Headaches caused by the cervical spine
Whether from chronic tension or acute whiplash injury, intervertebral disc disease or progressive facet joint arthritis, the neck can be a hidden and severely debilitating source of headaches. Such headaches are grouped under the term “cervicogenic headache,” indicating that the primary contributing structural source of the headache is the cervical spine. There are well mapped out patterns of headache relating to a multiplicity of muscular trigger points in the neck and shoulder-blade (or peri-scapular) region, as well as to disc and joint levels in the upper cervical spine. Even headaches located predominantly in the forehead, or behind, in and around the eyes are very often “referred”pain zones for pathology located in the back of the neck and at the base of the skull. This base of the skull area is called the suboccipital region, because it is below the occipital part of the head. The joints connecting the top two or three levels of the cervical spine to the base of the skull handle almost 50% of the total motion of the entire neck and head region, thus absorbing a continuous amount of repetitive stress and strain, in addition to bearing the primary load of the weight of the head. Fatigue, postural malalignment, injuries, disc problems, joint degeneration, muscular stress and even prior neck surgeries all can compound the wear and tear on this critical region of the human skeletal anatomy. One may also develop a narrowing of the spinal canal itself, through which runs the spinal cord and all of its exiting nerve roots, leading to a condition termed spinal stenosis, also a possible source of headaches, among other symptoms.
Cervicogenic Headache Treatment
Treatment requires a thorough evaluation of the possible contributing factors, several of which often exist together. Physical therapy, provided by an expert spine therapist, is critical to the success of most other treatment modalities, whether those include pain injections or surgery or relaxation and posture techniques. Injections can take the form of muscle (or myofascial) trigger point blocks, nerve blocks or epidural spinal injections. The most effective injections for cervicogenic headaches usually end up being x-ray guided facet joint blocks, especially of the upper facet levels. These should only be performed by a physician trained, skilled and experienced in such procedures, as the area in the neck where they are given is quite complex. If investigation leads to discovery of significant enough disc or joint disease in the cervical spine, leading to altered load bearing in that area and pain, surgery is sometimes the best answer. Any particular treatment, however, is provided in the context of a comprehensive program addressing all of the issues and possible contributing factors noted above.
Chiropractic adjustments, acupuncture and massage are all excellent therapeutic options to assist in managing chronic pain problems or in arresting acute flare-ups of headache pain emanating from the neck area. A word of caution about such modalities, though, is that they are passive. A critical component of any long-term effective pain-management regimen is a committed, active participation of the patient. Triggering activities need to be recognized. Early pain-building warning signs must be learned and counter-acted. Posture and exercise need to be attended to, while stress must be diffused out of the body. Medications are very effective for cervicogenic headaches, to the degree that they can be tolerated while an individual goes on living a functional life. Certainly in severe pain crises, the paramount goal is to maximally relieve pain as quickly as possible. The balance is to work toward minimizing the number of crises one has to experience, whether through corrective treatment or proactive effective management.
Severe headaches are almost universally described as “oh this was a migraine,” but true migraine variant headaches are thought to comprise only 8% of all headache episodes. The much more common, but just as severe, pounding, throbbing, stabbing and nauseating headaches originate from tension, absorbed most frequently in the body in the neck and shoulder region. The majority of these can fall into the category of cervicogenic headache. TMJ and sinus sources are in actuality small fractions of the primary etiologies of headaches. They certainly can be secondary contributors, which set off a smoldering major complex headache. But beware of sinus or major dental surgical procedures without at least a thorough evaluation of all diagnostic possibilities.
Remember, pain is invisible. Very few headaches “show up”on brain MRI scans. There is much to be seen and found in the high stress zone of the neck, however, and this area should be evaluated in detail and treated aggressively in anyone with chronic or recurrent headaches. Even patients with true migraines or cluster headaches will eventually also often end up with compounding cervicogenic headaches, because of the severe stress of the original headache in the first place. One headache is bad enough. No one needs two types to suffer under.