Prevention and Treatment of Headaches

Prevention:

The #1 way to prevent cervicogenic headaches (HA’s), or HA’s that begin in the neck or base of the skull, is good posture!  This includes keeping your head back with your ears directly over your shoulders, especially while using a computer or mobile device, as well as while driving.  When we assume a forward head posture, the stress and strain that’s placed on the structures of our cervical spine (neck) is significantly increased.

Good work station ergonomics is also key to sitting (or standing) with good posture.  Be sure your low back is well supported while seated, and that your elbows are bent 90 degrees while using a keyboard.  Most importantly, position your monitor so that your eyes are level with the top 1/3 of the screen.  If you use a laptop for longer than 30 minutes at a time, consider getting a docking station and an external monitor and keyboard.

Another way to prevent HA’s is by maintaining good mobility via regular stretching and cardiovascular (CV) exercise.  You should try to stretch all of the muscles in the front, side and back of your neck at least 3x/week.  Be sure to hold these stretches for a minimum of 30 seconds, repeat each twice, and never stretch to the point of pain.

The American Heart Association recommends 150 minutes of CV exercise per week, such as 30 minutes, 5x/week.  Among its MANY benefits, CV exercise helps to increase the mobility of all of your joints by increasing your blood supply.  This, in turn, increases the amount of oxygen and nutrition that is supplied to the muscles and joints of your neck (as well as all other areas of your body).

Treatment:

The first thing to do to relieve cervicogenic HA’s is to release the tight muscles at the base of your skull, as this is oftentimes a major contributor.  Place a rolled up hand towel under your neck while lying on your back.  Next, place two tennis balls in a sock and position them directly under the base of your skull.  Maintain this position for at least 5 minutes, until these muscles begin to relax.

Once you’ve release these tight muscles, you then need to activate them by performing repeated chin tucks (i.e. deep neck flexor head nods).  After removing the tennis balls, your head should lie flat on the floor or mattress with no pillow under your head.  Next, perform 10 chin tucks for 10 seconds each.  A physical therapist can best teach you how to properly and effectively perform this exercise.  Research shows that repeated chin tucks are the most effective way to reduce cervicogenic HA’s by “waking up” your deep neck flexors, which are your primary cervical (neck) stabilizers.  Traumatic injuries such as whiplash can cause these muscles to become inhibited, or “go to sleep”.  This increases the stress, strain and load on all of the structures of your neck, which in turn leads to HA’s.  By performing these exercises 1-2x daily, you teach these muscles how to fire again, thus decreasing the amount of load on the cervical spine.  This, in turn, decreases cervicogenic HA’s!

Flare-Up Management

 

Inflammation is the body’s natural response to injury or general overuse.  Immediately following an injury, swelling can occur to clean up and clear away the affected area for the healing process to occur, subsequently resulting in recovery.  However, prolonged inflammation can lead to chronic pain and dysfunction; therefore, controlling inflammation is a key first defense against pain.

How to Decrease Inflammation

Avoid the use of heat, which can exacerbate inflammation.

Icing is a great way to reduce initial inflammation and to interrupt the pain signals the body is sending out.  Apply ice over the affected area for 15-20 minutes, 5-6 times a day, not to exceed once an hour.  Icing before sleep can help calm the nervous system and overactive muscles, resulting in better sleep.

Icing instructions

  • Do NOT apply ice or a cold source directly to the skin. Instead, keep a thin layer of material between the skin and ice.
  • There are 4 sensations you’ll experience when icing: First – cold, then a burning feeling, followed by some aching in the area, and finally numbness.  Once numbness is achieved, continue icing for another 5-10 minutes.
  • When ice is not available, a bag of frozen vegetables or another safe cold source will suffice

Post-Icing Activities

Once icing has done its job and symptoms have reduced, it’s a great opportunity to stretch and move around. General mobility like walking promotes increased blood flow to bring oxygen and nutrient rich blood to the site of pain and inflammation.

Strength training and more demanding activities should be avoided initially after a flare up.  Although you may feel ready for these types of activities, it’s best to slowly recover for 3-4 days before resuming normal exercise.

Back Tips For People Who Sit

Did you know that sitting places a 50% greater load on your spine than standing?  After a long day of sitting you can feel stiff and sore, especially if you are sitting with poor posture or have a poor ergonomic set-up.  Poor posture will generally look like a “C” shape of the spine.  There is a rounding or slumping of the shoulders and a forward head position.  This can not only produce increased stress on the back but also the neck.  Good posture will look like a “S” shape of the spine.  In this position the spine is aligned in such a way as to minimize stress and tension.  Force is evenly distributed on each of the vertebrae and discs.  This keeps your muscles and tendons in their neutral position and prevents overstretching which can lead to an achy or burning feeling in your back muscles.  The following tips will help you in identifying some basic changes you can make to improve your sitting tolerance.

  1. Be active at work. Although you can make your desk ergonomically correct, one of the main causes of back pain is muscle atrophy caused by lack of use. Get up and go to the printer, take a walk around the office or walk around the block every 30 minutes.

 

  1. Consider using a exercise ball for a chair. Start with small intervals 3 times a day for 10 minutes. The ball should be at the same height as your desk chair when you sit on it. Engaging your muscles during these periods can strengthen your core muscles and relieve back pain.

 

  1. Choose a chair that has a lumbar support. Sitting up straight, although once thought to be the best position, can cause muscle fatigue, especially if your core muscles are not very strong. The worst position is slumping forward.

 

  1. Sit in your chair so that your thighs are flat, parallel with the ground. This is the height that your chair should always be at. Keep your feet flat on the floor.

 

  1. Bend your elbows until your forearms are parallel to the ground. Your desk should be slightly lower than this height so that your forearms are flat when typing. If you cannot adjust your desk, it is better that it be too high than too low. For a desk that is too high, adjust your chair so that your elbows are parallel to the ground. Place a foot rest under your desk so that your thighs stay parallel to the ground.

 

  1. Sit close enough to the desk so that your monitor is an arm’s width away from your face. With good eyesight, you should not have to lean forward at all. Place the monitor high enough so that you do not have to move your head up or down to see the screen.

 

  1. Buy a headset if you talk on the phone a lot. Holding your neck  toward a phone or holding it between your chin and shoulder is extremely bad for your cervical spine and will result in neck pain or a repetitive stress injury.

 

  1. Adjust your desk chair arm rests so that they lift your shoulders very slightly. You do not want your shoulders to be up too high, but a little lift can give you length in the body and extra support for your wrists.

 

  1. Place your wrists so that you hold them right above the keyboard. Make sure they do not tip down or up.

 

  1. Place all commonly used desk objects, such as a mouse or a stapler to the right or left within an easy arm’s reach.

Something to try…

Take your index finger and pull it back toward the back of your hand until you feel a slight pull.  Hold this position for a few minutes then let the finger go back to it’s neutral position.  You will feel aching in that finger as a result.  The aching that you feel is due to overstretching of the ligaments and tendons.  This is similar to what you experience when you sit with a slumped posture then sit straight.  Even though poor posture may not cause initial discomfort, continual poor posture can eventually lead to long term back pain.

Strengthen, Strengthen, Strengthen…Stronger muscles will help you to maintain your body in proper alignment.