What is Tension headache Or CERVICAL HEADACHE?

Headaches are a common complaint with impaired posture. chronic and recurrent headaches are diagnosed as cervical headaches and are related to musculoskeletal impairments. Often there is associated tension in the posterior cervical muscles, pain at the attachment of the cervical extensors, and/or pain radiating across the top and side of the scalp.

Causes of Tension Headache

Many factors may cause a cervical headache. Headaches may follow soft tissue injury or may be caused by faulty or sustained postures, nerve irritation or impingement (the greater occipital nerve emerges through the neck extensor muscles where they attach at the base of the skull), or sustained muscle contraction(from faulty posture or emotional tension) leading to ischemia. With cervical headaches, the joints and ligaments of the upper cervical spine are often inflamed or dysfunctional.

Headaches may be related to temporomandibular joint dysfunction or other conditions such as allergies or sinusitis, or there may be vascular or autonomic involvement as with migraine or cluster headaches. Whatever the cause, there usually is a cycle of pain, muscle contraction, decreased circulation, and more pain, which leads to decreased function and potential soft tissue and joint impairments.

Signs and Symptoms of Tension Headache

Differentiating cervical headaches and related impairments in the musculoskeletal system from other kinds of headaches, such as cluster or migraine headaches, is important for developing a plan of care that effectively manages the headaches. Although there is overlap in symptomatology, the following are usually associated with cervical headaches.
History and symptoms include:

• Unilateral headaches or bilateral headaches with one side predominant
• Pain in the neck or suboccipital region that spreads into the head
• Intensity can fluctuate between mild, moderate, or severe
• Precipitated by sustained neck postures or movements
• Maybe precipitated by stress (also common with other types of headache)
• It may be related to trauma, degenerative joint disease, or a sedentary lifestyle and postural stresses
• More prevalent in females but no familial tendency

Musculoskeletal impairments include:

• Joint impairment in the upper cervical spine (pain and motion restrictions)
• Impaired muscle performance (impaired tonic postural control and endurance in upper and deep cervical flexors possibly multifidus and small posterior suboccipital muscles)
• Impaired shoulder girdle/scapular posture with related muscle imbalances
• Impaired lumbar posture with related muscle imbalances
• Impaired neural tissue from pressure or inflammation in
• the upper cervical/suboccipital region
• Impaired neuromotor control

General Management Guidelines

Management is directed toward reversing the physical impairments, including posture correction, stress management, and prevention of future episodes.

Pain Management for Cervical headache

Modalities, massage, and muscle-setting exercises are used to break into the cycle of pain and muscle tension.

Mobility Impairments and impaired Muscle Performance

Examine the flexibility and strength of the muscles in the cervical, upper thoracic, shoulder girdle, and lumbar spine and design an exercise program to regain balance in flexibility and neuromuscular control in conjunction with posture correction and training. Interventions that have been reported to decrease the intensity and incidence of cervical headaches include the following.

1. Increase joint mobility in the cervical spine and flexibility in the suboccipital muscles to relieve tension in that region as well as be able to activate and train the deep cervical flexors for control of capital flexion and cervical retraction. Control and support from the deep/core muscles are the foundation of management.
2. Utilize cervical stabilization exercises to emphasizing tonic holding of the core muscles in isolation from the global muscles.
3. Train the lower trapezius, rhomboids, and serratus anterior muscles in tonic holding postures to improve control of scapulothoracic posture.

Stress Management

If the person is in tension-producing situations, relaxation techniques, ROM and muscle-setting techniques, and proper spinal mechanics are taught.

Prevention of Tension Headache

Underlying the prevention of future episodes of cervical headaches is the education of the patient to correct postural stresses, to maintain a healthy balance in the length and strength of the postural muscles, and to adapt the home, work, or recreational environment to minimize sustained or repetitive faulty postural alignment