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For quite some time now, physiotherapists have been successfully treating headaches by manipulating stiff tissues in the neck.  There are countless testimonials from patients cured from migraines and other types of headache that support this approach which is based on the anatomical link between the spinal nerves in the upper part of the neck and the part of the brain stem that we know is central to the generation of head pain in most cases, the trigeminocervical nucleus.  In other words, noxious information from stiff or painful structures in the upper part of the neck sensitises the brain stem which can then trigger head pain. The existence of cervicogenic headache (headache coming from the cervical spine) is well documented but in our experience has been considerably underestimated as a primary source headache, including migraine.  This diagnosis requires relatively skilled examination of the neck in order to demonstrate that head pain is reproducible during neck assessment.  However, as most headache sufferers are examined in general practice, a complete and thorough examination of the neck is often not carried out.  Hence the diagnosis of cervicogenic headache being missed in a large proportion of headache sufferers and the opportunity to have this assessed by a physiotherapist not considered. New research about to be published looked at patients with migraine and tension type headaches which, according to the current medical model of headache classification, are distinct entities.  However, the researchers found that head pain similar to the pain suffered during migraine attack was reproducible in all but one of the patients during examination from a skilled physiotherapist.  This supports the notion that there is a large degree of overlap in headache diagnoses and that the cervical spine may well be significantly underestimated as a primary cause of lots of different types of headache including migraine.  Examination by a skilled manual therapist to assess the necks of all headache sufferers should be routine. This is certainly supports our own experience at HFS Clinics where we have been successfully treating patients with most types of headache for years by improving neck mobility followed up with postural correction and ergonomic intervention where needed.   Check out this story on the BBC website.

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