Cervicogenic Headache Treatment Techniques

Cervicogenic Headache Treatment Techniques

• Sub-Occipital Release (SOR): A 5-10 minute treatment involving cradling the occiput with fingers to relieve sub-occipital muscles. The patient lies supine, and dim lighting is ideal. The technique aims to relax muscles, potentially centralizing headache pain and easing it. After, the patient rests their head for a few minutes to prevent headache return.

Inion Traction

• Applied pressure: 5-10 pounds.
• Treatment duration: 5-15 minutes.
• Technique: Clinician's forearm supports the occiput, and a supinated forearm rests on the patient's occiput. The forearm then pronates, creating cervical spine traction. The clinician also uses their other hand on the patient's forehead. This position is both comfortable for the patient and clinician, allowing for longer treatments

Muscle Energy Techniques

• Posture: Seated or supine.
• Purpose: To unlock upper cervical spine facets.
• Procedure: Patient positioned in slight flexion, side-bending, and rotation away from the affected side; they perform a 50% sub-maximal isometric contraction (e.g., looking up and over a shoulder). Clinician passively guides into further flexion/side bending/rotation. This process repeats 3-5 times.

Repeated Retractions

• Highly effective for cervicogenic headaches.
• Progression: Start with simple seated retractions, progressing to supine variations and eventually supine traction/retraction/extension off the end of the table.
• Important: Instruct the patient to avoid hitting their nose, encouraging full range of motion for maximum effect.

Upper Cervical Spine Stretching

• Posture: Seated or supine.
• Type: Patient-generated or clinician-assisted stretches.
• Procedure: Patient performs a retraction, then a nodding movement (small flexion of the upper cervical spine), with or without overpressure using a fist under the chin.
• Duration: 2-3 repetitions, held for 30-60 seconds for optimal elongation.

Thoracic Spine Mobilization

• Technique: Grade V rotational mobilization/manipulation of the thoracic spine.
• Benefit: Decreases cervical spine pain (upper and lower).
• CPR Clinical Prediction Rule: Identifies patients likely to benefit from thoracic spine manual therapy. Criteria include symptom duration less than 30 days, no symptoms below the shoulder, cervical extension not increasing symptoms, FABQPA score below 12, diminished upper thoracic kyphosis, and cervical extension ROM below 30 degrees.

C7-T1 Mobilization/Manipulation

• Technique: Grade V traction mobilization/manipulation of C7-T1.
• Posture: Seated.
• Benefit: Decreases pain and pain pressure threshold; no change in shoulder strength was observed (although hypothesized that releasing the suprascapular nerve might increase it).

C1-C2 Self-Snag Technique

• Method: Self-sustained natural apophyseal glide (SNAG) using a towel. Clinician or patient can perform.
• Benefit: Reduces headache pain and increases range of motion in patients with locked or inflamed upper cervical spine facets.

Cervical Spine Mobilization (Caution)

• Technique: Grade IV rotational mobilization of the cervical spine.
• Caution: Possible risks (vertebral artery injury).
• Use: A last resort treatment option for upper and lower cervical spine pain or cervicogenic headaches. Combine with therapeutic exercise.

Postural Education/Correction

• Common issues: Poor posture, forward head posture (common in students and computer users).
• Techniques:
  • Lumbar and cervical rolls (to correct lumbar/cervical posture).
  • Headrest while driving.
  • Slouch-overcorrect (repeated 15 times/hour).
  • Ergonomic workstation assessment.
  • Visual cues to remind patients of proper posture.

Explore various treatment techniques for cervicogenic headaches, including Sub-Occipital Release and Inion Traction. Gain insights into the procedures, applied pressures, and patient positions required for effective treatment. Enhance your understanding of muscle energy techniques and their role in alleviating headache pain.