NECK PAIN | HEADACHES | DIZZINESS

a. Cervicogenic Headache

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.

Predisposing factors:

  • Muscular weakness of the deep stabilising muscles of the neck
  • Dysfunction or reduced mobility at the upper cervical levels C0-C3
  • Poor mobility
  • Stress/anxiety
  • Whiplash
  • 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.

Once the pain is down, the priority shifts to introducing new muscular patterns and exercises to strengthen the deep neck muscles and desensitise the painful ‘tight’ areas.

We will often take you through exercises involving the Deep Neck Flexors. They are deep stabilising muscles and are similar in function to the deep abdominals of the trunk, so you can think of them as the ‘core’ of the neck.

Often in painful states, or poor postures, these muscles are inhibited and our superficial muscles – the thick big muscles that run from the base of your head to your shoulders, chest and back, work over -time. They can leave you feeling tight, sore and overworked.

In order to get over these painful episodes your physio will assess, treat, educate then guide you through homework and exercises you need to take control and prevent reoccurrence.

  1. Cervicogenic headache

Cervicogenic headache is commonly associated with movement relating to dysfunction neck joints and muscles, secondary to a cervical musculoskeletal injury.  Symptoms are often experienced as a headache, with referral from the neck and back of the head, and often on one side.  C2-3 is common a location of tenderness due to the association of cranial nerve innervation (trigeminal number 5) within the area.

Symptoms may include: pain, reduced range of motion, pain on neck movement, pain around shoulder, neck or head, and headaches.

We look to manage cervicogenic headache with hands on manual therapy to dysfunction joints and muscle, education, exercise to correct dysfunction movement patterns, and use of heat.  Longer term we look to any underlying musculoskeletal dysfunctions that may predispose an individual to developing the condition.


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.

We look to address any musculoskeletal dysfunctions of the neck or surrounding structure, with education on headaches, symptoms and treatments.  Hands on manual therapy, exercise, heat and activity modification are used to assist in management of symptoms.


c. Vertigo

  1. Cervicogenic Vertigo:
  2. BPPV:

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.

We look to initially assess BPPV with a positional manoeuvre (Dix Hall Pike), that involves exact movement of the head relative to the body to illicit a response.  If positive, this test is followed by the Epley manoeuvre. More than one consultation may be required to completely resolve symptoms.


d. 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.

We look to managed cervical facet joint arthropathy initially with hands on manual therapy, reduce inflammation with use of ice and/ or anti-inflammatories, activity modification and education on management.  Longer term we look to address any underlying musculoskeletal dysfunctions, aiming to increase range of motion, strength and function.


e. Cervical Disc Pathology

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.

We look to manage acute cervical disc injuries with hands on manual therapy to reduce compression and alleviate symptoms.  Education on sleeping positions, use of heat, anti-inflammatories and exercise is initially provided.  Longer term we look to correct any underlying musculoskeletal dysfunctions that may have resulted in the symptoms to prevent future occurrence.


f. Whiplash Associated Disorder (WAD)

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.

Symptoms vary and may include any of the following:  neck pain, headache, decreased range of motion, fracture, or neurological signs.  Symptoms may not be experienced by the individual initially, with gradual development of symptoms beginning after 48 hours.

We look to manage whiplash with early mobilisation, including education, hands on manual therapy, and range of motion exercises.  Later on, we look to increase function and return to normal activity as soon as possible.


g. TMJ

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.

We initially look to manage the condition with manual therapy and exercise.  Occasionally, co-management with a dentist with prescription of a night splint may be required if clenching/ grinding of the jaw at night is reported (sleep bruxism).


h. 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.

Management of this condition is usually a combination of initial cortisone steroid injection, followed by neuromuscular retraining.


i. Acute 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.

We initially manage wry neck by implementing gentle hands on manual therapy including joint mobilisation, soft tissue release, cervical traction, and recommend the use of a heat pack.

Longer term we look to postural retraining and motor control exercises when tolerated to aid prevention and enhance performance.   A cervical pillow assessment may also be address to avoid future aggravation.

If you are experiencing from neck pain and limited by pain, stiffness and unable to complete your daily activities and work without aggravation, feel free to email Sean at sean@evokerpps.com.au