Headaches associated with neck pain (known as cervicogenic headaches or CGH) are one of the leading causes of headache. CGH can present either on one side or both sides of the head, typically starting around the base of the skull or neck and migrating around to the front. Occasionally sufferers may also complain of arm or shoulder pain. The headache and neck pain can often be aggravated by certain postures or activities. Sitting for long hours at a computer or using hand held devices, such as phones and iPads, are common aggravating activities.
Typical assessment findings of CGH sufferers
- Forward head posture (ie jutting chin forwards). This increases stress on the upper joints of the cervical spine (neck). The nerves that supply the face, particularly over the forehead and eyes, exit from the spinal cord at the level of the upper cervical joints. In this posture these nerves can become compressed and irritated, giving rise to the headache.
- Reduced range of motion in the cervical spine
- Muscle imbalance. This is usually seen as tightness and overactivity in the muscles in the back of the neck (starting from the base of the skull and running down along to the point of the shoulders) and the pectoral (chest) muscles, coinciding with weakness in the deep neck flexors (anterior neck muscles) and scapula stabilising muscles (rhomboids and lower trapezius).
- Pain or discomfort when pressure is applied to the joints and muscles of the neck
- On occasion some sufferers will report pins and needles/numbness down one or both arms
Typical posture in the saddle
Those suffering from either neck pain or CGH (or both) will typically sit like the rider in the picture above, with their shoulders and upper back rounded and chin poking forward. You can see that her shoulders are elevated, her lower leg has come way forward and she has lost all of her natural spinal curvature. She looks compressed in the saddle, as if someone is pushing hard down on her head. I have no doubt that this rider would present with very tight pectorals and upper trapezius muscles and would be very weak through their lower trapezius and deep neck flexors. I would be interested to see how clear she would jump this course with that kind of seat in the saddle!
How does physiotherapy help?
Firstly - if you suffer from headaches it's important to have a thorough assessment by your GP or physio to establish the cause of the headache. Although CGH are a common cause of headaches, they are by no means the only cause, so it is important that your headache is diagnosed by a professional (not Dr Google!)
If your headaches are diagnosed as CGH, physiotherapy is a very effective solution. Upon assessment the physio is able to identify any abnormalities in the joints and muscles that may be contributing to your pain, and can use treatment techniques such as soft tissue release, joint mobilisations, dry needling and stretching to address these issues. At SEP we place a strong emphasis on treating the cause of the problem, not just the symptoms. Treatment will therefore include specific strengthening exercises, postural corrections and advice. A weakness in the core stabilising muscles is not uncommon in CGH sufferers and regular Pilates sessions can help patients enormously.
A great exercise to help improve posture and relieve headaches and neck pain
- Neck retraction - start the exercise sitting or standing up tall. Draw your chin backward as if you are sliding in a drawer. Apply pressure with your fingers. Ensure that you keep looking straight ahead (you should give yourself a double chin!) Hold for a count of 5 and repeat x 10.