Using Posture Treatment to Relieve Cervicogenic Headaches

About This Resource: This article was reviewed by the clinical team at NYDNRehab, a rehabilitation and physical therapy practice in New York City specializing in cervical spine dysfunction, postural rehabilitation, and chronic pain management. NYDNRehab uses advanced diagnostic and treatment approaches, including dynamic ultrasound imaging, cranio-cervical flexion testing, and individualized rehabilitation programs, to identify and address the root causes of musculoskeletal pain.

Introduction

When headaches recur with neck pain or stiffness, you’re not the only one. Cervicogenic headaches are often misdiagnosed and are highly responsive to specific rehabilitation when properly diagnosed. Our physical therapy team at NYDNRehab in New York City regularly assists patients in New York City to uncover the underlying cause of these headaches, and treat it using personalized cervical rehab programs.

A large number of people think that if they have recurring headaches, it must be a migraine headache or a tension-type headache, but a large percentage of people do have problems with their cervical spine. Education, exercise, and behavioral modification are a viable and evidence-based approach for improving cervical health by addressing poor posture habits, and are one of the most modifiable factors to influence cervical health.

A cervicogenic headache is a secondary headache, which occurs due to dysfunction in the upper cervical spine, that is the joints, muscles, nerves and soft tissue of the neck. The trigeminocervical complex (TCC) is a shared neurological pathway between the upper cervical nerve roots and the trigeminal nerve, and is felt in the head, forehead or around the eyes.

The Neuro-Anatomy of Referred Pain: The TCC is a neurological center where the sensory fibers of the cervical nerve roots C1, C2 and C3 meet the trigeminal nerve. If the upper neck joints or muscles are irritated, the brain will misinterpret the signals as being from the forehead, temples or behind the eye, so treatment of the neck is frequently the most effective.

1. My headaches start at the back of my neck or base of my skull

2. My headache is typically on one side and doesn’t move from side to side

3. Turning or tilting my head makes my headache worse

4. I spend 4+ hours a day at a desk, computer or phone

5. I have stiffness or limited range of motion in my neck which is obvious to others

6. My headaches are associated with a feeling of tightness in my shoulders or upper back

7. I have pain in my neck before or during my headaches

8. I have to move a lot to relieve my headaches

If you answered 5 or above and live in NYC, you may want to make an appointment for a cervical spine evaluation with NYDNRehab to get help diagnosing your cervicogenic headache with the advanced assessment tools they use.

• Neck pain that is associated with or comes before headache
• Headache starting from the back of the head and moving forward
• Headache on one side that will not move to the other side
• A decreased range of motion in the neck.
• Neck pain that increases with neck movement or holding a position for a long time
• Stiffness and tightness in the upper trapezius muscles and shoulders.
• Soreness following sitting, computer use, or driving for extended periods of time
• Upper cervical joint tenderness or suboccipital muscle tenderness

Diagnosis should always be confirmed by a trained health care professional with clinical evaluation and imaging.

Cervical dysfunction is a common and often overlooked contributor to headache. Studies have shown that impaired performance of deep neck flexor muscles and impaired cranio-cervical flexion (the gentle nodding motion controlled by the deepest cervical muscles) is a cause of cervicogenic headaches. A weakness or abnormalities in the cervical facets (small paired joints between each vertebra) may lead to chronic referred head pain.

Forward head posture is the position in which the head moves forward compared to the shoulders, thus creating a high mechanical load on the cervical spine. As the head moves forward just one inch, the load on the spine greatly increases, placing stress on the joints, muscles and intervertebral discs.

• Pectorals shorten and get overactive
• The deep cervical flexors and scapular stabilizers are stretched and weak
• Upper trapezius and suboccipitals take on compensatory overload

Longus colli and longus capitis (deep muscles along the front of the cervical vertebrae) are important for providing segmental stability. The sternocleidomastoid (SCM) compensates when it is underactive, changing the biomechanics of the cervicoscapular complex and increasing the risk of joint irritation and referred pain. These effects are aggravated by prolonged sitting, which also causes thoracic kyphosis and anterior pelvic tilt. Neuromuscular retraining is necessary to correct posture, and not just “standing up straight.

Disclosure: NYDNRehab may prescribe postural support devices as part of an individual assessment and treatment plan, such as the PostureJac.

In addition to corrective exercises, postural support devices can be used to help alleviate the effects of cervical facet dysfunction.

There are three ways these devices operate:

• Treatment of rounded shoulders and forward head posture, biomechanical correction
• Enhanced body awareness (kinesthetic)
• Sensorimotor learning, reinforcing good posture using neurological feedback

Devices are tools, not standalone treatments. Do not wear them all the time, only during periods of active exercise. If symptoms do not decrease in frequency and/or postural awareness does not improve after 4-6 weeks of using the device and exercising, review your strategy with a qualified clinician.

Avoid starting without a health care professional’s advice if you have: cervical instability, recent whiplash or trauma, inflammatory arthritis of the cervical spine, osteoporosis, or progressive neurological symptoms.

Exercises are done in a sequence, one exercise builds up the tissues for the following exercise.

Exercise 1: The Release

Frequency: No more than 5 times a day, discontinue if numbness or dizziness occurs.

Relaxes the upper trapezius and sternocleidomastoid.

• Look in a mirror and see how your shoulders are positioned.
• Hold device handles (or hands) very lightly down.
• Imagine that the top of your head goes towards the ceiling.
• Take a deep sniff in through the nose and slowly exhale through pursed lips while maintaining the position.

Exercise 2: Chin Tucks

2-3 series of 10-15 reps per day, hold for 5 seconds; stop if dizziness worsens.

Engages and tones the deep cervical flexors.

• Do not tilt the head, look straight ahead.
• Use two fingers on your chin as a guide.
• Pull the chin straight back, as if to make a “double chin”
• Hold for 5 seconds and then slowly release.

Exercise 3: Scapular Retractions

Perform 2-3 times per day, 10-15 reps each, 5 seconds hold, no shrugging.

Tones up the middle trapezius and rhomboids.

• Sitting or standing with a neutral spine and arms at the sides.
• Pull shoulder blades together and downwards.
• Pause for 5 seconds and relax.

Exercise 4: Doorway Chest Stretch

3 repetitions per day, 20-30 seconds hold \ Stretch should be comfortable, not painful

Extends the shortened pectoral muscles

• Forearms on door frame, elbows at 90 degrees.
• Gently step forward until a slight stretch is felt in the chest.
• Hold 20–30 seconds. Do not bounce.

Exercise 5: Thoracic Extension over foam roller

The number of passes is 2–3 per day and support the head throughout.

Activates the thoracic spine and decreases cervical compensations.

• Rest lower mid-back on a foam roller that is lying horizontally.
• Place your hands on your head and not your neck.
• Slowly stretch the upper back across the roller.
• Pause for 20-30 seconds at each stiff spinal segment.

What about the program not working? If after 6-8 weeks of following this program you have not seen any significant improvement, get a professional assessment. Clinicians at NYDNRehab leverage dynamic ultrasound imaging and cranio-cervical flexion testing to determine areas of impingement and modify treatment as needed.

• Top of the screen at or near eye level
• Hips and knees 90° with feet supported
• Sit or stand for 1-2 minutes each 30-45 minutes
• Hold the phone at eye level, do not allow too much flexion of the neck
• Sleep on your side with a supportive pillow; don’t sleep on your stomach
• Wear a backpack with two straps to wear weight evenly
• Add gentle cervical and thoracic mobility exercises each day

• Inconsistent exercise, sporadic effort yields limited adaptation
• Poor workstation setup, undermines even the best program
• Overcorrecting posture, “military posture” causes its overactivation itself
• Devices without strengthening, build awareness, not strength
• Remodeling requires weeks to months and has to be done quickly
• Ignoring pain signals, dizziness or numbness means stop and seek guidance

The research is ongoing, and results are different for each person. These results are based on education and do not guarantee results.

Measurable improvements in endurance of the deep neck flexors have been shown in clinical studies where the use of the postural support device was combined with corrective exercise, compared with those who were not treated (Jull et al., 2002).

The severity of dysfunction, consistency of exercise, habits at work, fitness level, and whether the exercise is clinically directed or not, all influence the level of improvement. Patients often find that they start to improve gradually within 4 to 6 weeks of diligent effort. Individually tailored rehabilitation programs are created at NYDNRehab to reflect each patient’s baseline condition, lifestyle, and functional goals, to help establish realistic and meaningful rehabilitation milestones. No guarantees for any specific outcome for any individual.

• Worst headache of the life or severe headache that develops suddenly.
• Headache after head or neck injury
• Numbness or tingling in arms or hands that doesn’t go away
• Weakness of arm or hand muscles
• Fever accompanying headache
• Changes in vision, or visual disturbances
• Unsteadiness or trouble standing up and walking
• Progressive neurological symptoms
• Severe headaches that do not get better after a few weeks of conservative treatments

Residents of New York City who are having any of the above should encourage them to seek immediate evaluation. Patients who have persistent, worsening, or complex headache presentations are eligible for a comprehensive cervical spine assessment at NYDNRehab.

Cervicogenic headaches can be a major cause of chronic headache that is often overlooked. Many people have a problem in the mechanics of the cervical spine due to bad postural habits, muscle imbalance, and the stresses of modern sedentary life. A comprehensive rehabilitation program that includes strengthening the deep neck flexor muscles, maintaining scapular stability, improving thoracic mobility and postural awareness provides a pathway and purpose for symptom reduction.

People who have headaches that do not go away or get worse should consult a healthcare professional for evaluation. The most important thing is to get an accurate diagnosis and a tailored rehabilitation plan, which will give you the best chance of making a long-term improvement.

Self-assessment tools and general exercises can be a good initial step, but can’t be used to determine if your headaches are cervicogenic and can’t design a treatment plan to meet your needs unless you have a qualified clinician.

NYDNRehab provides extensive cervical spine assessments in NYC, which include a postural assessment, cranio-cervical flexion testing, dynamic ultrasound imaging and individualised rehabilitation programming. Schedule Your Evaluation at NYDNRehab → Serving patients throughout New York City and the surrounding area.

The content of this article is for general educational information only and is not intended to be medical advice. Please always check with a trained health care provider before starting any exercise or rehabilitation program.