The mental and physical exhaustion resulting from constant intense pain can be overwhelming. The aching sensations and tension in your neck and shoulders can damper your overall health and sense of well-being. However, we are here to accompany you on your path of comprehension, improvement and possible resolution of cervicogenic headache.
As we go deeper into the topic of cervicogenic headaches, our goal is to provide you with the tools necessary to investigate the complexities of your pain and learn useful techniques for coping with it. We want to provide you with the understanding, compassion, and practical answers that can make a real difference in your life. It is our primary purpose.
Did you know that 70% of patients with migraine get neck pain as an early migraine attack symptom? This commonly leads to an assumption that neck pain is the cause of the headaches, when it is actually the reverse in that the neck pain is referred pain caused by the migraine. This occurs due to the trigeminocervical nucleus, which is the magic link and relay center between headache and neck pain. Therefore, it is very important to differentiate true cervicogenic headache (less common) from migraine associated neck pain (more common), as discussed in much greater detail here. Focusing treatments on cervicogenic headache, when the real cause is referred migraine pain can lead to a whole list of unnecessary invasive procedures and surgeries that could potentially worsen pain.
This blog article will focus on true cervicogenic headache, but I would also recommend reading the above linked article on headache, migraine and neck pain to be aware of this more common scenario, and make sure to rule it out first.
Identifying Cervicogenic Headache Symptoms – The Basic Details
Cervicogenic headaches differ from other types of headaches in how they feel and look. Knowing the cervicogenic headache symptoms is important so they can be properly diagnosed and treated.
1. Neck Pain
Neck pain is one of the main cervicogenic headache symptoms. Usually, the pain starts at the base of the head or upper cervical spine and spreads to the forehead, temples, or behind the eyes. Cervicogenic headache tends to be side-locked to one side of the neck and head.
2. Referred Pain
Referred pain can happen differently for different people but usually takes the same path based on the affected nerves. Depending on which level of the cervical spine is affected, the specific location of pain referral into the head and face may vary.
3. Limited Range of Motion
People with cervicogenic headaches may notice that they can’t move their necks as much as they used to. This problem can make it hard to turn the head or tilt it back or forwards. Typically, one side is harder to turn to then the other and this direction may trigger the pain in the neck and into the head.
4. Unilateral Headache
The pain might only be in one spot or all over the head. It’s important to remember that, unlike migraines, the pain doesn’t move from side to side during an attack. Cervicogenic headaches tend to be sidelocked to one side, along with the neck pain on that side.
5. Associated Symptoms
Symptoms that can occur with cervicogenic headaches. Some of these are shoulder pain, arm pain (cervical radicular nerve pain referral), tingling or stiffness in the upper limbs, dizziness, and sometimes even vision problems. Occipital neuralgia is often accompanied by cervicogenic headache as well. These related signs show that neck and head pain are often associated in some way.
Identifying Cervicogenic Headache Symptoms – The Finer Details
According to the International Headache Society International Classification of Headache Disorders (ICHD3), cervicogenic headache is a “headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.”
The diagnostic criteria require clinical and/or imaging (such as MRI or CT) evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache. With that said, this association can be tricky. Imaging findings such as canal narrowing, disk bulging, and arthritis in the upper cervical spine are common in patients without headache as well. These abnormalities can be suggestive but do not always confirm a definite cause of cervicogenic headache. In fact, most of the times these common arthritic findings (which most everyone has) are unrelated. Findings such as herniated disks (more than just bulging) and cervical radicular pain (sharp pains going from the neck down an arm into the fingers) are usually more relevant and suggest an association with true cervicogenic headache. Cervicogenic headache tends to be most commonly side-locked to only one side of the head.
The criteria also require evidence of causation demonstrated by at least 2 of the following 4 features:
- Headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion. For example, perhaps a new cervical disk herniation is seen on MRI which was not present on a previous MRI.
- Headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion. For example, if a herniated disk or severe spinal stenosis (narrowing) undergoes surgery and then the headache resolves.
- Cervical range of motion is reduced and the headache is made significantly worse by reproducible movements. For example, the headache is triggered by moving the head and neck certain ways, or by pushing on specific muscles or areas in the neck. These maneuvers cause pain to spread from the neck and back of the head forwards. For example, if the person turns their head to the right side and that triggers the head and neck pain.
- Headache resolves following diagnostic blockade of a cervical structure or its nerve supply. These include procedures such as cervical facet blocks or cervical epidural injections.
Cervicogenic Headache Exercises for Relief
When treating cervicogenic headaches, doing cervicogenic headache exercises can be very helpful. Referral to a good physical therapist who is well versed in treating the cervical spine is a standard conservative first line treatment and is usually very effective. These movements aim to increase the range of motion in the neck, strengthen the muscles that support it, and ease tension in the cervical spine.
1. Shoulder and Upper Back Strength
Shoulder and upper back muscles that are strong and stable can help support the neck and relieve stress on the cervical spine. Shoulder shrugs, shoulder blade squeezes, and rows are good cervicogenic headache exercises to add to your practice.
These movements work on the trapezius, rhomboid, and other supporting muscles. They help you stand up straighter and relieve tension in your neck.
2. Isometric Neck Workouts
In isometric workouts, the muscles are contracted without moving. These movements can help strengthen the muscles in the neck and make the body more stable. One such practice is the chin tuck.
First, make sure you’re sitting or standing in a good way. Keep your head level as you gently tuck your chin in, looking at a double chin. Hold the pose for 5 to 10 seconds, then do it repeatedly. These cervicogenic headache exercises help strengthen the deep neck flexors and improve the alignment of the neck.
3. Range of Motion Exercises
Exercising the neck’s range of motion can help make it more flexible and less stiff. To improve flexibility, these movements involve moving the neck in different ways. Some examples are turning the neck, bending the neck to the side, and tilting the head.
Start with gentle movements and slowly improve the range of motion over time. Pay attention to any pain or discomfort and change the movements as needed.
Medications and Interventional Treatments
When it comes to dealing with cervicogenic headaches, there are several drugs and in-person treatments that can help relieve pain and improve your life. These methods aim to get to the root of the headaches and relieve their painful influence. This section will discuss some of the most popular medicines and procedures used for cervicogenic headache treatment.
1. Over-the-Counter Pain Relievers
Over-the-counter pain relievers can help with mild to heavy cervicogenic headaches for a short time. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium can help lower pain and swelling. Naproxen tends to last longer, up to 12 hours, whereas ibuprofen lasts up to about 8 hours. But it’s important to use these medicines as recommended and talk to a doctor if your headaches keep returning or if you have any other health problems.
2. Prescription Drugs
If your cervicogenic headaches are strong or last long, your doctor may prescribe certain drugs to help with the pain and other symptoms. These may include muscle relaxants to ease muscle tightness, triptans, gepants, or DHE to treat migraines that may accompany the cervicogenic headache (can commonly trigger migraines), or antidepressants such as amitriptyline or duloxetine to change how pain signals are sent. Gabapentin is also commonly used as a first line daily preventive treatment. The right medicine for you will depend on your symptoms and medical history. It’s important to follow your doctor’s advice and let them know about any side effects.
3. Nerve Blocks
Nerve blocks involve injecting a local anesthetic or a combination of anesthetic and corticosteroid into particular nerves or trigger points linked to cervicogenic headaches. This treatment aims to stop pain messages and give short-term relief. For cervicogenic headaches, nerve blocks like occipital nerve blocks, and trigger point shots are often used. Nerve blocks are usually done by a pain expert or doctor specializing in interventional pain management.
4. Botox Injections
Botulinum toxin type A, or Botox, can also be used to treat recurring headaches that come from the neck, specifically when accompanied by chronic migraine (15 or more headache days per month with at least 8 days having migrainous features). Without associated chronic migraine documented in the chart, insurance will deny this treatment though. Botox works by stopping the release of certain inflammatory neuropeptides that are needed for pain to be felt. Botox also causes the muscles to chemically relax for 3 months, which can help with the muscular pain. The shots are put into certain muscles of the head and neck, specifically in the places where the headaches happen. Most of the time, this cervicogenic headache treatment is done by a doctor who can give Botox shots, particularly a headache specialist.
5. Physical therapy
Physical therapy is a key part of treating headaches that come from the neck, and should always be considered a first line treatment. A physical therapist can look at your stance, how mobile your neck is, and any muscle imbalances. They can make a treatment plan just for you based on these things. They will also put a specific tailored treatment program together that you can continue to do on your own after their treatment sessions are done. Physical therapy may include manual therapy methods, exercises to improve strength and flexibility, postural correction, and education about ergonomic principles. Physical therapy can help lower pain, improve function, and stop headaches from happening again.
It’s important to remember that doctors are the only ones who should recommend and give you medicines and other treatments. They will examine your unique health problem, consider any underlying health issues, and develop a cervicogenic headache treatment plan that fits your needs.
You can retake control over your life if you are armed with knowledge and a repertoire of effective ways to deal with cervicogenic headaches. This extensive guide has discussed the complexities of cervicogenic headache exercises, symptoms, and therapies. Make an effort to seek assistance from medical specialists such as a neurologist, headache specialist, pain management specialist, or spine specialist, to get you started on a tailored treatment program today and the road to recovery.
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