What else can we offer patients with neck pain and headaches?
"Cervicogenic" is simply a name for a headache that originates from the neck – it's one of the most common types of headache, and physiotherapy can help. Cervicogenic headaches are typically worse on one side of the head, although the affected side may swap from side to side, or pain may spread from one side to both.
Joints and muscles in the upper neck refer pain into the head, temples, ear, face, sinus, forehead, jaw or base of skull – becoming a headache. It is often but not always associated with pain or stiffness in the neck and shoulders, and occasionally associated with dizziness. For some people who are prone to migraine headaches, they may experience cervicogenic headache in the lead up to a migraine, and treating it early and effectively may prevent migraine onset.
There are several factors that predispose patients to developing cervicogenic headaches. These need to be assessed and corrected where possible with direction from a physiotherapist. These include:
> Neck and upper back stiffness
> Muscle imbalances around the neck and shoulders
> Previous neck injury or trauma (e.g. whiplash)
> A sedentary lifestyle
> Stress or fatigue
> Poor desk setup at work or home
> Inappropriate pillow or sleeping postures
> Excessive slouching, bending forwards or shoulders forwards activities
Whilst some clients respond well to standard Physiotherapy techniques (or osteopathy or chiropractic), unfortunately many are stirred up from treatment, take a fairly long time to see improvement, or see little to no improvement. These are the clients that have often frustrated us as Physiotherapists, where we struggle to help them usign out traditional techniques. This is where Maia and Karrie's alternative approach using the Watson Headache Approach has made a significant difference.
Your GP may prescribe pain killers, anti-inflammatories, or triptan “migraine” medications for symptomatic relief. They will also ask questions and do tests to rule out your headaches being a symptom of more sinister medical pathology.
A thorough assessment with a physio skilled in headache treatment like Karrie, Janetta or Maia will allow them to assess if your headaches will respond best to typical physio manual therapy, exercise based physio treatment, or the Watson Headache Approach.
Typical Physiotherapy treatment may include:
> Restoring comfortable neck movement and joint mobility using
gentle manual therapy techniques such as massage, joint
mobilizations, dry needling or gentle stretching.
> Assess if muscular weakness or overactivity is contributing to your headaches, and set specific exercises to retrain them.
> Joint manipulation of thoracic spine if stiffness is contributing
> Taping or use of a postural support brace in the short term
> Ergonomic, pillow and activity modification advice
> Exercises to improve posture, flexibility, control and strength
around the neck and shoulders
> Discuss possible headache or migraine triggers and avoidance or
> Test and treat causes of dizziness inlcuding vestibular issues if you experience these
In rare cases manual therapy may initially stir up your symptoms.
If this occurs, please discuss with your Physiotherapist so they can adapt treatment accordingly.
Do you suffer with headaches or migraines?
> Using very precise techniques to assess the upper cervical spine, our specially trained
Physiotherapists (Janetta, Karrie and Maia) can assess if these levels are a contributing
factor to the patient’s headaches and migraines, or not.
> During an Initial 45minute Headache Consult, and pre-screening questionnaire,
we can assess if this approach will be appropriate and effective for the client.
> Even if the patient has been suffering for many years, we should know by the end of the
second consult whether continuing Watson treatment is warranted, or other Physiotherapy
strategies might be helpful.
> With 23 years experience in treating only headache and migraine patients, Physiotherapist
Dean Watson has developed the Watson Headache Approach, and has demonstrated great
> This sounded too good to be true, but at FLEX Headache Clinic we are excited to be seeing
the same amazing success, and the change it's making in our patients’ lives.
> World leading neurologists and headache specialists are acknowledging the role of upper
cervical spine (neck) sensory input, and central sensitization of the lower brainstem (TCN) in
both headaches and migraines.
> Triptan medications offer short term, symptomatic relief to some migraineurs, but no change
in the frequency or duration of migraines.
Previously triptans were prescribed for their vascular effects, however research has now
shown them to have a desensitising effect on the lower brain stem (TCN).
> Emerging research offers us new insights, that support this approach. Below are some
excerpts from research articles by world renowned researchers, and a list of related articles.
> "One of the confusing phenomena about the Cervicogenic Headache is that its symptoms can present
as migraine headaches, tension-type headaches, or even cluster headaches."
Dr Peter Rothbart, Anaethetist and Internationally recognised pain researcher
(Rothbart P. The cervicogenic headache: A pain in the neck. Canadian Journal Diagnosis
> "For the clinician, pain presentations in the headache patient are frequently a diagnostic challenge."
"Headache of cervical origin and migraine often shows similar clinical presentations."
Dr Peter Goadsby, internationally renowned researcher
(Goadsby PJ, Bartsch T. Anatomy and physiology of pain referral patterns in primary and cervicogenic
headache disorders. Headache Currents 2005; 10:42-48)
> "Cervicogenic headache has been described for many years by clinicians of varying professions and
specialities. Most authorities agree that many patients experience neck symptoms associated with
headache. Whether the neck is the cause of, or part of, another headache type, careful attention to
the neck and its relationship to headache are extremely important."
(Gallagher R, Cervicogenic Headache: A Special Report.
Expert Review Neurotherapeutics 2007; 7 (10) 1279-83)
> To find out more, please book an appointment to talk with our
Level 3 Certified Watson Approach Practitioners, Janetta or Karrie,
or Maia who has completed her level 2.
> Karrie is happy to meet with health professionals to further explain the mechanisms and
underlying theory behind this approach, and explain more about what we assess and treat.
Andrew Charles – Professor of Neurology at UCLA interviewed on "Health Report" on ABC. Available on podcast via http://www.abc.net.au/radionational/programs/healthreport/migraine-research/4039834
Goadsby PJ. Neurostimulation in primary headache syndromes.
Expert Review Neurotherapy 2007 Dec;7(12):1785-9
Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain 1996; 119:1419-28
Matharu MS, Goadsby PJ. Persistence of attacks of cluster headache after trigeminal nerve root resection. Brain 2002;125(pt5):976-984
Peres MF, Stiles MA, Siow HC. Greater occipital nerve blockade for cluster headache. Cephalalgia 2002;22:520-522
Striessnig, J. Pietrobon, D. Neurobiology of Migraine. Nature Reviews - Neuroscience, 2003; 4, 386-398.
Goadsby, P,J. The vascular theory of Migraine. A great story wrecked by the facts. Brain 2009, 132 (1), pp 6-7.
Watson DH, Drummond PD. Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache 2012
Watson DH, Drummond PD. Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014; 54:1035-1045