The cervical spine in tension type headache

Introduction: The concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally linked to cervicogenic headache; however, current evidence supports the presence of cervical musculoskeletal dysfunctions also in tension-type headache.Purpose: This position paper discusses the most updated clinical and evidence-based data about the cervical spine in tension-type headache.Implications: Subjects with tension-type headache exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, positive flexion-rotation test and also cervical motor control disturbances. In addition, the referred pain elicited by manual examination of the upper cervical joints and muscle trigger points reproduces the pain pattern in tension-type headache. Current data supports that the cervical spine can be also involved in tension-type headache, and not just in cervicogenic headache. Several physical therapies including upper cervical spine mobilization or manipulation, soft tissue interventions (including dry needling) and exercises targeting the cervical spine are proposed for managing tension-type headache; however, the effectiveness of these interventions depends on a proper clinical reasoning since not all will be equally effective for all individuals with tension-type headache. Based on current evidence, we propose to use the terms cervical component and cervical source when discussing about headache. In such a scenario, in cervicogenic headache the neck can be the cause (source) of the headache whereas in tension-type headache the neck will have a component on the pain pattern, but it will be not the cause since it is a primary headache.

Automated summary

This article discusses the relationship between the cervical spine and tension-type headache, proposing that the cervical spine may be a component of tension-type headache rather than its primary cause. Individuals with tension-type headache often exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, and disturbances in cervical motor control. Therefore, physical therapies targeting the cervical spine, such as upper cervical spine mobilization or manipulation, soft tissue interventions, and exercises, may be considered for managing tension-type headache, but treatment effectiveness should be based on individual clinical reasoning.