By Dr. Adams Scott
People who are suffering from neck pain and headaches are often being undiagnosed or misdiagnosed as tension headaches or migraines. If this type of headache occurs very regularly, then it is most commonly caused by a problem in the upper spine, shoulder or most importantly the neck. These headaches and neck pain are also medically known as cervicogenic headaches.
Cervicogenic Headache Explained
A cervicogenic headache or neck headache is a headache that stems from shoulder or neck pain that is primarily experienced in the forehead, temples or orbital region. It is commonly caused by medical problems such as degenerative disk disease, arthritis, whiplash or muscle spasms. Most commonly than not, the problem usually occurs in the cervical spine with the top 3 vertebrae in particular – especially the C2 and C3 (2nd and 3rd vertebrae). Pain that is generated from the problem is primarily being experienced in the head.
This neck and headache pain will often get worse if you keep your neck in the same exact position for a long time or by specific neck movements. Cervicogenic headaches are a form of referred pain since the pain is experienced in the head even though the problem lies with the neck, shoulders or upper back.
Scoliosis is a common spine problem that causes the headaches and it can be detected using X-ray or MRI scans. In a healthy person, there is usually a gentle curve in the spine; those with cervicogenic headaches usually have no curves and their spines are straight. The scans may also show abnormal movements when the neck or head is flexed. Other than that, there may also be fractures or other bone and tissues abnormalities.
Neck pain and headaches problems can be very difficult to detect since most people that have this problem also have tension headaches or migraines occasionally at the same time. As such, this makes it very easy for doctors to misdiagnose cervicogenic headache as migraines or tension type headaches.
What Causes Neck Pain and Headaches?
1. Sports and Exercises
Do you know that sports such as rock climbing or scuba diving can cause hyperextension or hyperflexion on the neck which can lead to a cervicogenic headache? These are just examples of some sports and exercises that can be possible causes of the neck problem.
Basically, any kind of sports that require extreme movements of the head and neck are potential causes of the problem.
If you have already been diagnosed with cervicogenic headache, then it is best to avoid doing such sports or exercises until you are fully treated.
Whiplash is basically a type of soft tissue neck injury which is normally a result from a car accident; the victim suffers severe impact to the bones when the head was violently thrown forward and backward. It is common for whiplash patients to recover within days or weeks with treatment. However, in some cases, the condition may persist for months or even years. The patient will often experience severe chronic cervicogenic headaches during the period of injury.
Whiplash may also occur from sports and exercises described in Point 1 above. When the pain from whiplash lasts for more than 6 months, then it is considered a chronic medical problem.
2.1 Symptoms of a Whiplash
Patients who are suffering from a whiplash will experience the common symptoms below:
- Neck pain
- Pain in the shoulder or/and back
- Unable to concentrate properly
- Headaches are sometimes accompanied with dizziness and confusion
- Double vision
- Imbalance of movements
2.2 Treating Whiplash Headaches
If the injury is severe, the patient is often asked to wear a soft cervical collarfor a few weeks, as an effort to minimize neck movement.
Other than this, they may also undergo neck exercises and physical therapies; these are typically followed by a series of range of motion exercises or strengthening program that is aimed at helping the patient to fully recover.
3. Degenerative Disk Disease
There are disks that lie between each vertebra in the spine and they can get worn away with aging. Most people above the age of 40 normally have some disk degeneration problems that can be easily observed from X-ray scans.
Degenerative disk disease can cause neck pain and headaches if not properly treated. The common treatment for the disease can include but are not limited to the following:
- Massage therapy
- Surgical procedures
4. Headaches and Neck Pain from Arthritic Problems
It is common for people over the age of 40 to have some form of wear and tear in their cervical spine. Arthritis in the spine will increase the risk of cervicogenic headaches; at times, this could be inherited from parents.
Most of the time, people with Arthritic problems will also suffer from degenerative disk disease. With the problem being compounded, it is very likely for the patient to develop chronic headaches and neck pain.
5. Other Causes
While the above are some common causes of cervicogenic headaches, there are also other reasons that may cause the headaches. Other types of injuries such as bone fracture or a bad fall may sometime lead to neck and headache pain as well.
Sometimes an injury will only cause a minor damage but can continue to erode your tissues and muscles which then lead to problems at later stages.
Symptoms of Cervicogenic Headaches
The next time you suspect that you are suffering from cervicogenic headaches, first check if you experience the key symptoms below. Seek help from a doctor immediately if you experience any of them.
- Pain in shoulders
- Flexibility of neck becomes limited
- Neck movements or pressure on neck will cause headache pain
- Neck becomes tender to touch
- Pain amplifies when lying or sitting down for long hours
- Have minor neck pain prior to experiencing severe headaches
Diagnosing the Headaches and Neck Pain
Diagnosing a cervicogenic headache often starts with a physical examination followed by X-rays, CT or MRI scans.
The doctor may also interview you to find out your line of work and your sitting/standing posture. For example, working as a computer programmer, truck driver or as a white-collar worker may increase the chances of getting neck pain; these jobs may require you to remain at certain standing or sitting positions for long hours. Maintaining a good posture at most time is important as bad sitting or standing postures increase the risk of neck headaches significantly.
If you have been experiencing headaches for years and most medications or treatments are not helping, then consult your doctor to consider if you are suffering from cervicogenic headaches. Your doctor may refer you to a specialist who can diagnose neck and headache pain better.
Treating Neck Headaches
There are many approaches to treat the neck pain and headaches. However, different people may react differently to each one and doctors usually work very closely with their patients to work out the best option.
1.1 Trigger Injections
This is one of the popular ways to relieve cervicogenic headaches. For this to work, doctors will perform trigger point injections of anesthetic drugs on the patients. The drugs will be injected into the muscles surrounding the upper cervical spine in a series of shots.
Relief may come quickly within hours or sometimes not at all. The following are the type of drugs that are most commonly used here.
- Lidocaine or similar drugs
- Steroids such as methylprednisolone
1.2. Botox Injections
Over the recent years, patients have seen significant improvements to their cervical headaches after doctors prescribed them with Botox injections.
This treatment is ideal if there is a severe range of motion limitation or if spasm is a major contributing factor to the problem. Sometimes, doctors will also prescribe this if the patient did not respond to any other treatments that have been given so far.
1.3 Joint Injections
In this treatment, doctors will inject corticosteroid drugs into the affected joints to relieve the neck or back pain. These are generally very effective but for most time, the pain usually comes back after 3 to 4 months.
The drug has an anti-inflammatory effect which helps in the relaxation of muscles as well. The entire treatment process only takes about 20 minutes and can be performed in the doctor’s office.
1.4 Nerve Block Injection
In this procedure, anesthetic or steroid medications are injected to block out the pain at the affected nerve – this is usually and the 2nd or 3rd cervical disk. A fluoroscope or a CT scanner are normally used to help the doctor to see where to inject.1
Most of the time, doctor will prescribe drugs to bring the cervicogenic headaches under control. This section will identify the common medications that are being used.
Low dosages of Pamelor, Aventyl or Elavil are usually used here. These drugs induce drowsiness and will help the patients to sleep better.
Note that these drugs are not only used to treat depression. High dosages of these drugs are required for depression but only minimal amount is required for headaches.
Also commonly known as nonsteroidal anti-inflammatory drugs, these are usually used for neck pain and headaches.
|Over-the-counter NSAIDs||Prescribed NSAIDs|
Do note that there is an increased possibility of developing stomach ulcers or cardiovascular disease if NSAIDs are consumed regularly.
2.3 Preventive Medications
Some examples of these include Tegretol and Topamax; they are anti-seizure drugs that have been proven to be effective in preventing chronic headaches.
However, Topamax may have some side effects including:
- Sense of fogginess
- Tingling sensation in fingers and toes
- Loss of weight
2.4 Over-the-Counter Medications
There are OTC creams available in the market that helps to alleviate the muscle pain from the neck. Most if them contain Lidocaine or other numbing agents that help to numb the pain occurring just below the skin.
3. Massage Therapy
This method is mostly used as a preventive measure and is effective for chronic tension headaches and migraines as well. Visiting licensed therapists with at least several years of experience is important in getting the best out of this.
However, this method is generally not effective if the patient is already in the midst of a severe headache attack.
4. Chiropractic Treatment
Performed by a chiropractor, this treatment will attempt to forcibly change 1 or more points in the spinal alignment. Before this, the chiropractor will analyse various factors of the patient such as medical history, X-ray results and so on.
Nowadays, many chiropractors use both massage therapy and spinal alignment at the same time to treat their patients and studies have shown mixed results with chiropractic treatments. Some patients with cervicogenic headaches responded very positively to the treatment, while some did not show any significant improvements.
5. Physical/Physio Therapy
In this treatment, the patient is taught some basic exercises aimed at gaining strength and mobility in the affected areas. These exercises help to stretch and relax the tensed up muscles as well as strengthening the weak muscles. Heat is sometimes being applied to help the muscles to relax as well.
The therapist will usually design a special program that is tailored to the patient’s needs. Some of these exercises can be performed at home without the need of any special equipment.
Each session can typically last for about 30 to 60 minutes.
6. Corrective Surgeries
This is usually the last option for treating cervicogenic neck headaches. Patients who are treated using this option usually suffer from severe chronic headaches. Surgeries are sometimes also recommended if the patient suffers from pain due to degenerative disk disease.
There are mainly 2 types of surgical procedures as follows:
6.1 Spinal Fusion
This option is rarely used on patients who are suffering from cervicogenic headaches. However, doctors may recommend it if the patient is experiencing continuous pain from the spinal disks.
The procedure involves removing the disk that is causing the severe pain; the rest of the bones will fuse together by themselves over time. For most time, the surgeon will make use of plates, screws or other bone materials to help in this fusion.
Spinal fusion is also a very complex procedure and should only be performed by an experienced surgeon. Unfortunately, there are 2 main drawbacks from this procedure:
- Long and painful period of recovery of at least 3 months
- Decreased of range of motion
As such, this procedure should only be used as the last resort; proper planning and thought must also be carried out in advance.
6.2 Radiofrequency Neurotomy
This procedure is targeted at the affecting nerve that is causing the pain. The main objective is to cut off blood supply to the nerve. Once the problematic nerve is being identified as the main pain generator, the physician will first inject it with Lidocaine; this will be followed by a series of radiofrequency waves directed at the nerve. As such, blood flow to the nerve will be restricted and pain will eventually subside.
After this procedure, the patient will usually require minimal or no painkillers at all for their headaches.