OCULOMOTOR THERAPY FOR CERVICOGENIC HEADACHES: WHAT YOU NEED TO KNOW

Cervicogenic headaches (CGH) are a specific type of headache caused by dysfunction or pathology in the cervical spine and its surrounding structures. Unlike migraines or tension-type headaches, CGH originates from the neck, often presenting with pain radiating to the head, restricted neck movement and other cervical symptoms.

One innovative approach to managing CGH involves oculomotor therapy, which targets the coordination between the neck, eyes and brain.

From a physiotherapist’s perspective, understanding the interplay between these systems and incorporating oculomotor therapy into treatment plans can provide substantial benefits for patients.

What Are Cervicogenic Headaches?

Cervicogenic headaches are secondary headaches, meaning they stem from another condition - in this case, cervical spine dysfunction. They are often linked to:

Poor posture, such as forward head posture.
Muscle imbalances or tightness in the suboccipital and cervical muscles.
Joint dysfunction, particularly in the upper cervical segments (C1-C3).
Trauma, such as whiplash or repetitive strain injuries.

Symptoms of CGH often mimic other headache types, which can complicate diagnosis. Common indicators include:

Headache triggered by neck movement or sustained positions.
Pain localised to one side of the head or neck.
Tenderness in the upper cervical spine and occipital region.
Visual disturbances or dizziness in some cases.

The Role of Oculomotor Dysfunction

Oculomotor dysfunction refers to abnormalities in eye movements or coordination, often linked to issues with the vestibular or proprioceptive systems. Given the close relationship between the cervical spine, visual system and vestibular system, dysfunction in one area can amplify symptoms in the others.

For patients with CGH, this dysfunction often presents as:

Difficulty focusing or tracking objects.
Increased headache symptoms with screen use or reading.
Sensitivity to movement in the visual field.

By addressing these issues, oculomotor therapy aims to retrain the brain and eyes to function cohesively, reducing strain on the cervical structures and alleviating headache symptoms.

How Oculomotor Therapy Works

Oculomotor therapy involves structured exercises designed to improve the coordination between eye movements and cervical proprioception. These exercises target key components:

1. Smooth Pursuits

These exercises focus on improving the ability to track moving objects. For example, a patient may follow a pen or a laser pointer with their eyes while keeping their head still.

2. Saccades

Saccadic exercises train rapid eye movements between two targets, such as shifting focus from one corner of a room to another. This helps improve gaze stability and reduces neck strain caused by compensatory movements.

3. Gaze Stabilisation

This involves maintaining focus on a stationary target while moving the head. For instance, patients may fixate on a dot on a wall while performing gentle cervical rotations.

4. Vestibulo-Ocular Reflex (VOR) Training

VOR exercises enhance the ability to stabilise gaze during head movements. This can be particularly beneficial for patients with dizziness or balance issues accompanying CGH.

Benefits of Oculomotor Therapy for CGH

1. Pain Reduction

Improving oculomotor function reduces the strain on cervical muscles and joints, which can decrease headache intensity and frequency.

2. Enhanced Proprioception

Exercises that integrate eye and neck movements improve cervical proprioception, reducing maladaptive movement patterns.

3. Improved Posture

By addressing visual deficits, patients often adopt a more natural head and neck posture, alleviating chronic tension in the upper cervical region.

4. Better Functional Outcomes

Patients report improved performance in daily activities like reading, driving, or computer work, which are often hindered by CGH symptoms.

Ben Harris Physiotherapist Nottingham — BEN HARRIS - OCULOMOTOR THERAPY SPECIALIST

How to Integrate Oculomotor Therapy in Physiotherapy

1. Assessment

A thorough assessment is essential to identify oculomotor dysfunction and its contribution to CGH. Tools like cervical range-of-motion tests, eye-tracking assessments and balance evaluations can help.

2. Tailored Exercise Programmes

Oculomotor exercises should be customised based on the patient’s specific deficits and tolerance. Gradual progression is key to avoiding symptom exacerbation.

3. Combining Therapies

Oculomotor therapy works best when combined with other physiotherapy interventions such as:

Manual therapy for cervical spine mobility.
Strengthening exercises for deep cervical flexors.
Postural retraining and ergonomic advice.

4. Education

Teaching patients about the connection between their visual and cervical systems empowers them to engage in their recovery actively.

Oculomotor therapy is a valuable, evidence-based addition to physiotherapy protocols for cervicogenic headaches. By addressing the visual-cervical connection, it can significantly enhance symptom relief and functional outcomes.

For patients and physiotherapists alike, this holistic approach offers a path to long-term recovery, improving quality of life while minimising reliance on pharmacological interventions.

If you or someone you know is struggling with CGH, consider consulting a physiotherapist trained in oculomotor therapy for a comprehensive and innovative treatment plan.

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