One reason people seek help from physiotherapists is for their neck pain and headaches.

Headaches can come in many forms such as tension headache, migraine, cluster headache, all of which can be life altering. Often patients have sought many opinions, been offered drug and lifestyle change advice before coming to see a physio. But in many cases the headaches are actually what is known as cervicogenic headache, i.e. the cause is related to the neck and the pain is from information received by the brain from the nerves in the upper cervical spine.  

Features that imply that there may be a neck component to your headache include headache that can change between left and right side, either in separate headaches or during the same episode or one which is stronger on one side and which changes during the episode. Headache starting in the neck or one which comes on with specific head movements can also suggest that the neck is involved. Migraine has so many factors, including sleep, nutrition, sensitivity to certain foods, light and stress but it too can have a neck component. By changing one or more of these factors it is possible to improve the tendency to have migraine as well as lessening the pain and other effects such as nausea if they do occur.  

One theory that has been shown more recently in research is that what most headaches have in common is what we call a “sensitised brainstem”. The brainstem is the small structure connecting the nerves from the brain to the rest of the body via the spinal cord. It sits above the neck at the base of the brain. It is well known that in chronic pain there often is no longer a physical cause for the pain but that the brain can be sensitised and this produces an amplification of both pain and sensation to touch known as “allodynia”. It would appear that messages from the three upper neck or cervical joints can also cause sensitisation and this can be experienced as headache or migraine. By affecting the input from the neck to the brain, this can help to bring down that sensitisation and thus reduce the pain and other symptoms such as aura, nausea etc.   

As with all physiotherapy assessments, the patient’s telling of their problem, “their story,” the symptoms they feel, what makes them worse or better and what their life is like is the most important. This may sound unconnected but we know that much of the pain science points to the importance of stress, sleep, nutrition etc. on symptoms. It is very common for patients to find that their pain is better when they have settled into a holiday or are out of a stressful situation.  

During this assessment we can check that there are no red flags such as a sudden onset or worsening of regular headache but for no particular reason. Headaches associated with a history of cancer, high blood pressure, fever, pregnancy or by increased pressure such as coughing should also be investigated separately too.    

Examining the patient includes looking at head and neck movements as well as a brief overview of general movement. Palpation of the muscles and joints that could create headache would be performed and blood pressure should be taken.   

A particular method of headache treatment was started by a physiotherapist, Dean Watson, in Adelaide. He discovered that if one applies a specific type of pressure through specific upper cervical vertebral joints and that pressure brings on the headache but also resolves it within a minute or so, this can be a helpful method of resolving headache in the longer term. This can be extremely successful in the treatment of migraine too.  

Self management then continues with most likely some advice about changes in habits, exercise and well being. The advice I would give to myself would be don’t knit for hours on end trying to look at the tv at the same time!

Sarah Babbs

Sarah Babbs


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