Headaches are an incredibly complex assortment of pain and misery. A Cervicogenic Headache is one of those nasty creepers that usually starts in the back of the neck and travels up one side of the head, into and surrounding the eye, and sometimes settles near the jaw. It’s also usually accompanied by limited range of motion in the neck when flared. Common causes of these headaches are from neck injuries such as whiplash, but there are numerous triggers to take into consideration.
Recently I had one of those roundabout out of state referrals for such a case.
During the Initial Session the client indicated that there was no known cause of the cervicogenic headache. They recall having started experiencing this around Jr High, but they were not as severe at that time. The headache is a chronic background noise that doesn’t flare or recede, just sits stagnant. The client went the traditional route with seeing their GP, worked with a PT using dry needling, and had also sought relief with cortisone injections.
The kicker on this timeline history (all about the timeline here) is that all notable events took place after the headaches began. My brain began shuffling the puzzle pieces and considered the possibility of hormonal or emotional aspects due to the dreaded teenage years. But why sit and wonder when the body wants us to know.
The Cervicogenic Headache Assessments
The client was in a full #protectthehuman state. Something in this human’s history produced a response from the Nervous System to be on high alert at all times. The response stabilized when attention was brought to the upper cervical area near C1/2. I always check the pain sites first before going into items of their history or gut instincts. After reducing the threat response, the client was now open to introducing movement and muscle testing assessments.
But first. In my office when it comes to any kind of headache or migraine, I want to check some higher level players. There was faulty processing of Cranial Nerves IV, V, X, and XI. That’s a whole lot of action happening and it all brought us to the right upper portion of the Temporalis. Again travelling the symptom referral lines.
Next, we introduced what I call PtH safety triggers. We are able to test a movement as a whole and clear many patterns this way. Cervical flexion, left cervical rotation, and scapular elevation also known as the shoulder shrug movement were all sounding the alarm. The Systems did not feel safe doing these simple movements. Each movement was stabilized by a different area near the cervical spine at C3/4 and C5/6.
As we moved into the muscle testing I was a bit surprised how much was still showing as problematic for our motor control assessments. However, when you look at the length and severity of the issue it makes sense that the compensation patterns have had ample time and reason to build more compensations that built more compensation patterns, etc.
The pattern for you Expert Explorers was: WIC BL Longus Coli, SCMs, Locked BL Scalenes, Upper Traps, Levators, and Suboccs. This pattern brought us right into the C2/3 area. Which, after going back through notes, was interesting to see that THAT particular area was not touched with global or PtH movement assessments. The body tells you what it want when it wants.
See what I meant by a lot? That’s with what we tested out of what we deemed necessary to test according to the main complaint. I’m sure there were numerous other muscles down the line that were also responding abnormally.
Now, there’s also something I like to do when I have plenty of time remaining in session and it’s something I call bulletproofing. It’s another form of assessments driven by curiosity and client history to see what else could be affecting the main complaint in the moment. By doing this we were able to discover that the associated neck/shoulder muscles were also acting as supportive structures for some low back and pelvic instability. Once those patterns were sorted the neck/shoulders no longer were affected. Bonus!
Whew. That was a lot. And with the out of state thing I made sure to cover as much ground as possible that the client’s systems were willing to take.
Doing self-care is vital in this work. You need to keep a good thing going. When good information is introduced to the Systems, it’s going to be primed to keep looking for more good things. We don’t want to disappoint.
In this case the biggest changes were made in the upper cervical area where the spine meets the base of the skull. I advised the client to find the most tender area and apply soft tissue work to that spot and follow it up with some chin tucks and natural neck movements. This can be done as often as needed for as long as needed.
The Follow Up
In general and a perfect world, the best way to schedule appointments when beginning this work is once a week for 3-5 weeks. This series has consistently provided the best results. With this particular client having to travel from out of state for these appointments the Follow Up took place a month after the Initial Session. Not ideal, but better than nothing!
Honestly, I never know what to expect, but I was pleasantly surprised. The client reported that they responded incredibly well and that the cervicogenic headache symptoms were about 99% gone. Yay! They had an ENTIRE month between sessions to live all kinds of life in that space. Subjective information is how I run my sessions, but I also need to see the Objective findings to know if things are still going in the right direction.
Follow Up Sessions always begin with the general assessments and retesting of the previous findings. Everything was holding well. Their Systems took the info and ran with it. We used the remainder of the time to explore a few other things that we were curious about from previous discussions.
This is one of those ‘magical’ cases that I wish we could bottle and sprinkle everywhere for everyone in pain. Is this going to stay or are the symptoms going to return? I have no idea. These headaches have numerous triggers and only time will tell.
However, the client now has a good idea of what to do on their own if symptoms return so they can turn that noise down. They now know it’s possible to not be burdened by chronic pain. AND I was also able to give a wonderful referral for someone much closer to them that can help with any ongoing maintenance that may be needed for the headaches or any other pain or movement issue that may arise in life. And if things go sideways I’m always willing to help where I can.