OK, so in part 1 we looked at causes and effects of the cervicogenic headaches, now let us turn our attention to treatment options that can be utilized to help decrease their severity and frequency as well as postural and lifestyle changes to eliminate the underlying cause. Treatment options and expectations can be difficult to establish as the cervicogenic headache can be somewhat of a “chicken and the egg” process. The better we can tell what caused what the more accurate the recommendation and prognosis. For the purpose of this article we will divide recommendations into acute or recent onset that resulted from an injury or event and chronic or long term conditions without a history of injury. Certainly there can be a combination of both acute injury and chronic resultant conditions but for simplicity we will look at the former:
An acute injury or traumatic event is most commonly associated with a sports injury or auto accident. Remember, just because you may have not been the driver in an accident, the body goes through 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’s of force. This force is absorbed by 22 cervical ligaments and tendons in the neck that attach key muscles allowed for movement and overall function. Common treatment options for an acute cervical injury with resultant cervicogenic headache include muscle relaxants, pain killers, manipulation / chiropractic, physical therapy and massage. Ideally, studies indicate that the best results may in fact be accomplished with all of the above used in combination. Pain killers should be considered as a last resort or at best a temporary option due to the potential side effects and addictive qualities. The muscle relaxants do just that, they serve to relax the muscles that are in spasm. These muscle spasms are the body’s natural defense mechanism, however left in spasm for too long they can cause on- going issues including but not limited to the cervicogenic headaches. So, from a relaxation and functional standpoint the anti-inflammatory, muscle relaxer and pain killer (preferably over the counter) provide the body a chance to rest which is important when injured. However, it does little to actually treat the underlying cause of the injuries, that being the sprain and or strain of the cervical spine muscles and ligaments as well as potentially the minor misalignment of the 7 cervical vertebrae or bones in the neck. The manipulation process addresses specifically the top three vertebrae to ensure proper nerve flow, think of it in terms of having a water hose with a kink in it and then releasing the hose to its normal position. Additionally, the muscles need to be addressed through physical therapy and massage in order to maintain the proper alignment. Like a tug of war, if the bones are manipulated to take pressure off of the nerve, yet the muscles remain in spasm then the muscles will simply pull the bone back 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.
The treatment management of chronic or long term cervicogenic headaches can certainly utilize some or all of the above options as well, however generally speaking the results may be slower as the body has already adapted perhaps with cervical muscle scar tissue and / or cervical spine osteoarthritis depending on the events if any and the duration that led up to the headaches. The body will heal itself the best way it can to function and protect itself in the short term, however if the joint integrity and / or muscle tone is compromised for a prolong period of time then this healing process may not have been biomechanically correct if you will, resulting in chronic cervicogenic headaches. The most common cause for cervicogenic headaches appears to be resulting form postural imbalances. The head forward or flexed positions that we face through the day in front of computers, etc. coupled with poor overall posture sitting, standing and sleeping have lead to headache complaints in record numbers. Some studies indicate that over 2% of the population, translated to 18 million people have suffered cervicogenic headaches resulting in clinical outpatient visits every year! In addition to the above referenced treatment options it is very important to be aware of the potential detrimental result of poor posture of the neck and the relation to cervicogenic headaches. Options for treatment of the chronic cervicogenic headache should include adjusting any book, computer etc. to be at a position that does not require the neck to be in a flexed position for a prolonged period of time. Headsets for phone work are much better than having a phone to the ear (including cell phones). Additionally, daily stretching and range of motion exercises for the neck are very important and lastly, our sleep habits. It is important to sleep on your back or side (do not tuck chin) with the usage of a cervical pillow. The cervical pillow is designed to maintain the integrity of the neck in its proper alignment while we sleep, allowing the supporting and overstressed muscles a much needed chance to rest.
As mentioned earlier cervicogenic headaches are complex to evaluate and treat. Try these suggestions under the direction of your doctor as individual circumstances and results vary. You may just discover that those headaches you have learned to live with may not be around much anymore. Maintain good cervical posture and timely and appropriate health care for any neck injury…The quality of your life may depend on it. Best Wishes.