Cervicogenic Headaches

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Cervicogenic Headaches 2016-11-17T09:53:18+00:00

What Are Cervicogenic Headaches?

Cervicogenic headaches are characterized as head and neck pain originating from the cervical region. Cervicogenic headaches are a type of secondary headache. This classification is due to the source of the headache being in the neck.  The primary nerve in the cervical region associated with cervicogenic headaches is the occipiatal nerve, located at the base of the skull.  In addition to the occipital nerve, this region also implicates the trigeminal nerve, which is why cervicogenic pain can be felt in the facial and forehead regions.

Multiple studies have indicated that cervigogenic headaches may be under-diagnosed, with estimates of prevalence ranging from 2% up to 22%. Cervicogenic headaches can be differentiated from other types of headaches by several symptoms. Cervicogenic headaches rarely present auras that are commonly associated with migraine headaches. Cervicogenic headache pain is often not described as throbbing or increasing when bending forward, which is often associated with migraine headaches. Patients also rarely experience nausea with cervicogenic headaches and the pain is not responsive to traditional migraine medications. Lastly, and perhaps most indicative of cervicogenic headaches, is the location of the onset of pain. While migraine pain often begins toward the front of the head, cervicogenic headache pain begins in the back of the head, base of the skull, or neck.

Cervicogenic headaches are, in part, characterized by pain in the upper neck or base of the skull. One way in which cervicogenic headaches can be readily diagnosed is if treatment of the neck is able to provide rapid relief from the headache. Neck soreness is not required for the diagnosis of a cervicogenic headache, however. The stress to the joint of the neck may still be present, even if it does not cause direct pain to the patient. This can lead to a more difficult diagnosis, which is why it is important to consult your physician.

Causes Of Cervicogenic Headaches

Any injury to the neck or cervical region of the spine can lead to cervicogenic headaches. This injury may be an acute, sudden injury resulting from an automobile accident, a sports-related injury, or a fall, or it may be the result of a long-term sustained injury caused by bad posture or age.  It is often easiest to identify the source of cervicogenic headaches when they can be traced back to a specific neck injury. The following section focuses on causes that are less immediately recognizable.

Weak neck muscles may be a cause of cervicogenic headaches because they do not offer sufficient support and stability to the vertebrae in the upper neck. A lack of stability causes unnecessary motion and increased damage from impacts. Over time, this can damage the vertebral discs in the neck, causing them to shift or bulge. Keeping your neck in a stiff and suboptimal position (poor posture) can also lead to damage of the neck muscles and joints. However, it is unclear whether posture contributes significantly to cervicogenic headaches. When this happens, the area becomes inflamed and the nerve becomes irritated, leading to increased pain signaling.

Damage to the vertebral discs resulting from age, arthritis, or injury can lead to additional bone growth on the vertebrae. This additional growth can reduce the space in the spinal column or directly put pressure on surrounding nerves. In the neck, this can cause pressure and irritation of the cervical or occipital nerves, resulting in a cervicogenic headache.

Treatments For Cervicogenic Headaches

The specific treatment for cervicogenic headaches varies by patient and by what is found to be the cause of the headaches. For patients whose cervicogenic headaches are a result of damage to vertebral discs, there is often underlying inflammation contributing to nerve irritation. In this case, an injection of a steroid may suffice to reduce the inflammation and relieve the pressure on the nerve.

For patients with a severely damaged or herniated cervical disc, a steroidal injection may not be sufficient. In that case, surgery may be a better option for long-term relief. The tissue bulging from a herniated disc may put pressure on the surrounding nerves, including the occipital nerve. Excess disc material can be surgically removed to relieve pressure on the surrounding nerve fibers.

If the problem found in the neck is a result of musculature, then muscle-specific treatment options may provide short- and long-term relief. In the short-term, muscle relaxants can be used to relieve strain of the neck muscles. Following successful pain relief by muscle relaxants, more long-term muscle-related approaches can be taken. For patients who are prone to neck injuries, they may benefit from muscle exercise and strengthening, while many patients may find long-term benefits from physical therapy using a combination of stretching and exercise.

To directly address the nerve triggering the cervicogenic headache, nerve blocks can be administered by a physician to inhibit the problematic signaling. Nerve blocks directly block signaling from the nerve fiber and prevent the pain signals from being transmitted. This is useful as a form of pain relief during other treatments, and it can also be used when no clear skeletal or muscular source of the nerve irritation can be identified.

Conclusion

There are many different types of headaches, many of which have overlapping symptoms. Properly identifying the type of headache can be useful in identifying the cause of the headache. Cervicogenic headaches are a type of secondary headache characterized by an origination of pain in the upper neck and subsequent pain around the eyes or forehead. Cervicogenic headaches are also associated with neck problems such as strain or limited range of motion. Providing your doctor with an accurate description of your symptoms will allow them to make a more accurate diagnosis. Although cervicogenic headaches may be chronic, treatment options exist depending on their cause. Some patients may require steroidal injections or surgery, while physical therapy is much less invasive and provides relief for most patients.

References

  1. Antonaci F, Sjaastad O. Cervicogenic headache: a real headache. Current Neurology and Neuroscience Reports. 2011;4:149-155.
  2. Farmer PK, Snodgrass SJ, Buxton AJ, Rivett DA. An investigation of cervical spinal posture in cervicogenic headache. Physical Therapy. 2015;95(2):212-222.
  3. Gross A, Kay TM, Paquin JP, Blanchette S, Lalonde P, Christie T, Dupont G, Graham N, Burnie SJ, Gelley G, Goldsmith CH, Forget M, Hoving JL, Brønfort G, Santaguida PL, Cervical Overview Group. Exercises for mechanical neck disorders. Cochrane Database of Systemic Reviews. 2015; 1:CD004250.
  4. Hall T, Briffa K, Hopper D. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. The Journal of Manual and Manipulative Therapy. 2008; 16(2):73-80.
  5. Lucas S, Hoffman JM, Bell KR, Walker W, Dikmen S. Characterization of headache after traumatic brain injury. Cephalalgia. 2012;32(8):600-606.

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