What Is a Cervicogenic Headache?
Have you ever woken up with a headache and a nasty crick in the neck?
The two symptoms are probably related! A neck ache combined with a
headache could indicate a cervicogenic headache.
Cervicogenic comes from "cervico," meaning "neck," and "genic," meaning
"relating to." These headaches originate from the neck and by some
definitions the spine.
How Is It Different From a Tension Headache?
Tension headaches are more common and are caused by tightening of
muscles on or around the head and neck. The tightening can be due to
stress or staying in one position for too long. On the other hand, a
cervicogenic headache is caused by a partial misalignment (subluxation)
of one or more of the neck vertebrae.
If you have a headache and neck pain, it's probably cervicogenic.
The misalignment can be isolated to just the neck vertebrae, but it can
also originate from subluxation of another joint, most commonly in the
thoracic or lumbar spine, shoulders, ribs, and pelvis. People with
hypermobile joints are more likely to experience these headaches.
How Does It Cause So Much Pain?
The base of the skull is a very dense and complex region filled with
joints, nerves, blood vessels, and a multitude of muscles, both large
and small. All of this to support your head, and most importantly, your
brain! With so much going on, it's easy to see why a misalignment can
cause problems—like a truck tipped over in Manhattan traffic.
When the vertebrae aren't in position, they can directly or indirectly
rub up against the nerves, especially the occipital nerve (to your eye).
According to the National Institute of Neurological Disorders and
Stroke, the pain caused by occipital nerve irritation starts at the base
of the neck and spreads up to the scalp. Sometimes, the pain can be
felt at the scalp, forehead, and behind the eyes.
What Causes a Cervicogenic Headache?
Any condition or disorder of the cervical spine or tissue can cause cervicogenic headaches. These include
- Whiplash or other neck injuries
- Spinal misalignment
- Crick in your neck
- Arthritis
- Elhers-Danlos syndrome (this is what caused my headaches)
- Posture and other lifestyle factors
Modern life includes sitting in front of computers, driving, hand-held
devices, and watching TV—all of these activities create severe stress on
our neck and shoulders. While we know we should take constant breaks
from these activities, we often "forget!"
Holding our arms out in front of us and/or cocking our necks to see the
screen properly, we put pressure on our neck and shoulders that they
weren't built to handle. This sets us up for muscle and joint strain and
often leads to tension headaches. Over time, repetition of poor posture
can weaken muscles that normally hold our necks in the correct
alignment. When they weaken over time, the cervical bones can move
around in ways that they shouldn't, pinching, squishing, and generally
wreaking havoc. Muscle spasms, also caused by long-term bad posture, can
do the same thing.
What Kind of Headache Do You Have?
About 42 million Americans suffer from headaches. Twenty percent of
chronic headaches are said to be cervicogenic, and four times as many
women as men experience these.
There are many types of headaches, including migraines, tension, and
sinus headaches. There is also a variety of causes. However, migraine
and tension headaches most closely mimic a cervicogenic headache. You
are much more likely to be diagnosed with a migraine or tension
headaches because so many of the symptoms are the same. For instance,
they all can affect one side, consist of severe throbbing pain, nausea, a
sensitivity to sound and/or light.
Because diagnostic tests (blood work, X-rays, and MRIs) are mostly
ineffective in this case, cervicogenic headaches are still widely
under-diagnosed. According to the National Institute for Health, some
doctors don't even believe they exist.
If a practitioner does suspect a cervicogenic headache, the traditional
way of diagnosing it is to do a neural blockade in the neck. However,
according to The Journal of the American Osteopathic Association,
diagnostic criteria have been developed to provide "a detailed,
clinically useful description of the condition." This allows for a
diagnosis without the need for the neural blockade.
Approaching Your Doctor About Your Headache
As I always recommend for conditions that are uncommon or, at least, not
commonly diagnosed, do your research. Spend time looking for
information about your headache. When you find information pertinent to
your specific case, print it out. Highlight the information that
resonates with you.
If you find that your headaches fit into the cervicogenic profile, make
an appointment with your health care provider to discuss this. When you
schedule the appointment, be sure to ask for a consultation so you have
adequate time to talk without either of you feeling rushed.
Bring copies of your printed information that you can give them along
with a list of your particular symptoms and experiences. This helps keep
the consultation on track. It's also helpful if you know which
direction you'd like to go for treatment.
Important: Be sure your information is from a reputable source that your health care provider is probably familiar.
If your practitioner seems skeptical, give them time to digest this new
information and do their own research, and make another consultation
appointment. No practitioner can know everything. If they are not
willing to listen, look for another practitioner.
Remember, this is your body, and you deserve the best care you can get,
but it is your responsibility to take proactive steps to get the care
you need.
Disclaimer
If your headaches are severe or do not go away, don't attempt to
diagnose or treat yourself. Do your own research, but always consult
your healthcare provider before starting any treatments.
How Do You Treat Cervicogenic Headaches?
Generally, cervicogenic headaches are treated most effectively with a
multi-faceted approach. Since no real studies have been done, this
information is gleaned from anecdotal evidence.
- Pain Medications: Although considered a temporary fix, pharmaceuticals can be helpful to survive a headache and relieve the stress the pain causes. Generally, a combination of medicines for migraines, NSAIDs, and perhaps anti-convulsive, antidepressant, or muscle relaxants can be helpful. Narcotic medicines are not considered effective in this case. Important: You must discuss these medicines with your primary care practitioner since the side effects need to be monitored with regular blood work.
- Manual Therapy: Manipulation of the musculoskeletal system can help correct the misalignment. Reputable chiropractors, osteopathic doctors who specialize in manipulation, and physiotherapists can help realign the joints, often permanently, after a series of visits.
- Physical and Occupational Therapy: Physical therapy can help treat cervicogenic headaches. Both of these therapies are important modalities to help you correct posture and other lifestyle habits that created the misalignment and muscle spasms in the first place. Long-term results are the goal and are achievable for most people.
Trigger Point Therapy Might Help!
I wanted to add information about my discovery of trigger point therapy.
This is therapy I can do myself when I need it most. I don't think I'm
being too dramatic by saying that this has been a game-changer for me.
While the physiology of trigger points isn't well-understood, we can all
find spots on a muscle that hurt more intensely than the rest of the
muscle. By searching for these spots and massaging them, the muscle can
often be coaxed into releasing the stored energy that is causing it be
so tense. For cervicogenic migraines, there are specific trigger points
that definitely help.
For instance, you can get amazing relief from finding the trigger points
on the sternocleidomastoid muscle. This is a very large muscle attached
to the clavicle bone in the front and the base of the head towards the
back. However, there are major nerves and arteries located in this
region of the neck. It's very important that you research how to
properly find and massage these trigger points so that you don't
accidentally damage the nerves and arteries.
Trigger point charts and books are good starting points. However, you
must get familiar with your own trigger points and the muscles involved
with your pain. For example, trigger points in my gluteus maximus and
gluteus minimus muscles are sometimes the keys to relieving my
cervicogenic migraine!
The best part about trigger point therapy is that it's something you can
do to help yourself when you probably feel the most desperate and
helpless. There are lots of charts, guides, and books. The only tools
you need are your fingers, knuckles, or tennis ball. This therapy is
well worth a try.
Important
You must be very familiar with the anatomy surrounding your trigger
points to avoid accidentally damaging important structures. If you are
not comfortable performing this technique yourself, seek guidance from a
professional.
How to Prevent a Cervicogenic Headache
Prevention is always the best medicine. By preventing shoulder stiffness
and misalignment of my neck, I get far fewer of these headaches.
- For instance, I have found that when I sleep with my head flopped to the right, I'm sure to wake up "in trouble." So, I have a few methods to prevent this:
- I prop my pillow up slightly on both sides, usually just using towels underneath.
- If I've been getting mild headaches that I know are caused by misalignment, I wear my cervical collar to bed. It's not the most comfortable thing, but it is way better than the severe headaches that can develop.
- I have several different pillows that work well depending on my needs. Sometimes, I need something firmer; other times, I need something soft.
- I also try to spend 15 minutes a day on my Real-Ease Neck and Shoulder Relaxer. I have prevented imminent cervicogenic headaches by doing this—even in the middle of the night when I wake up feeling one starting up.
- Because of I have Ehlers-Danlos syndrome, I get regular treatment from an osteopath who does low-impact manual therapy. Most of you won't have the chronic problems that I have and may only need a few treatments.
- Work on your posture and ergonomics. Be sure that when you work at your computer, for instance, you have good ergonomics. Customize the keyboard and monitor heights and angles to your needs. Sit up straight Our teachers and parents were right. It might temporarily feel uncomfortable to remain in good posture, but your effort will be worth it.
- Get up regularly and move around. We used to spend more time standing and walking than we do now. If you are at work, walk over to your coworker's desks instead of calling or emailing them. Drink water: refilling and going to the restroom will get you away from your computer. Take a walk around your house, inside or out. Get up and look out the window.
- Many wearable fitness devices (like a Fitbit) encourage 250 steps per hour. This corresponds to the simple advice my physical therapist gave me to be more mobile. If you are goal or numbers oriented, these devices can be great motivational tools.
- Stay away from your smartphone. The position or posture you're in when using your smartphone tenses the muscles around your neck and aggravates the spine. This was hard for me at first, but the headaches reminded me not to play those addictive games for so long!
