If you sit at a desk all day working at a computer and start to notice frequent headaches, you may have what’s known as a cervicogenic headache. These headaches have nothing to do with eye strain but rather are caused by nerves and muscles of the neck and spine that have been aggravated by posture or perhaps an injury.
The source of a headache can sometimes be tricky to pinpoint given there are more than 150 unique kinds of headaches, but there are distinct hallmarks of cervicogenic headaches, namely:
They are often one-sided
They start at the back of the head or behind the ear and wrap around to the front
It’s common to experience pain behind the eye, a decrease in neck movement, or pain that stays in one spot
Onset may frequently occur while you’re in front of the computer or at the end of the day – typically, you don’t wake up with the headache
Over-the-counter pain medications don’t really alleviate the pain, even temporarily
These headaches are caused by structures in the neck – muscles, nerves, the joints of the cervical (upper) spine, disks, and the muscles at the back of the head – that, when irritated or strained in some way, send a pain signal to the brain. What’s interesting is that most people who develop cervicogenic headaches don’t complain of neck pain and aren’t aware that their neck is stiff until we begin exercises to remedy the problem.
While a sports injury to the neck or shoulder or a fall or any accident that abruptly jerks the head backward or forward (whiplash) can cause cervicogenic headaches, sitting at a desk all day is one of the worst culprits. Specifically, if you slouch forward or hunch over your keyboard while working at the computer, this poor posture compresses the joints at the base of the neck and strains the muscles to support your head, leading to cervicogenic headaches.
It’s hard to say how long it takes before poor posture may trigger cervicogenic headaches. I see people of all ages, some as young as their early twenties. In particular, I’ve noticed a rise in cervicogenic headaches among people who do a lot of computer work with two screens. Oftentimes, the placement of the screens requires people to swivel their heads, precipitating neck strain.
If you experience headaches at work that sound like cervicogenic headaches, try the following:
Fix your posture at the computer by having an ergonomic assessment done of your work space
Take breaks every 30 minutes from your computer or tablet
Use a headset or speaker phone
Regularly stretch your neck muscles, especially during work hours. This also forces you to take those frequent breaks
Strengthen the muscles between your shoulder blades
If the headaches persist or worsen, schedule an appointment to see your primary care doctor. If your doctor suspects your headaches are caused by a neck issue, you’ll probably be referred to a physical therapist. At your first appointment, a physical therapist will ask you questions about the severity and frequency of the headaches, what you’ve tried to do to address them, and then do a physical exam of your neck – range of motion, mobility, etc.
Treatment involves correcting the ergonomics of the work space as outlined above, but also providing at-home and at-work exercises to strengthen the muscles as well as some mobilization of the neck during your PT visits. Initially, I see people 2x per week to give them education and thorough exercise instruction and also to loosen the muscles of the neck slowly and safely. Within just a few weeks, many people notice a lessening of the severity of their headache, then frequency of the headaches follows. About 3-4 weeks into treatment, we decrease the PT visits to 1x per week. The total treatment time is about 8-10 weeks.
There are four primary exercises we teach people to use at home or at work to stretch and strengthen the muscles of the neck. Consult with your own doctor or physical therapist to make sure these will be beneficial for you, but I have illustrated and described them below:
The Upper Trapezius stretch
Place your right hand behind your back, resting it at the center of your lower back
Pull your shoulder blades back and down (do not hunch your shoulders)
Then slowly tilt your head as far as you can to the left, stretching the muscles on the right side of your neck
Hold that position for 30 seconds, then slowly move your head to an upright position and drop your arm
Reverse sides and repeat this exercise using your left hand and tilting your head to the right to stretch the muscles on the left side of your neck
You should do this stretch, one time on each side, twice daily (morning and evening)
The Sternocleidomastoid stretch
Place the fingers of your right hand gently in the left side indentation made by your clavicle or collarbone (the bone you can feel that runs from your shoulder to the base of your throat)
Cover your right hand with your left, tilt your head slightly to the left, and then gently pull down, trapping and slightly stretching the base of the muscle that runs up the left side of your neck
Slowly tilt your head to the right to further stretch that muscle
Hold that position for 30 seconds, then slowly move your head to an upright position and drop your hands
Reverse sides and repeat this exercise on your right side collarbone to stretch the right-side neck muscle
You should do this stretch, one time on each side, twice daily (morning and evening)
The Levator Scapulae stretch
Place your right hand behind your back, resting it at the center of your lower back
Pull your shoulder blades back and down (do not hunch your shoulders)
Move your head to the left and down, as if you are trying to look at your left armpit. This stretches the muscles on the right side of your neck
Hold that position for 30 seconds, then slowly move your head to an upright position and drop your arm
Reverse sides and repeat this exercise to stretch the muscles on the left side of your neck
You should do this stretch, one time on each side, twice daily (morning and evening
The Pectoralis Major stretch
Stand in a doorframe and place your right arm out and bent upward at a 90-degree angle so your arm above the elbow is resting on the wall
Step forward with your left leg in a bent position.
Lean forward while keeping your arm strong to create a good stretch for your right-side shoulder and neck muscles
Hold that position for 30 seconds
Reverse arms and repeat this exercise to stretch your left-side shoulder and neck muscles
You should do this stretch, one time on each side, twice daily (morning and evening)
About Scott McDonough, PT
Scott McDonough is a Physical Therapist who joined Atrius Health in 2015. He earned his PT degree at the MGH Institute of Health Professions in Boston, MA. Prior to joining Atrius Health, Scott worked in an integrated health care center for 10 years and a private practice clinic for 3 years. He enjoys treating chronic injuries, sports injuries and helping people return to their prior activity level, hobbies, or sport. In his free time, Scott enjoys traveling and watching all the local Boston sport teams.
If you sit at a desk all day working at a computer and start to notice frequent headaches, you may have what’s known as a cervicogenic headache. These headaches have nothing to do with eye strain but rather are caused by nerves and muscles of the neck and spine that have been aggravated by posture or perhaps an injury.
