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
- 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.
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.
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!