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Physiotherapy & Exercise Physiology Penrith

Treatment of Neck Pain and Headache

What is neck pain and headache?

The most prevalent primary headaches tension-type headache and migraine are frequently associated with neck pain. The frequent co-occurrence of headache and neck pain is attributed to common nociceptive innervation of the head and neck in the dorsal horn C1-2, located in the trigemino-cervical complex. This convergence of cervical ánd trigeminal pain fibres on the C1 and C2 dorsal horn provides a neuro-anatomical basis for the clinical phenomenon of referred pain. The co-occurrence of headache and neck pain can be explained by referred pain, that is pain originating from the neck perceived as originating from the head and vice versa.

What else can neck pain and headache be called?

Neck pain and headache can also be referred to as cervicogenic (neck generating) headaches, tension-type headaches, neck causing migraines and neck and head pain.

What are the symptoms of neck pain and headache?

Presenting symptoms of neck pain and headaches will include neck pain, shoulder pain, posterior head pain, pain around the back and upper portion of the neck and lower skull, pain on manual pressure to this area and pain on rotating the head. Symptoms will not likely be nerve related- so no numbness, burning or pins and needles.

Diagnostic criteria for neck pain and headache

Diagnosis of neck pain and headaches includes mechanical firm pressure to myofascial structures of upper cervical segments (C0-3) can provoke the patient's typical headache in patients with cervicogenic headache, tension-type headache and migraine. Palpation of trigger points in suboccipital muscles and trapezius, restricted motion of the upper cervical segments C0-3, and stress on joints in the upper cervical spine are related to different types of headache. Often cervical extension-rotation test will be positive confirming neck joint involvement.

What other conditions could it be?

Cervical myelopathy, cervical spondylosis, cervical disc protrusion, cervical uncovertebral joint hypertrophy, migraine, tension-type headache.

What are the most appropriate outcome measures to evaluate the treatment of neck pain and headache?

The Neck Disability Index (NDI), the headache impact test (HIT) and VAS are recommended outcome measures for assessing treatment of neck pain and headaches.

Guideline-based treatment of neck pain and headache

The majority of neck pain and headache guidelines suggest both passive and active interventions as treatment. This This will include joint mobilisations and manipulation, soft tissue work and active exercise therapy. Both joint mobilisations and active neck exercises will work via the ‘gate-control' hypothesis, which states that the relative high amount of proprioceptive afferent joint and muscular input of upper cervical segments to the central nervous system may help to inhibit ascending pain. Stimulation of proprioceptive input by active exercises for neck muscles may decrease the excitability of neurons and activation of the supraspinal DNIC system by stimulation of myofascial fibres by manual pressure techniques at the upper cervical spine can be of added value. The importance of an active treatment of neck muscles is supported by research, with many stating that an active physical treatment including exercises shows promising results on reduction of headache associated with neck pain.

What guideline/consensus statements does Agility use in the treatment of neck pain and headache?

Castien R and De Hertogh W. A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Frontiers in Neurology 2019; 10: 276.

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