(Upbeat music)
- Welcome my friends to the Bob and Brad podcast
produced by Bob and Brad, the two most famous
physical therapists on the internet.
I am Bob, am exactly one half of the Bob and Brad team
and today, my return guest is Cynthia.
She's a physician's assistant
with Summit Orthopedics,
where I'll place up in the twin cities
actually, they have multiple locations
in Minneapolis and St. Paul.
And today we're going to talk about, well,
we got three subjects where we're
really gonna talk about and one is whiplash.
The second is cervicogenic headaches,
which is neck headaches and the third is just,
regular all overall neck pain.
And hopefully we can get you some solutions
if you have any one of those three.
So join us for the program.
Welcome back to the program, Cynthia PAC,
who was last time coupled up with Dr. Ekstrom,
but this time she's going solo.
- I'm flying solo. (Cynthia laughing)
- Thanks for taking the time and being with us.
So how does a cervicogenic headache present itself?
- So I think cervicogenic headaches
or cervicogenic migraines, or neck headache,
yeah, whatever you wanna call them.
I think they are so interesting because
there is such a crossover between
these type of headaches and migraine headaches.
So usually how they present themselves
as they're some type of degree of neck pain.
So cervical, meaning the cervical spine,
something going on in the neck
and whether someone perceives it
as a deep neck pain, someone perceives it
as a muscular tension it's all gonna
vary on the person.
A lot of the times we'll see headaches that will kind of sit
in this occipital regions of the base of the head.
And sometimes, behind the ear
or behind the eye for a lot of people
or the jaw kind of in a trigeminal nerve pattern.
- Often one sided or can it be both?
- So it can be, it can be both. Yep.
And that's where that kind of blurry line
between migraines and cervicogenic headaches come
in because migraines were always thought
of unilateral one-sided, but migraines can also
present as both and cervicogenic
headaches can be one-sided or both.
- Sure, in fact, I think they called it like Ram's horns?
- Yeah. (Cynthia laughing)
- Yeah. - [Bob] But--
- I know I can just imagine you should get a tattoo.
- There we go.
- [Cynthia] Yeah
- Like a Mike Tyson type thing.
- Yeah
- So, these headaches, anything else
that accompanies them?
I do you get the aura?
Do you get I mean nauseated?
Do you get, what are some of the things you might see
along with these headaches?
- So cervicogenic headaches in general
or in most studies say that there's not really
an aura that accompanies them.
However, some of the other kind of migraine features
definitely can pop up in these cervicogenic headaches.
So, nausea, vomiting, photophobia, and phonophobia.
So sensitivity to light, sensitivity to sound.
You'll, a lot of these people,
I suffer from headaches too.
So a lot of these people are in the bed, lights off,
hoodie on covering their ears.
Cause everything is just hyper sensitive.
- Gotcha.
So, yeah, I had Steve August,
he's a therapist from New Zealand
and he was talking about the same headaches.
And he was saying that,
injecting the joints with a chemical
that would irritate the joint basically.
- Oh, like a Prolo therapy, almost?
- Well, it was, they wanted it for research.
They wanted to see what--
- Oh okay.
- What created the pain.
- Okay.
- And it did create that pain going wrong.
I always thought it was the greater occipital nerve.
I don't know what the thoughts are on that now,
but he seems to think just the joint itself
can send pain all the way around like that.
- Yeah, so there's kind of an interesting connection
between the neck and the medial branches
we were talking about at-- that sit at those
joints and their connection between
the greater occipital nerve.
So, the third occipital nerve
is kind of a superficial medial branch of the C2 nerve.
And so that radiates up the back of the head, kind of medial
to that greater occipital nerve.
But the greater occipital nerve also
comes off branches of the C2 and some innervation
from the C3.
So they are all very interconnected.
And so sometimes aggravating those joints
or even isolating those joints can take care
of that same type of pain because
of the connections that those nerves have.
- Well, why don't we talk about that?
What do you think some of the main causes
are of cervicogenic headaches?
- So, going back to kind of the first thing we were talking
about, whiplash, whiplash is definitely
- [Bob] Sure. - A big contributor
to cervicogenic headaches.
Posturing, so sometimes cervicogenic headaches,
there might not be a structure or finding
in the cervical spine, like a disc herniation or arthritis,
and it might just be muscular posturing,
poor posture, kind of tugging.
I tell people a lot of times sort of
your head and your neck are playing
a tug of war and it's locally irritating
some of these nerves, like the greater
occipital nerve, the suboccipital nerve.
And so those can get irritated too,
and cause, but other things
like disc herniations, underlying
pathology that can sort of trigger this cascade
of issues up and to the muscles too
can cause these headaches.
- I mean, overall while you've been three years,
I don't know if that's a good period of time to judge this,
but I mean, have you seen a drastic increase
in these types of cases?
Because this therapist had, he had--
- Yeah
- Like it was a tsunami is what he called it.
(Cynthia laughing)
- I actually feel that kind of since
the COVID pandemic started and a lot of people
have been working from home,
their setup is much different than it's been at work
and the ergonomics are different.
- And so-- and I seen a lot more people present
with an onset of these headaches over the past couple years
with no trauma, no injury,
just a change in their ergonomics.
And we're not going out as much.
We're on our phones a lot more.
And so that is-- - Not being as much.
- Yep, stressors this has been stressful for many people.
So I've seen an uptick, I guess in that sense.
- Makes total sense. - [Cynthia] Yeah.
- Yeah I think people don't realize,
well, one thing you just, when you're working at home,
you don't have the distractions of co-workers, but--
- [Cynthia] Right.
- Which is good because you get out of movement.
But I think people are shocked at how much pain
you can have from just poor posture.
That's just shocking.
Like something must be really wrong.
- Yeah, well, and I know so many
people have had those mornings, even when
they've slept wrong and they wake up
and they're like, "I can't move my neck", something,
no, I gotta go to the ER, which,
I'm not blaming anyone a lot of the times,
it's scary to not be able to move your neck,
but yeah posture can play a big role,
especially if it's not corrected early.
And you probably seen that a lot from a therapy standpoint,
it's like pulling teeth if it's a chronic.
- And then it gets to the point where it's very hard
to correct.
So, well, why don't we talk about some of the treatments
again, I know that you're gonna
have different types of patients and a whole
span from, less serious to more complicated,
but what are some of the treatments you might
try for somebody with cervicogenic headaches?
- Yeah, so from a medication standpoint,
sometimes there's different medications we can use
other than over-the-counter medications.
Some of the issues too, going with migraine
and cervicogenic headaches is overuse
in some of these medications.
So someone that taking Excedrin twice a day
for weeks can actually cause kind of a cascade
of more headaches.
- Really?
- We try to kind of sparingly use medications,
but a lot of the times there are different
medications, different muscle relaxers,
some antidepressants, and things that can be
helpful in preventing some of these headaches.
If they're chronic and even almost daily.
therapy, we rely on therapy heavily
to do, a lot of posturing,
repositioning, retraining muscles working
on that trigger point like I was talking about
that myofascial release.
So trying to get rid of those maybe muscle knots
for people that are referring pain to the head
or the shoulder blade.
Dry needling is a technique
that therapy can use that has been beneficial.
And we can add to that by doing trigger point
injections, which is, it's similar to dry needling
in a sense that what we're trying to do is mechanically
kind of get into that muscle knot, break it up.
And we do use a little bit of an anesthetic
to help with kind of that pain relief as well.
And then going a little more further into,
I guess, from conservative to less conservative
would be doing occipital nerve blocks.
And that's if we think the headaches are really coming kind
of from a local irritation of those occipital nerves
that we'll use a little bit of anesthetic and some steroid
and place it, where that greater and lesser occipital nerve
run to kind of decrease the irritation that that nerve
is causing.
And then sometimes Botox treatment,
we can use for cervicogenic, what I would categorize
as a cervicogenic migraine, we'd use Botox treatment.
- How long do those last, Botox?
- So Botox is done every three months.
And so there's been studies on having people do Botox
for a couple years and then kind of weaning them down.
And I think most of the studies I've seen
show that it's just better to keep the treatment going
every three months.
There hasn't been any really efficacy of stopping it.
But every three months, so it usually lasts three months
and then we repeat it.
- I see.
And in the case where you do the anesthetic
and steroid, that's kind of a,
how often could you do that?
- So if we're using an anesthetic only,
so sometimes we can do that in nerve blocks
or trigger point injections, just an anesthetic.
I mean, we could really repeat it every month
or so if there is a steroid,
we limit that to usually four times a year,
every three months, if you're injecting steroid
into that same area.
- In these cases, you're not trying to kill the nerve?
- Correct. Nope.
We're letting it live.
(Bob laughing)
What we're trying to kind of dampen
the response that it's giving or the pain
signals that it's giving off.
- I take it, the therapist also goes to add
the approach to therapy ergonomically try to look at their,
hopefully look at their setup and their desk
and they're--
- Yup.
- Trying to correct the posture.
- And we do we've done even recently,
again, with the pandemic, we've done a lot of work notes
for people about getting a sit to stand desk.
About getting, a proper chair and things that their work
might provide to make their home set up
a little more ergonomic for them.
- Sure, and that falls in the lifestyle changes.
Are there any others--
- [Cynthia] Yeah. - That you might make?
- So lifestyle changes and it's so hard
to say this because I know none of us do this,
but avoiding stressors, finding some type of outlet.
So exercise and eating healthy,
all the things that we all know we should be doing,
but don't necessarily do.
So, with migraines and cervicogenic headaches.
I mean, there's kind of an overlap in some triggers
so lack of sleep again, poor posture, sometimes,
intake of too much sodium, sugar.
All of that can definitely lead to an increase
in some of these headaches.
- Oh, interesting.
Do you have a nutritionist on staff or not?
- We don't. I would love to.
I guess it's not up to me.
I don't own it, but we don't.
There are definitely,
especially in the Maple Grove area here,
there's a couple chiropractic clinics
that have a nutritionist on staff.
I know a lot of grocery stores nowadays
will have a dietician or a nutritionist,
which is really helpful, very feasible kind of access
to a nutritionist.
So that can be helpful too.
- Yeah, back to the girl we have on our program quite often,
she used to work for Hy-Vee the grocery store.
- Oh yeah! Yep.
- And so yeah, she loves to nutrition,
but she's also fitness instructor.
So, well, anything else
you want to talk about as far as cervicogenic headaches
or anything else you want to convey to people or...?
- I guess that, just that people know
there's a lot of options out there to treat headaches.
There's a lot of causes.
We don't necessarily treat migraines
in the absence of some type of neck pathology,
whether it's just a muscle pathology or a disc
or joint pathology, migraine headaches,
without any of those would go to neurology
for further workup.
But there is an extensive
amount of overlap between types of headaches
and there's a lot of options for treatment.
So don't give up.
- Very good! Again there's always hope.
(Cynthia laughing) - There's always hope.
That should be your new slogan.
- My new tagline, yes.
- There's always hope.
(both laughing)
- And upon that excellent advice,
I think we'll bring it to an end here.
I really appreciate you coming by again, Cynthia,
and hopefully we'll see you maybe and Dr. Ekstrom
again soon and--
- Yeah.
- [Bob] So--
- Yeah we appreciate it.
Thanks for having me on.
- Yeah, thanks for taking the time.
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