At Walker and Hall we appreciate that headaches, jaw pain and facial nerve palsy can be extremely painful and distressing.

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below


Headaches that respond well to physiotherapy treatment are known as Cervico-genic headaches, i.e., arising from the neck. They are also known as cervical headaches, neck related headaches or referred pain from the neck.

Anatomy of the Neck

The neck comprises 7 bones (vertebrae). Each bone is connected to the one above and below by 2 joints at the back and a disc in between. Nerves emerge from between two adjacent bones and ligaments and muscles cover the joints and provide support and allow movement of the neck.

When you move your neck or adopt certain postures for a period of time, these structures are stretched, compressed or a combination of both. If the force applied to the structures is more than they can handle then they can become damaged and headaches can arise. These are cervico-genic headaches.

Causes of Cervico-genic headaches

Cervico-genic headache usually occur as a result of activities placing excessive stress on the upper joints of the neck. These may occur as a result of prolonged activities e.g., prolonged slouching, poor posture, lifting, carrying (especially in poor posture), excessive bending or twisting of the neck, working at a computer, activities using the arms in front of the body (e.g. housework) and trauma (e.g., whiplash injuries).

Signs and symptoms of cervico-genic headache

Patients presenting with Cervico-genic headaches usually experience a gradual onset of neck pain and headaches during the causative activity. However you may also experience pain and stiffness after the activity, particularly waking the next morning.

The headaches usually present as a constant dull ache pain, normally situated at the back of the head, however occasionally behind the eyes (retro-orbital headaches), over the temple region, on top of the head, forehead or even ears.

Pain is usually felt on both sides of the head, symmetrically, but occasionally one side only maybe affected.

Often but not always with cervico-genic headaches you may also experience neck pain, stiffness and a difficulty turning your neck.

Other symptoms associated with Cervico-genic headaches:

Occasionally patients may experience other symptoms, including: light-headedness, dizziness, nausea, tinnitus, decreased concentration, an inability to function normally, and depression.

How Walker and Hall can help cervico-genic headaches

A thorough musculoskeletal examination is required to determine the origin of the cervico-genic headaches. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence. It is not unusual during the examination for the cervico-genic headaches to be reproduced.

Following the diagnosis the treatment plan is devised and discussed with you.

The types of physiotherapy treatment for cervico-genic headaches includes:

  • joint mobilization
  • joint manipulation
  • traction
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • postural education including the use of a lumbar roll for sitting
  • education
  • anti-inflammatory advice
  • activity modification advice
  • the use of an appropriate pillow for sleeping
  • exercises to improve flexibility, strength (particularly the deep cervical flexors) and posture

Jaw pain (also known as Temporo-mandibular pain and TMJ pain)

Jaw pain is often the result of inflammation of the Temporo-mandibular Joint or “TMJ”.

Anatomy of the TMJ joint

This is the Joint between the jaw bone (mandible) and the temporal bone of the Skull. It is an unusual joint because like the knee joint it has a disc inside it. It works like a hinge when you initially open your mouth and then begins to glide forwards as the mouth continues to open. It is often the gliding movement that causes pain in the joint. In some people the pain is associated with clicking.

Causes of TMJ pain

These include grinding your teeth, trauma (e.g., a punch to the jaw), osteoarthritis (i.e., similar to other joints in the body the TMJ is prone to “wear and tear”) and rheumatoid arthritis in the TMJ.

Signs and Symptoms of TMJ pain

These include pain or clicking in the TMJ, temple headaches, TMJ arthritis identified on x-ray, teeth grinding or jaw clenching (Bruxism) and an inability to open your mouth far enough to insert three fingers vertically.

How Walker and Hall can help TMJ pain

A thorough musculoskeletal examination is required to determine the exact nature of the TMJ pain. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence

Following the diagnosis a treatment plan is devised and discussed with you.

The physiotherapy treatment may include:

  • electrotherapy (e.g. ultrasound)
  • joint mobilization
  • soft tissue massage
  • anti-inflammatory advice
  • exercises to improve mobility, flexibility, strength and posture

In order to prevent the pain from returning we then assess your posture. Neck stiffness can affect the jaw alignment so you may need some treatment of your neck muscles and joints. Additionally the mid back and spinal posture alignment will keep your jaw in alignment and prevent a recurrence of the problem.

Facial nerve palsy

Facial Nerve Palsy is also known as Bell’s palsy or Facial palsy and is a condition involving damage to the 7th Cranial nerve.

The 7th Cranial nerve is responsible for the muscles of facial expression, and taste sensations from tongue and inside of the mouth.

At Walker and Hall we are particularly aware of how distressing Facial nerve palsy’s can be and consequently we will do all we can to help you recover from this condition as quickly as possible.

Anatomy of the Facial Nerve

The Facial nerve emerges from the brain and passes through the skull via the internal auditory meatus (close to the inner ear). It then under goes two tight turns through the facial canal and eventually emerges from the stylomastoid foramen.

It is because the route of the Facial Nerve is so complex, lying close to other structures and passing through small bony holes in the skull that it can be damaged.

Cause of Bell’s palsy

The exact cause of damage to the facial nerve is unknown. However contributing factors are thought to be:

  • a viral infection such as the cold sore virus (herpes simplex).
  • In association with other medical conditions e.g., mumps, Flu, cold, headaches, chronic middle ear infection, high blood pressure and diabetes
  • trauma such as skull fractures and facial injuries,

As a result of the above the cranial nerve becomes inflamed and swells in size. Because the nerve passes through the narrow canals of the skull it is squashed against the inside of the canal and as a result the nerve is unable to function properly.

Symptoms of Bell’s Palsy

Occasionally you may have had a cold before the symptoms begin.
The symptoms often start suddenly, may take 2 – 3 days to fully develop and are almost always on one side of the face only.
The face will feel stiff, numb and maybe pulled to one side.
You may experience a dry eye and mouth, a headache, loss of sensation and or taste, sound that is louder in one ear and occasional twitching in the face.

Effects of a facial palsy

Drooping of the face, such as the eyelid or corner of the mouth
Difficulty in closing the eye
Problems smiling, grimacing, or making facial expressions
Difficulty eating and drinking; food can fall out of one side of the mouth
Drooling due to lack of control over the muscles of the face
Twitching or weakness of the muscles in the face

How Walker and Hall can help Facial Palsy

Facial Palsy although rarely painful can be extremely distressing.

Physiotherapy treatment is useful to help the progress of your recovery and includes:

  • advice, with regards to eating and drinking, eye care, exercises and oral stimulation
  • electrical stimulation
  • soft tissue massage