NECK PAIN | HEADACHES | DIZZINESS
a. Cervicogenic headache
There are many different types of headaches. Migraines, tension headaches, cluster headaches, the list goes on. Ranging from mild discomfort to agonising pain and altered senses.
One of the classifications that we, as physiotherapists can effectively treat, includes Cervicogenic headaches. That is – headaches that originate from the neck.
What does it feel like? Cervicogenic headaches may start as an ache at the base of the head/behind the ear on one or both sides, that progresses up over the head towards the forehead or even the eye socket.
Typically, there will be associated neck pain or a history of neck issues.
Cervicogenic headaches can be episodic, and people often report having had them on and off for a long time if not treated.
- Muscular weakness of the deep stabilising muscles of the neck
- Dysfunction or reduced mobility at the upper cervical levels C0-C3
- Poor mobility
- Poor ergonomic set up at work or any sustained/prolonged posture that isn’t varied regularly.
- Inappropriate pillows/sleeping arrangement, particularly if pain is characteristically worse first thing in the morning
What will physio do for me?
Initially physio will be focused on assessing the neck, quality and range of motion, muscular strength and function.
Treatment will generally involve improving mobility at the neck segments, addressing associated muscular changes, in order to reduce pain and improve comfort.
b. Tension headache
Tension headache are a common type of headache experienced with classification as either episodic or chronic, depending on the regular occurrence of symptoms. Symptoms experienced >15 days in a month for three consecutive months is classified as chronic. Usually symptoms are reported as pressure or tightness around the head or neck, and may be experienced on one or both sides of the head. Initial management with anti-inflammatories and analgesics may be beneficial.
Benign paroxysmal positional vertigo (BPPV) is a type of vertigo that may be experienced following a change to the position of the head. The inner ear contains small crystals that regulate the bodies awareness of movement relative to gravity. When these crystals are affected, symptoms of BBPV arise with individuals often reporting dizziness, nausea, eye twitching and nausea amongst other symptoms. Symptoms may be experienced by movement of the head, sudden movement or rolling movements that trigger the posterior semi-circular canal. BPPV symptoms may be further aggravated by stress, poor sleep or changes in barometric pressure.
e. Cervical facet joint arthropathy
Arthropathy is the disease of a joint and may include inflammation or degradation of the joint. Commonly cervical facet joint arthropathy is marked by neck stiffness, pain with movement and local swelling. This condition usually affects older individuals due to the degenerative arthritic nature of the condition.
f. Cervical disc
Acute cervical disc with nerve root compression usually presents with moderate to severe pain, that is easily irritated. The pain is reproduced with movement of the neck that compresses the exiting nerve roots. Associated neural signs including pins and needles/ numbness and/ or weakness may be present. Movement of the arm (shoulder, elbow or wrist) that increases neural tension may cause an increase to symptoms.
Whiplash is a common acute injury experienced in motor vehicle accidents (MVA) involving a sudden acceleration-deceleration mechanism to the cervical spine. Whiplash in sport may also present in incidents where the neck is suddenly impacted by an opponent of with contact to the ground. The whiplash mechanism results in bony and soft tissue injuries of varying degree. In whiplash, the lower cervical spine and upper thoracic spine extend, while the upper cervical spine flexes, with the result force compressing joints. Due to the speed of whiplash, the body is too slow to respond to the movement.
Temporomandibular joint dysfunction is commonly characterised by clicking, locking, pain and reduced range of motion. There may an involvement of postural dysfunction involving the cervical and thoracic spine, in addition to an imbalance of muscle activity, specifically the muscles used to masticate (chew food). The condition may include intra and/ or extra articular involvement.
i. Bell’s Palsy
Bell’s palsy is caused by dysfunction of cranial nerve VII (facial nerve) resulting in facial paralysis. The condition is idiopathic in nature, meaning no conclusive cause has been established. Commonly the facial nerve is affected by inflammation of the cranial nerve, with limited blood supply to the exiting nerve. Commonly an individual will present with decreased muscle control on the affect side of face. Partial or full paralysis of the affected side may be reported.
j. Wry neck
Wry neck is characterised by a sudden onset of sharp neck pain and limited movement. Often symptoms commence on waking or following abrupt, quick movements. Typically, a history of change to typical movements or abnormal positioning is reported before the onset of pain. The most common report is a change in pillow, bed or sleeping on the lounge before waking with symptoms.
You can expect to feel neck stiffness and muscle tightness/ spamming/ guarding. Movement of the neck is typically limited in one or more directions. Typically, side flexion and rotational movements are markedly reduced and painful. There may be some referred symptoms to the scapular region.