Cervicogenic Headache Treatment Techniques

Cervicogenic Headache Treatment Techniques

• Sub-Occipital Release (SOR): A 5-10 minute technique where the clinician cradles the patient's occiput, applying continuous pressure on sub-occipital muscles. Dim lighting in a private room is recommended. The goal is muscle relaxation, potentially centralizing headache pain. The patient should rest after the release.

• Inion Traction: Involves 5-10 pounds of pressure and a 5-15 minute treatment duration. The clinician positions their forearm at the base of the patient's occiput, transitioning from a supinated to a neutral position to create traction.

• Muscle Energy Techniques: Used to unlock upper cervical spine facets. The patient, seated or supine, performs a 50% sub-maximal isometric contraction, then the clinician moves the patient into further flexion, side-bending, and rotation away from the involved side. This is repeated 3-5 times, potentially unlocking (or mobilizing) the facet.

• Repeated Retractions: A highly effective technique for treating cervicogenic headaches. The technique progresses from simple retractions in sitting to supine variations, and finally traction/retraction/extension off the end of the table. Instructions include preventing nose contact to ensure full range of motion. This is crucial for maximal benefit.

• Upper Cervical Spine Stretching: Involves patient-generated and clinician-assisted stretches to elongate upper cervical spine muscles. This includes a nodding movement (minor flexion) with overpressure to reach end range, or using a fist under the chin while performing the same nodding motion. 2-3 repetitions, held for 30-60 seconds, are recommended.

• Thoracic Spine Mobilization: Grade V rotational mobilizations/manipulations of the thoracic spine are often effective in decreasing both upper and lower cervical spine pain.

• C7-T1 Mobilization/Manipulation: A seated traction/lifting technique targeting the C7-T1 region. This technique is seen as beneficial for upper and lower cervical spine pain. A study on college students showed decreased pain and pain pressure threshold post-treatment.

• C1-C2 Self-Snag Technique (SNAG): A self-sustained natural apophyseal glide (SNAG) technique using a towel that aims to decrease pain in the upper cervical spine and increase range of motion in locked or inflamed facets. Studies show this technique can reduce headache pain by 54% compared to a placebo.

• Cervical Spine Mobilization (Limited Use): Grade IV rotational mobilizations are a last resort due to potential vertebral artery injury risk. Combining with therapeutic exercises is recommended.

Postural Correction and Education

• Postural Education is essential. Common issues include poor posture and forward head posture often seen in students and those working at computers or phones. Techniques include:
  • Lumbar Roll/Cervical Roll: Positioning a roll at the belt to address lumbar posture that impacts cervical posture.
  • Headrest While Driving: Proper use of headrests and mirror adjustment.
  • Slouch-Overcorrect: Practicing postural correction through repetition (15 times/hour).
  • Ergonomic Workstation Assessment: Evaluating and improving workstation ergonomics.
  • Visual Cues: Using visual cues (e.g., green dot) to remind individuals of appropriate posture.

This quiz covers various techniques for treating cervicogenic headaches, including Sub-Occipital Release, Inion Traction, and Muscle Energy Techniques. Each technique is explained with its purpose and methodology. Test your understanding of these therapeutic approaches.