Anterior Neck and Cervicogenic Headaches
Introduction[edit | edit source]
As discussed here, cervicogenic headache (CGH) is caused primarily by dysfunction in the upper cervical spine. However, patients with CGH are also highly likely to have myofascial trigger point pain from overactivity in their anterior neck muscles, including sternocleidomastoid (SCM), as well as upper trapezius and temporalis.[1]
While there is debate over whether or not the SCM is specifically implicated in CGH,[2] its trigger points have a similar referral pattern to that seen in CGH.[1] The anterior neck should, therefore, be considered and addressed when assessing and treating CGH. The following video shows the most common SCM trigger points and their referral patterns.
Please click the links for more information on assessing and managing the upper cervical spine and the superior scapular region for patients with CGH. This page explores the assessment and management of CGH related to dysfunction in the anterior neck.
Potential Causes for Anterior Neck Dysfunction[edit | edit source]
- Poor posture
- Deep neck flexors dysfunction
- Disordered breathing pattern
Assessment[edit | edit source]
Posture - Janda Upper Crossed Syndrome[edit | edit source]
It is important to assess the posture of patients presenting with CHG. In particular, the upper crossed syndrome is a postural pattern commonly seen in patients with neck pain and headaches.[1] It refers to a specific pattern of:[4]
- Muscle activation (particularly in the neck, trunk, and scapular muscles)
- Altered movement (i.e. scapula dyskinesia)
These altered patterns exist alongside recognised postural changes, including:[4][5]
- Forward head position
- Rounded shoulder posture
- Increased thoracic kyphosis
These changes have an impact on the biomechanics of the non-contractile parts of the cervical spine. Because of these changes, individuals with upper crossed posture typically have more active (or over-active) neck muscles in order to achieve cervical stability.[5]
Common changes associated with upper crossed posture are:[1][2][5]
- Inhibited deep neck flexors
- Overactive or tight pectoral muscles
- Overactive upper trapezius
- Inhibited lower trapezius and serratus anterior
Deep Neck Flexors[edit | edit source]
CGH and neck pain are often associated with weak or inhibited deep neck flexors.[2] To assess the strength and endurance of the deep neck flexors, you can position your patient in supine with knees bent. The patient is then asked to lift his / her head and look at his / her toes. A normal test would result in a smooth reversal of cervical lordosis and the chin would remain tucked. If the patient has deep neck flexor weakness, SCM tends to compensate. There is also an early protraction of the chin at the beginning of the movement.[1]
The craniocervical flexion test (CCF), described by Jull and colleagues, can also be used to assess deep neck flexor strength.[1] It is a reliable measure of deep neck flexor performance.[6] It has been found that, during this test, greater activation of the superficial flexor muscles indicates reduced deep cervical flexor activity JULL and FALLA 2016
It does, however, rely on the use of an inflatable cuff (biofeedback) to perform. The cuff is placed under the patient’s neck while she / he lies supine. The patient is asked to nod, and maintain a target pressure on the cuff. Pressure is increased by 2 mm/Hg over five levels, with progressive increases in the range of craniocervical flexion. The test is concluded if / when the patient performs craniocervical flexion while maintaining 30 mm Hg. PAGE
When performing these assessments, it is important to look for contraction of the SCM during the nodding movement. Normally, this muscle would not activate during a nodding motion. WEB Falla and colleagues demonstrated that individuals without neck pain had less SCM and scalene muscle activity during this movement on EMG when compared to individuals with neck pain FALLA 2004. The activation patterns became more pronounced as the degree of flexion increased. FALLA 2004. Inhibited deep neck flexors typically lead to, or correlate with, hypertonic and overactive SCM. WEB
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011; 6(3): 254-66.
- ↑ 2.0 2.1 2.2 Kaplan A. Cervicogenic Headaches - Anterior Neck Course. Physioplus, 2020.
- ↑ NAT Education. Sternocleidomastoid Muscle (SCM) Trigger Points. Available from: https://www.youtube.com/watch?v=kOYm9xZMCdg [last accessed 22/12/2020]
- ↑ 4.0 4.1 Seidi F, Bayattork M, Minoonejad H, Andersen LL, Page P. Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Sci Rep. 2020; 10(1): 20688.
- ↑ 5.0 5.1 5.2 Arshadi R, Ghasemi GA, Samadi H. Effects of an 8-week selective corrective exercises program on electromyography activity of scapular and neck muscles in persons with upper crossed syndrome: Randomized controlled trial. Phys Ther Sport. 2019; 37: 113-9.
- ↑ Falla D, Jull G, Dall'Alba P, Rainoldi A, Merletti R. An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion. Phys Ther. 2003; 83(10): 899-906.
