For an increasing number of young female students, cervicogenic headaches - pain that originates from muscle tension or myofascial structures in the neck - are becoming a common problem of adolescence. The person that comes to therapy with this kind of headache usually fits a fairly specific profile. Typically the patient is a high-achieving adolescent who puts a lot of pressure on themselves and develops increased tone and tension in their neck muscles and also in the scapular muscles as well.

Doug Fickes, DPT, MCT and clinic director of the Harrisburg office of First Choice Rehab, has studied cervicogenic headaches and treats many patients with this condition. "The clinical signs of this kind of headache are steady, persistent head pain and upper neck tightness without nausea that spreads until it hurts all over the inside of the patient's head. Often, one side of the head and neck will hurt more than the other and medication often fails to help the duration or frequency of symptoms."

Why the increased number of young females with these symptoms? Studies have shown that the "allostatic load", which is the cumulative wear and tear that occurs in tissues and organs of an individual under chronic stress are usually related to neuroendocrine hormone release. There seems to be a relationship between high allostatic load and early onset of menarche in young women. Also, teens under the pressure of high expectations seem to be at risk. As the number of girls playing sports at highly competitive levels swells, the pressure is increased to succeed. Two other trends may be contributing the the cervicogenic headaches among young athletes: the increased risk of dehydration and the heightened quest for weight control. 

What can be done to help the young patient with these headaches? Fickes explains that many times, the pain can be alleviated by muscle-strengthening approaches for the neck and shoulder girdle. "I aim to strengthen the deep neck flexors, scapular stabilizers and rotators and improve the neck extensor flexibility," he says. "In addition, manual therapy combined with addressing poor body mechanics and postural dysfunction can really help the patient." 

Adolescents who slump when they walk and stand may be prone to develop these postural asymmetries and neck symptoms.  "The first approach may be to correct that problem," advises Fickes. "Postural training and lumbar strengthening will help the patient with their too-frequent habit of slumping." Fickes also believes that the one-on-one aspect of physical therapy seems to help these young people the most. "This regimen of treatment helps them gain confidence.  As physical therapists, we also spend a lot of one-on-one time with them, listening to the sources of their stress and helping them to manage those problems."

By Doug Fickes, DPT, MCT