Cervicogenic Headaches – A Pain in the Neck (Part 2) – Treatment Options
Ok so in part 1 we looked at the causes and effects of cervicogenic headaches, now let’s turn our attention to treatment options that can be used to help decrease their severity and frequency as well as postural and style changes of life to eliminate the underlying cause. Treatment options and expectations can be difficult to establish, as cervicogenic headache can be somewhat of a “chicken and egg” process. The better we can tell what caused what, the more accurate the recommendation and prognosis will be. For the purposes of this article, we will divide the recommendations into acute or recent onset resulting from an injury or event and chronic or long-term conditions with no history of injury. Certainly, there can be a combination of acute injuries and resulting chronic conditions, but for simplicity, we’ll look at the former:
An acute injury or traumatic event is most commonly associated with a sports injury or automobile accident. Remember, just because you were not the driver in an accident, the body suffers the same injury. As an example, studies indicate that a typical low to medium impact “whiplash” injury has the same impact as taking off in a fighter jet…about 5 to 7G of force. This force is absorbed by 22 cervical ligaments and tendons in the neck that join the key muscles that enable movement and overall function. Common treatment options for an acute cervical injury with resulting cervicogenic headache include muscle relaxants, pain relievers, manipulation/chiropractic, physical therapy, and massage. Ideally, studies indicate that the best results can be achieved with all of the above used in combination. Pain relievers should be considered as a last resort or at best a temporary option due to potential side effects and addictive qualities. Muscle relaxants do just that, they serve to relax muscles that are in spasm. These muscle spasms are the body’s natural defense mechanism; however, if left in spasm for too long, they can cause ongoing problems including but not limited to cervicogenic headaches. Therefore, from a relaxation and functional point of view, anti-inflammatory, muscle relaxant and pain reliever (preferably over-the-counter) give the body the opportunity to rest, which is important when injured. However, it does little to really treat the underlying cause of the injuries, which are sprains or strains of the cervical spine muscles and ligaments, as well as possible minor misalignment of the 7 cervical vertebrae or neck bones. The manipulation process specifically targets the top three vertebrae to ensure proper nerve flow, think of it in terms of having a water hose with a kink and then releasing the hose to its normal position. In addition, the muscles should be treated through physical therapy and massage to maintain proper alignment. Like a tug-of-war, if the bones are manipulated to relieve nerve pressure, but the muscles remain in spasm, then the muscles will simply pull the bone back to where it was at the time of the accident or injury. Again, a combination of the above treatment options appears to have the best results for acute injuries.
Treatment management of long-term or chronic cervicogenic headaches can certainly use some or all of the above options, however, generally speaking, results may be slower as the body has already adapted, perhaps with tissue cervical muscle scarring and/or cervical spine osteoarthritis depending on the events, if any, and duration that led to the headaches. The body will heal itself to the best of its ability to function and protect itself in the short term, however, if joint integrity and/or muscle tone are compromised over an extended period of time, this healing process may may not have been biomechanically correct if you will, resulting in chronic cervicogenic headaches. The most common cause of cervicogenic headaches appears to be the result of postural imbalances. The forward head or the flexed positions that we face throughout the day in front of computers, etc. coupled with poor general sitting, standing and sleeping posture, have led to headache complaints in record numbers. Some studies indicate that more than 2% of the population, translated to 18 million people, have suffered from cervicogenic headaches that result in outpatient clinic visits each year! In addition to the treatment options listed above, it is very important to be aware of the potentially detrimental outcome of poor neck posture and its relationship to cervicogenic headaches. Options for the treatment of chronic cervicogenic headache should include the adjustment of any books, computers, etc. be in a position that does not require the neck to be in a flexed position for an extended period of time. Headphones for working with the phone are much better than having a phone on your ear (including mobile phones). Also, daily stretching and range-of-motion exercises for the neck are very important, and lastly, our sleeping habits. It is important to sleep on your back or side (do not tuck your chin in) with the use of a cervical pillow. The cervical pillow is designed to keep the integrity of the neck in its proper alignment while we sleep, allowing overworked and supporting muscles a chance to rest.
As mentioned above, cervicogenic headaches are complex to assess and treat. Try these suggestions under the direction of your doctor, as individual circumstances and results vary. You may find that those headaches you have learned to live with are no longer present. Maintaining a good cervical posture and timely and appropriate medical care in the event of any neck injury… The quality of your life may depend on it. Best wishes.