Treating Cervicogenic Migraines with Physical Therapy

For individuals who suffer from migraine headaches, can incorporating physical therapy help decrease pain, improve mobility, and manage future attacks?

Migraine Physical Therapy

Cervicogenic migraine headaches can cause pain, limited motion, or confusing symptoms like dizziness or nausea. They may originate from the neck or cervical spine and be called cervicogenic headaches. A chiropractic physical therapy team can assess the spine and offer treatments that help improve mobility and decrease pain. Individuals may benefit from working with a migraine physical therapy team to perform treatments for specific conditions, quickly and safely relieving pain and returning to their previous level of activity.

Cervical Spine Anatomy

The neck is comprised of seven stacked cervical vertebrae. The cervical vertebrae protect the spinal cord and allow the neck to move through:

• Flexion
• Extension
• Rotation
• Side bending

The upper cervical vertebrae help support the skull. There are joints on either side of the cervical level. One connects to the back of the skull and allows motion. This suboccipital area is home to several muscles that support and move the head, with nerves that travel from the neck through the suboccipital area into the head. The nerves and muscles in this area may be a source of neck pain and/or headaches.

Symptoms

Sudden motions can trigger symptoms of cervicogenic migraine, or they may come on during sustained neck postures. (Page P. 2011) The symptoms are often dull and non-throbbing and may last several hours to days. Symptoms of cervicogenic migraine headache may include:

• Pain on both sides of the back of the head.
• Pain in the back of the head that radiates to one shoulder.
• Pain on one side of the upper neck that radiates to the temple, forehead, or eye.
• Pain in one side of the face or cheek.
• Reduced range of motion in the neck.
• Sensitivity to light or sound
• Nausea
• Dizziness or vertigo

Diagnosis

Tools a physician may use may include:

• X-ray
• MRI
• CT scan
• Physical examination includes neck range of motion and palpation of the neck and skull.
• Diagnostic nerve blocks and injections.
• Neck imaging studies may also show:
• Lesion
• Bulging or herniated disc
• Disc degeneration
• Arthritic changes

Cervicogenic headache diagnosis is usually made with one-sided, non-throbbing headache pain and a loss of neck range of motion. (Headache Classification Committee of the International Headache Society. 2013) A healthcare provider may refer the individual to physical therapy to treat cervicogenic headaches once diagnosed. (Rana M. V. 2013)

Physical Therapy

When first visiting a physical therapist, they will go through medical history and conditions, and questions will be asked about the onset of pain, symptom behavior, medications, and diagnostic studies. The therapist will also ask about previous treatments and review medical and surgical history. Components of the evaluation may include:

• Palpation of the neck and skull
• Measures of neck range of motion
• Strength measurements
• Postural assessment

Once the evaluation is completed, the therapist will work with the individual to develop a personalized treatment program and rehabilitation goals. Various treatments are available.

Exercise

Exercises to improve neck motion and decrease pressure on cervical nerves may be prescribed and may include. (Park, S. K. et al., 2017)

• Cervical rotation
• Cervical flexion
• Cervical side bending
• Cervical retraction

The therapist will train the individual to move slowly and steadily and avoid sudden or jerky movements.

Postural Correction

If forward head posture is present, the upper cervical spine and the suboccipital area could compress the nerves that travel up the back of the skull. Correcting posture may be an effective strategy for treatment and can include:

• Performing targeted postural exercises.
• Utilizing a supportive neck pillow for sleep.
• Using a lumbar support when sitting.
• Kinesiology taping may help increase tactile awareness of back and neck position and improve overall postural awareness.

Heat/Ice

• Heat or ice may be applied to the neck and skull to help decrease pain and inflammation.
• Heat can help relax tight muscles and improve circulation and may be used before performing neck stretches.

Massage

• If tight muscles are limiting neck motion and causing head pain, a massage can help improve mobility.
• A special technique called suboccipital release loosens the muscles that attach the skull to the neck for improved motion and decreased nerve irritation.

Manual and Mechanical Traction

• Part of the migraine physical therapy plan may involve mechanical or manual traction to decompress the neck’s discs and joints, improve motion in the neck, and decrease pain.
• Joint mobilizations may be used to improve neck motion and manage pain. (Paquin, J. P. 2021)

Electrical Stimulation

• Electrical stimulation, like electro-acupuncture or transcutaneous neuromuscular electrical stimulation, may be used on the neck muscles to decrease pain and improve headache symptoms.

Therapy Duration

Most migraine physical therapy sessions for cervicogenic headaches last about four to six weeks. Individuals may experience relief within a few days of starting therapy, or symptoms may come and go in different phases for weeks. Some experience continued migraine headache pain for months after starting treatment and use techniques they learned to help control symptoms.

Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive therapies and functional rehabilitation procedures focused on restoring normal body functions after trauma and soft tissue injuries. We use Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility and mobility Fitness Training, and Rehabilitation Systems for all ages. Our natural programs use the body’s ability to achieve specific measured goals. We have teamed up with the city’s premier doctors, therapists, and trainers to provide high-quality treatments that empower our patients to maintain the healthiest way of living and live a functional life with more energy, a positive attitude, better sleep, and less pain.

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Chiropractic Care For Migraines

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References

Page P. (2011). Cervicogenic headaches: an evidence-led approach to clinical management. International journal of sports physical therapy, 6(3), 254–266.

Headache Classification Committee of the International Headache Society (IHS) (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia : an international journal of headache, 33(9), 629–808. doi.org/10.1177/0333102413485658

Rana M. V. (2013). Managing and treating headache of cervicogenic origin. The Medical clinics of North America, 97(2), 267–280. doi.org/10.1016/j.mcna.2012.11.003

Park, S. K., Yang, D. J., Kim, J. H., Kang, D. H., Park, S. H., & Yoon, J. H. (2017). Effects of cervical stretching and cranio-cervical flexion exercises on cervical muscle characteristics and posture of patients with cervicogenic headache. Journal of physical therapy science, 29(10), 1836–1840. doi.org/10.1589/jpts.29.1836

Paquin, J. P., Tousignant-Laflamme, Y., & Dumas, J. P. (2021). Effects of SNAG mobilization combined with a self-SNAG home-exercise for the treatment of cervicogenic headache: a pilot study. The Journal of manual & manipulative therapy, 29(4), 244–254. doi.org/10.1080/10669817.2020.1864960