Anatomy of Cervical Spine
The cervical spine begins at the base of the skull. Seven vertebrae make up the cervical spine with eight pairs of cervical nerves. The individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6 and C7. The cervical nerves are also abbreviated; C1 through C8.
The cervical bones – the vertebrae – are smaller in size when compared to the lower spinal vertebrae e.g lumbar. A complex system of ligaments, tendons, and muscles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement (e.g., rotate side to side, bend forward and backward).
What is a Headache?
Headaches are simply pains in the head and can be very different for different people. The pain may have different qualities: throbbing, sharp or stabbing, constant or intermittent, a dull ache. Some headaches may last only seconds or minutes, whereas others last hours or even days. Some headaches may be felt in the forehead, in the temples or in the back of the neck; sometimes headaches occur just on one side of the head. The quality, duration and location of a headache often helps your physiotherapist to make a specific diagnosis.
Headaches also vary in their frequency. Some people have rare or infrequent headaches. Others get headaches on a regular basis, including women whose headaches coincide with their menstrual periods. Still others have clusters of severe headaches that occur frequently over several weeks, then disappear for months or even years. Most troubling are the headaches that occur frequently, or even daily, over months or years.
Is My Headache a Cervical Headache?
There are many different types and causes of headaches. Not everyone with regular headaches falls neatly into a particular type of headache. Some people have headaches that appear to share features of more than one type of headache, and other people may have different types of headaches at different times. For example, some people may have occasional migraines interspersed with less severe tension-type headaches.
A cervical headache is due to a disorder in the neck which is associated with movement abnormalities in the individual cervical (neck) segments.
Signs and Symptoms
There are a number of features that are common to cervical headaches or ‘cervicogenic’ headaches. These include:
- Headache pain is limited to a particular side of the neck and doesn’t swap or change sides
- Headache pain is generally of moderate intensity and not a stabbing or sharp pain
- Headache pain always begins in the neck or back of the headHeadache pain can radiate down the neck into the shoulders or arm
- Headache pain on specific neck movements or postural positions e.g. looking behind you when reversing a car, or looking at a computer screen at work
- Usually the pain can be reproduced by applying pressure to the vertebrae in your upper neck or the surrounding muscles
- A reduced amount of mobility in the neck through any number of bending, rotating or tilting movements
The most important cause of this headache is mechanical dysfunction or chronic stiffness (fixation) of the upper cervical area and the rest of the cervical spine. Since the blood vessels to the brain pass through the cervical vertebrae, any dysfunction would irritate these arteries and possibly decrease the blood supply to the head and cause a headache. Other possible causes of this type of headache could include cervical spondylosis (fusion), rheumatoid arthritis, trigger points in the cervical muscles, and even improper neck position during sleep. Irritation of cervical nerves can also cause cervicogenic headaches. Dysfunction at the joints at the top of the cervical spine, the supporting trapezius and neck muscles can rub and irritate these nerves and result in localised neck pain, which is a common precipitator to a headache.
The aim of physiotherapy is to restore normal cervical movement, and reduce pain and stiffness. To achieve this, your physiotherapist may use techniques such as manual mobilization, traction, mobilisation with movement, manipulations, postural education and retraining, and restoring endurance, length and strength to the supporting neck muscles. You will also likely be provided with an exercise program to address and improve your neck mobility and postural alignment.
Once cervical mechanics is restored it is vital that you continue to maintain your cervical mobility, flexibility via ongoing maintenance program. It is also very important to be aware of your newly learned postural alignment during sustained and previously causative activities, to prevent the reoccurrence of headaches of cervical origin.