Cervicogenic Headache and Its Relationship to Upper Crossed Syndrome
Cervicogenic headache is referred pain perceived in the head and caused by musculoskeletal tissues innervated by cervical nerves.  It is characterized as unilateral head pain. Pain duration varies from hours to weeks and is usually moderate, spreading into the frontal-temporal and orbital regions. 
There are many important facts regarding the enormity of headache sufferers today. Alix and Bates  state that headaches are the cause of more than 18 million annual office visits in the United States, 156 million full-time work days lost yearly, and an estimated cost of $25 billion dollars in lost productivity. According to the same article, headaches are also found to be the most common reason to use over-the-counter analgesic medication.
The authors discuss the extent of impact of headaches on a patient’s quality of life and state that it exceeds other chronic conditions such as osteoarthritis, hypertension, and diabetes. The study also found that 27% of those reporting a headache have used a form of alternative management and that chiropractic was found to be the most common alternative management sought. 
Upper Crossed Syndrome
The upper crossed syndrome is defined as tightness of the upper trapezius, pectoralis major, and levator scapulae and weakness of the rhomboids, serratus anterior, middle and lower trapezius, and the deep neck flexors, especially the scalene muscles. Janda named this syndrome “Upper Crossed” because when the weakened and shortened muscles are connected in the upper body, they form a cross. 
This syndrome produces elevation and protraction of the shoulders, winging of the scapula, and protraction of the head. This atypical posture produces overstress of the cervical cranial junction, the C4-5 and T4 segments, and the shoulder due to altered motion of the glenohumeral joint.  Excessive stress on the T4 segment can occasionally cause chest pain of pseudoangina pectoris. 
The change of direction of the axis of the glenoid fossa will cause rotation and abduction of the shoulder blades.  This will cause the levator scapulae and the upper trapezius to have additional muscle activity to stabilize the head of the humerus.  This will be accompanied by increased and constant activity of the supraspinatus, causing early degeneration of the muscle. 
Cervicogenic headache is similar to migraine headache due to the ipsilateral pain and the typical migraine-like symptoms such as nausea, vomiting, and ocular problems.  It differs from migraines, according to Pfaffenrath et al,  in that it never alternates sides and initiates in the neck. He describes the headache as dull, dragging, boring pain with fluctuating intensity lasting a few minutes or several days in duration. It can also radiate into the face and the ipsilateral shoulder and arm with no definite radicular pattern, and there is usually a painful overall restriction of head movement. 
Other conjunctival symptoms, lacrimation, and lid edema can be seen with cervicogenic headaches but never Horner syndrome, which is occasionally found in cluster headaches.  Migrainelike symptoms such as nausea, photophobia, and visual blurring may occur, as well as difficulty swallowing, a sense of having a lump in the throat, or dizziness. The duration for cervicogenic headaches is typically longer.  In this patient’s case, he had headaches for several days at a time and his occurrence of headaches was 2 to 3 times weekly.
Studies in this report have shown the relevance of treating cervicogenic and other headaches with spinal manipulation. Further study is needed on the relationship of postural patterns, such as muscle imbalance, to headache symptoms and other ailments.
CONCLUSION: The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.
Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache
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