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1st Jun

2014

How Orthopedic Manual Physical Therapy Can Help Headaches
Over the years, I have written about various pain producing neck conditions, and how we can best treat them.  One type of headaches is referred to as cervicogenic headaches, which means that the headaches stem from the neck, or cervical spine.  All spinal joints have nerve fibers called nociceptive fibers, which when firing cause us to feel pain.  This can happen if spinal tissues are excessively stretched, compressed or chemically irritated, such as with inflammation.  For most of the spine, these nerve fibers can pick up what is going on a few levels next to them.  However, the nerve fibers in the upper cervical spine, near the skull can receive information from almost the entire neck below them.  That means that they may fire not only if there is a problem in the upper part of the neck, but also if something is compromised lower down.  When these pain fibers in the upper neck, typically at C1, C2 or C3 fire, they often produce headaches either in the front of the head or behind the eyes, on top or back of the head, or along the side of the head.  Because of a direct neurological connection in this region, some people also experience facial or jaw symptoms. Such cervicogenic headaches tend to be the most severe if there is a problem in the uppermost three levels of the neck.  However, for the reason mentioned above, it is not uncommon for people with pain lower in the neck or shoulder girdle, to also get headaches. Pain causes certain muscles to contract spontaneously, which we refer to as muscle guarding.  In the upper part of the neck, this includes a group of short and very strong muscles called the suboccipital muscles.  When they remain in a state of constant contraction, we typically feel more pain from the muscles themselves, or from the resulting extra compression on the upper neck joints, or sometimes from these muscles squishing occipital nerves that travel through them and up the back of the head, which can lead to nerve pain, or neuralgia, making the headaches especially bad. Orthopedic Manual Physical Therapy can be an effective form of treatment for cervicogenic headaches, which has also been shown with multiple research studies.  The first step is to identify where in the neck the headaches may be stemming from, and what tissues are compromised, and why.  This requires a comprehensive evaluation. A good trunk and head-neck posture must be established, restricted joints must be made to move better through gentle specific mobilization techniques, guarded and tight muscles must be released and loosened, and deep stabilizing muscles in the neck and back as well as postural muscles must be activated and over time trained.  That way we can restore normal and painfree movements and tolerate daily activities better, without compromising spinal tissues and setting off another vicious pain cycle.

Please pass this letter on to anybody who could benefit from the information.

Have a wonderful summer, and hopefully without headaches!

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