My mother and I have both found that neck-strengthening exercises reduce the frequency of our headaches, so I highly recommend these methods.
Anatomy and Physiology of a Cervicogenic Headache
What distinguishes a cervicogenic headache from your more classic headaches like migraines or tension type headaches are that cervicogenic headaches are actually caused from dysfunction in your neck.
Cervicogenic headaches are a form of referred pain – meaning that although the source of the pain is in the cervical spine, the sensation of pain is felt in the head as a headache. This happens because there are nerves in the upper cervical region (C1, C2, and C3) that have connections to nerves of the head (cranial nerve V via the trigeminal nerve spinal tract).
Although some controversy exists, a vast majority of the literature agrees that the most common cause of cervicogenic headaches is dysfunction from the C2-3 zygapophysial joints (facet joints).
However, there is also literature to support that cervicogenic headaches can arise from dysfunction in
- the C2-3 and C3-4 intervertebral discs of facet joints, as well as the
- atlantoaxial (C1-2) and
- atlanto-occipital (C0-1) joints.
Anatomy of the Upper Cervical Region
A recent systematic review in 2013 by Racicki et al came to the conclusion that “conservative physical therapy treatment techniques are an effective interventions for decreasing cervicogenic intensity and frequency, as well as neck pain.”
In particular, utilizing a combination of mobilization, manipulation, and cervicogenic headache exercises like cervico-scapular strengthening exercises, are the most effective intervention based on the results of that systemic review.
Cervicogenic Headache Exercises – Neuro-Reducation and Strengthening
We’ll highlight a few of our favorite “bang-for-your-buck” exercises that accomplish both strengthening and postural re-education as shown below,
Quadruped Deep Neck Flexor and Extensor Exercise
While training the deep neck flexors in patients with cervicogenic headaches or neck pain is important, we believe that the deep neck extensors are far too often forgotten during rehabilitation.
The deep cervical extensors (semispinalis cevicis, multifus, and rotators) along with the cranio-cervical extensors (rectus capitis posterior major/minor and obliquus capitis superior/inferior) are key muscles for cervical spine segmental support due to their relatively small moment arms, attachments to adjacent vertebrae, and high proportion (~70%) of slow twitch fibers.
Start with low load exercises like this one with the aim of inducing neurophysiological adaptations by specifically activating deeper muscles it the cervical spine.
Then, progress to high-load exercises with the aim of inducing morphological adaptations in order to increase the strength and endurance of the selected muscles and movements.
- Start in the quadruped position, watch this video to see how to properly engage the scapular stabilizers in quadruped
- Start first with a chin tuck in the quadruped position. This will activate your deep neck flexors. You should be able to see wrinkles in your chin.
- While maintaining the chin tuck, work slow and controlled into cervical flexion. Cue here is to “use your eyes” to follow an object (iPhone shown in video)
- Now here comes the best part of the exercise, the cervical extensors are already engaged in the quadruped position simply due to gravity. However, we can further preferentially activate the deep neck extensors in a segmental fashion on the return from cervical flexion (see video). Cue here with manual resistance at the spinous process or articular pillars.
Inhibiting The Upper Traps
There is a strong relationship between chronic neck and shoulder pain and dysfunction of the scapula. The scapula functions as a ‘bridge’ between the shoulder complex and the cervical spine and plays a very important role in providing both mobility and stability to the neck/shoulder region.” According to Bogduk and Govind (2009), “noxious stimulation of the atlanto-occipital and lateral atlanto-axial joints, the C2–3 zygapophysial joint, and the C2–3 intervertebral disc can produce pain in the occipital region.” We also know the upper trapezius muscle originates on the occipital bone and upper cervical C1-C3 spinous processes.
- Lay on your stomach and get into a comfortable position. Consider a pillow under your stomach, or under your chest, if your spine goes into excessive lordosis or kyphosis when you lay on your stomach.
- Rest your forehead on your heads and relax your arms on the table. Your head and arms should be fully supported so that you can relax.
- Push your hands into the table and pull your shoulder blades down towards your feet.
- Hold this position for 5s, and repeat for a total of 5 reps.
- Your neck and the region of the upper traps should be relaxed while you perform this exercise.
Improve Your Posture at Work!
As always, maintaining good posture while seated for countless hours at work is always beneficial.
Not just for cervicogenic headache prehab, but also for overall musculoskeletal health. Here are two of our favorite work posture hacks:
According to the literature, most patients treated conservatively with physical therapy see significant improvements in headache frequency, duration, and intensity within the first four weeks, so don’t be dismayed if you don’t see immediate results!
In summary, cervicogenic headaches are a particular subset of headaches that are caused by dysfunction in the upper cervical spine.