Headache and Physiotherapy

Headache is a complex type of pain. Headache may have several causes and may be difficult to diagnose and treat. Many headaches are unexplained. However, there is building evidence that a significant proportion of headaches have some contribution from the structures of the neck. There is also evidence that physiotherapy can help with this type of headache.

Headache from the neck

For many people, headaches start as pain or tension at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, the forehead, or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse. This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck joints or muscles can cause referred pain to your head.

What might it feel like?

Any of the following points could suggest that your neck may be causing the headache:

Headache associated with neck pain
Headache brought on or worsened by neck movement or staying in the same position for a long time e.g at a computer
Headache which always feels worse on the same side of your head
Headache eased by pressure to the base of the skull.
Headache which persists after your doctor has checked for other causes

What will a physiotherapist do?

An experienced physiotherapist will be able to determine if your neck is causing or contributing to the headaches. Physiotherapists may use:

Mobilisation of the joints and muscles in your neck
Manipulation.
Functional and rehabilitative exercises
Postural assessment, correction and advice
Ultrasound and electrotherapy.

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical ergonomic tips for work and in the home; adjusting furniture, relaxation and exercise.

Effectiveness of Physiotherapy.

An Australian study (Jull et al, Spine 2002) has compared the effectiveness of manipulative physiotherapy and exercise therapy on cervicogenic (this means neck-related) headache over a 12-month follow-up period. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity compared to the control group.

Physiotherapy Joint Mobilisations and Patient Self-treatment.

A further study has recently looked at the effectiveness of mobilising the C1-C2 facet joints in those with chronic cervicogenic headache, with a specific focus on self-administered treatment taught by an experienced physiotherapist (Hall et al, 2007). This study found that headache symptoms improved significantly in subjects treated with self-mobilisation of the C1-C2 joints. Improvements in neck range of motion and significant reductions in pain were found at 4 weeks follow-up, and sustained at 12 months follow-up.

References

Hall T and Robinson K. The Flexio-Rotation test and Active Cervical Mobility – a Comparative measurement study in Cervicogenic headache. Man Ther. 2004;9;197-202. Jull G, Trott P, Potter H, et al.
Hall T and Robinson K. The Flexio-Rotation test and Active Cervical Mobility – a Comparative measurement study in Cervicogenic headache. Man Ther. 2004;9;197-202. Jull G, Trott P, Potter H, et al.

Hall T and Robinson K. The Flexio-Rotation test and Active Cervical Mobility – a Comparative measurement study in Cervicogenic headache. Man Ther. 2004;9;197-202. Jull G, Trott P, Potter H, et al.

A Randomised Controlled Trial of Exercise and Manipulative Therapy for cervicogenic headache. Spine. 2002;27:1835-1843.

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