Sternocleidomastoid muscle imbalance in a patient with recurrent headache

Abstract

Headache is a common complaint seen by physical therapists. Headache that develops from the upper cervical spine has been called cervicogenic headache (Bogduk, 1992; Nilsson et al., 1997; Biondi, 2001). The three upper cervical spine joints (atlanto-occipital, atlanto-axial, and C2/3) are often associated with headache (Bogduk, 1992; Dvorak and Walchli, 1997; Jull, 1997; Bogduk, 2001). Besides problems of upper cervical joint mobility, problems related to the muscles of the cervical spine have also been linked to cervicogenic headache (Jull, 1997; Jull et al., 1999). Muscle impairment of the sternocleidomastoid (SCM), the anterior scalene (AS) and the deep cervical flexor muscles (longus capitus and colli and rectus capitus anterior) has also been found to be associated with neck pain and cervical osteoarthritis (Gogia and Sabbahi, 1994; Barton and Hayes, 1996; Jull et al., 2002; Falla et al., 2004). The author has noticed that patients with cervicogenic headache often have imbalances in muscle length and strength between the left and right SCM and AS muscles. This case report describes the evaluation and treatment of a patient with cervicogenic type headache who also showed left to right imbalance between the SCM muscles and restricted upper cervical spine motion.