CERVICOGENIC & CHRONIC TENSION TYPE HEADACHES

Key features of a Cervicogenic Headache (CGH) include:

1. main symptoms originate from the neck with movement or sustained, awkward head position
2. external pressure at the base of skull and/or upper neck is present
3. restriction of movement of the neck
4. location/hemisphere of head pain does not shift to the other side
5. Moderate-severe non throbbing pain that usually starts in the neck
6. episodes of varying duration, fluctuating or continuous pain
7. marginal or no effect when taking migraine medications

Location of Cervicogenic headaches

key features of Chronic Tension Type Headache (CTTH) include:

Has at least two of the following characteristics

1. bilateral location: pressing or tightening sensation
2. mild or moderate intensity
3. Not aggravated by normal daily activity
4. no more than one episode of photophobia (increase pain with bright light), phonopho- bia (increased pain with load noises) or mild nausea are present
5. neither moderate or severe nausea or vomiting are present
6. main clinical findings of tension type headache are myofascial trigger points, typically located in the upper trapezius, suboccipital, sternocleido- mastoid, and temporalis muscle groups
7. Other findings include decreased deep neck flexor strength and endur- ance, and postural abnormalities.

Location of Chronic Tension Type headaches

TREATMENT

CTTH & CGH Can be treated successfully with a combination of trigger point massage and/or trigger point dry needling, mobilization of the cervical spine and of the thoracic spine; postural correction; and isometric strengthening of the deep neck flexors. CGH may require traction if there is disc involvement and joint specific mobilization to the painful joints in the neck. Treatment generally is similar; however, with a very thorough physical examination the source of pain can be identified and addressed.

THE JUDY

Self Massage : I recommend using thumb-index finger pincher grasp for SCM massage, index and middle fingers for sub occipitals and upper traps and the muscular portion of the palm side of thumbs to massage temporalis muscle. Each region should be examined for tender points, once finding tender points focus on that region 5-10 min until pain reduces.

1. suboccipitals

1. temporalis

1. sternocleidomastoid(SCM)

1. upper traps

Self mobilization of the neck: use a strap, thin scarf or pillow case, place it at the level of stiffness or pain, lift arms so hands are at the height of eyes. Gently pull forward as you slightly extend your neck by looking up, return to start position and release the gentle forward pull repeat 10x without pain, can be repeated 3x daily or all at once. The rotation mobilization is similar, instead of looking up, you will actively turn your head with the gentle assist of the strap. Same sets and repetitions as extension mobilization. You can perform this at any level of your neck, please error on the side of less pull and make sure your knuckles are in front of your eyes.

1. extension with strap

1. rotation with strap

Cervical Traction/DIY towel: SIMPLY USE A TOWEL AND SMALL ROPE: tie the rope to the end of the towel which forms a neck hammock and loop the rope over the door knob and tie other end of rope to towel. The towel should not touch the floor, a few inches above. Place your head in the towel hammock and gradually move your body just a little bit away from the door for a traction force that is gentle. You could also purchase a neck hammock that is very inexpensive, check the link on home page for details. I believe starting slow is the way to go, starting with 5 min of traction daily and gradually working up to 20 min with increase of 1 min increments if there is no increased pain or headache.

The Neck Hammock for Neck Pain Relief and Physical Therapy

Self mobilization of the mid back (thoracic spine)

1. extension while sitting in chair with arms against wall

Deep neck flexor muscle training: A towel is placed under the neck. The patient is instructed to gently nod their head (yes position). This position may be held for 3-10 seconds.  Repeat 6 repetitions 6 times daily. I know it doesn’t look like I am doing much; however, I am tucking chin and lifting the weight of my head off the towel.

Postural awareness: Avoid prolonged positions ie: looking at computer or smart phone, working on puzzle or needlework, etc. Lift technology and crafts up to eye level if possible, use your eyes to look more so than just neck movements. Sitting in a slouched positions tends to allow the head to come forward in front of your body and this shortens the muscles in the back of neck as you need to look up to see. If you do all the treatments above and still are unaware of postural contributions you might as well just spit in the wind.