It’s the end of the work day and you can feel it coming on: the pounding starting at the back of your skull and reaching over your head into your eyes and temples. You try to stretch your neck out side to side with no avail, the headache stays. In an article published in the journal Cephalagia, Stovnern et. al. found that upwards of two-thirds of the world’s population suffers from headaches.

There are many different types of headache, and may be caused from a number of different issues. Some of the more common headaches are migraines, tension headaches, and cervicogenic headaches (CGH).

I’d like to write about the latter of that group today, as this is a kind of headache that physiotherapy can have the greatest impact on (although tension headaches, we can also help with!).

Cervicogenic put simply means that the pain originates in the neck, typically the area from the bottom of the occiput (skull) to the third cervical spine. The actual definition of a cervicogenic headache is published by the International Headache Society (IHS) and is explained as pain, referred from a source in the neck and perceived in 1 or more regions of the head and/or face.

Diagnosis of cervicogenic headaches can be done by your physiotherapist through an assessment method known as the flexion-rotation test, or FRT. This test checks for rotational mobility between the first (atlas) and second (axis) cervical vertebrae – the atlanto-axis joint or AA joint (the motion at these joints contribute almost half of our total neck rotation). If there is marked loss of rotation to one side, it there is a very good probably of having restriction in the  AA joint that is leading to your headaches. The restriction is often on only one side, and thus headaches are also predominantly on that same side.

Okay, great. My physiotherapist has given me a diagnosis of having a restriction in my AA joint leading to headaches, now what the heck can I do about it??

With proper diagnosis, we can give a very specific exercise to help mobility of this joint. The exercise can then be used when you have your headaches, and diminish or abolish your symptoms!

The image above shows the patient working on a restriction on the left side of her neck. She is using a custom strap, but this can also be done with a towel. Pressure is applied by the right hand on the left atlas (C/1) while looking forward. Pressure is maintained on the atlas as you rotate as far to the right you can without pain. End-range is then held for a few seconds, and then you return to the start position, while again maintaining the forward pressure on the atlas.