Headaches are one of the most widespread diseases affecting 66% of the world population (1). It is a medical disorder that greatly affects the quality of life and the performance at work of the people who suffer from it.
Fourteen types and several headache subtypes are documented by the International Headache Society’s International Classification of Headaches which distinguishes between primary headaches with no other apparent cause, such as tension headaches and migraines, and secondary headaches associated with or caused by other disorders, i.e. cervicogenic headache, headaches associated with temporomandibular disorders, and the like.
The most common headaches are tension (38%), followed by migraines (10%) and cervicogenic headaches (2.5 to 4.1%) (1), which are the least prevalent but with a much greater impact on the quality of life of those who suffer.
Physiotherapy has its role to play in the treatment of headaches, but only in some of them. Scientific evidence (Jull et al., Bronfort et al.) Supports the use of manual therapy and exercises in the treatment of cervicogenic headaches, but not for migraines and tension headaches. Low evidence also supports the use of postural exercises and treatments of trigger points in the treatment of tension headaches (2).
For this reason, a correct classification of the type of headache is paramount in order to determine whether the person could respond to the treatments in physiotherapy or it should be referred in medicine, especially since different types of headaches can coexist.
The assessment is based primarily on symptom presentation and clinical examination. The physiotherapist is vigilant for the presence of “red flags”, that is, signs of serious pathologies. In this case he will refer the patient for medical consultation.
The cervicogenic headache originates from a musculoskeletal dysfunction of the first three cervical segments (1). Symptoms are severe non-pulsatile pain in the head that begins from the neck and rises to the eye on the same side. This pain may occur because of unsteady movements or unsteady positions of the head or pressure on the sub-occipital or upper cervical region. The pain is always on the same side, but often we also speak of unilateral pain on both sides. There is a decrease in cervical joint amplitudes, decreased strength and endurance of the deep flexor muscles of the neck and, often, muscle tensions and trigger points in the upper trapezius muscles, etc.
Cervicogenic headaches are treated in physiotherapy with manual therapy, posture exercises, mobility, strengthening and cervical motor control of the shoulder and scapula.
- Hall T, Briffa K, Hopper D, Robinson K. Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache. Manual Therapy. 2010;15(6):542-546
- Jull et al. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1:subjets with single headaches, cephalalgia,2007,volume27,793-802
- Bronfort et al. Non-Invasive Physical Treatments for Chronic/Recurrent Headache. Cochrane Database Syst Rev, 2009
- Les maux de tête: comment les identifier et les traiter. Beneva K., Benoit S., Khalife R. et Labrecque L., en collaboration avec C. Elaine Chapman pht, Ph.D. 2014 Programme de physiothérapie, école de réadaptation, Université de Montréal