A patient with severe right frontal headache

Abstract

As physiotherapists, our primary role in the field of headaches is the management of cervicogenic headaches, that is, headaches arising from musculoskeletal dysfunction in the cervical spine. A recent randomized controlled trial conducted in Australia demonstrated the benefits of specific therapeutic exercise and manipulative therapy for cervicogenic headaches (Jull et al., 2002). The problem with headaches is two-fold: (1) all headaches have commonalities in their anatomy and physiology in that they are mediated by the trigeminocervical nucleus (Bogduk, 1995); (2) there can be symptomatic overlap between many headache types as well as some seemingly common provocative factors (IHS, 1988; Leston, 1996; Hagen et al., 2002). Therefore, the ability of physiotherapists to identify cervicogenic headache, or to exclude it and refer accordingly is important, especially when acting as first contact practioners (Jull, 1994). This case study demonstrates the significance of recognizing headaches of nonmusculoskeletal origin.