will also ask about any previous treatments you have tried for your pain and review your past medical and surgical history.
Components of the PT evaluation may include:
Palpation of your neck and skullMeasures of neck range of motionStrength measurementsPostural assessment
Once the evaluation is completed, your therapist will work with you to develop a plan of care and rehab goals for your headaches. Then treatment can be started. There are various treatments available to help treat your cervicogenic headaches. Be sure to check with a healthcare professional before starting any treatment for your cervicogenic headaches.
Exercise
Exercise should be your main tool in the treatment of cervical headaches and migraines. Exercises to improve neck motion and decrease pressure on cervical nerves may be prescribed by your therapist. These exercises may include:
Cervical retraction Cervical flexion Cervical side bending Cervical rotation
When performing neck exercises for your headaches, be sure to move in slow, steady motions and avoid sudden or jerky movements. Your therapist may have you add overpressure with your hands to each neck stretch, and the end range position of stretches may be held for up to 1 minute.
Postural Correction
If you have a forward head posture, your upper cervical spine and suboccipital area may be pinching on the nerves that travel up the back of your skull. Correcting your posture may be an effective strategy for treatment. Postural correction may include:
Using a lumbar roll when sitting Performing the slouch-overcorrect exercise to find an optimal posture Using a supportive neck pillow when sleeping
Your physical therapist may also use kinesiology taping to help improve your overall postural awareness. The tape may increase tactile awareness of your back and neck position.
Heat or Ice
Heat or ice may be applied to your neck and skull to help decrease pain or inflammation. Heat can help relax tight muscles and improve local circulation and may be an effective treatment to do just before performing your neck stretches.
Massage
If tight muscles are limiting your neck motion and causing headache pain, massage may be performed by your physical therapist to help improve mobility. A special technique called suboccipital release may be performed to loosen the muscles that attach your skull to your neck, allowing for improved motion and decreased nerve irritation.
Traction
Your therapist may use mechanical or manual traction to help decrease pain from cervicogenic headache. Traction may decompress your neck’s discs and joints and allow for improved motion to occur in your neck. Your therapist may also perform joint mobilizations to improve your neck motion and manage your pain.
Vestibular Therapy
If you are experiencing vertigo or dizziness due to your cervicogenic migraines, you may benefit from vestibular therapy. This specialized form of rehab involves performing specific neck, head, and gaze stabilization exercises to improve the way your vestibular system functions.
Electrical Stimulation
Your physical therapist may use electrical stimulation, like transcutaneous neuromuscular electrical stimulation (TENS), on your neck muscles to decrease pain and improve your headache symptoms.
Your physical therapist may use one or many different treatments for your cervicogenic headaches. Be sure to work closely with your therapist to understand which treatments are right for you and to determine the effectiveness of each treatment for your headaches.
How Long Should Therapy Last?
Most episodes of care for cervicogenic headaches last about four to six weeks. You may experience relief within a few days of starting therapy, or your symptoms may remit over the course of weeks.
Some people experience continued migraine headache pain for months after starting therapy and use the techniques they learned in PT to help control exacerbations of their symptoms. Your therapist should be able to give you an idea of how long your specific therapy should last.
If you continue with symptoms of migraine headache after PT has ended, you should visit your physician to search for other treatment options for your headache pain.
A Word From Verywell
Cervicogenic migraine headaches can cause pain, limited motion, or confusing symptoms such as dizziness or nausea. You may benefit from working with a physical therapist to find the best treatments for your specific condition. That way, you can be sure to quickly and safely get pain relief and return to your previous level of activity.
