Most people will experience a headache at some point in their lifetime. For many, headaches are infrequent and easily treated with over the counter remedies. For others, headaches are a daily battle and can be debilitating.
There are many types of frequent headaches, and those who experience headaches can have more than one type. Commonly known types of frequent headaches are migraines, tension headache, and cluster headaches. As more of the population is becoming sedentary and spending increased amounts of time sitting at a desk and in a car, an additional type of headache should be considered. This type is known as a cervicogenic headache.
A cervicogenic headache is a condition caused by dysfunction at the upper cervical spine. When a person spends all day at a desk reading documents or viewing a computer screen, it is a natural tendency to move the chin forward, called cervical protraction. In addition, while sitting, most people will draw their shoulders into a rounded position. These postural impairments cause excessive extension at the upper cervical spine (called capital extension,) which restricts the mobility of the upper cervical spine.
The suboccipitals are a group of muscles than run over the upper cervical spine.When the mobility of the upper cervical spine is compromised from poor posture, over time the suboccipitals will shorten in length. The suboccipital nerve runs through the musculature, and when the muscle shortens it can cause compression on the suboccipital nerve. This nerve runs up the occiput into the back of the head, thus compression of the nerve causes head pain. The headache caused by the above postural impairments and resulting shortened muscle length, muscle weakness, and nerve compression is known as a cervicogenic headache.
A cervicogenic headache is typically located on one side of the head, and can create pain at the base of the skull, behind the head, or behind the eye. It can also create a horn like pattern of pain from the base of the skull radiating to the forehead. Often times the affected person will also report neck pain and tenderness at the involved muscle groups.
Over the counter medications (with consultation from your doctor), heat, lying supine, and stretching can temporarily relieve the symptoms of a cervicogenic headache. For long term symptom management, the source of the problem must be addressed. Often this means assessment and ergonomic changes made to a work station. Factors that should be considered include the height of the computer screen, height of the desk, position of the keyboard and mouse, angle of the desk user's elbows/ wrists/ knees/ hips, and the type of chair the person uses.
Once ergonomics are addressed, one can also benefit from a flexibility program to address soft tissue restrictions at the suboccipitals and pectoralis minor to correct the muscle length restrictions caused by the forward head and rounded shoulder posture previously described. These muscle length restrictions cause weakness in the reciprocal muscle group, thus a stabilization program for the midback and the anterior neck is vital in long term management. If the symptoms have been present for more than a few months, it is likely that the joint structures of the upper cervical spine are involved, and the affected person may also benefit from joint mobility interventions. A physical therapist can help a client improve joint mobility as well as provide manual therapy at the suboccipitals to increase muscle length and promote tissue healing.
Headaches are a commonly treated condition, and a cervicogenic headache should be considered if the person spends a large amount of time at a desk or driving. While over the counter treatments may temporarily relieve pain, for long term management a consultation with a physical therapist or qualified fitness professional is beneficial. Before starting a new exercise program, contact your health care provider.
Carla Pryor PT, DPT, OCS, RYT 200. Co Owner of Redefine Health and Fitness located in North County San Diego. Redefine is a wellness based company focused on providing excellent comprehensive and research driven care to assist clients in meeting their fitness and nutrition goals. Contact firstname.lastname@example.org for further inquiry.