What is Cervicogenic Headache (Neck and Headache)?
A cervicogenic headache is a type of pain that typically starts on one side of the neck and moves to other parts of the head or face. It’s often a recurring issue and can start after moving your neck. This type of headache can also make it harder for you to move your neck as freely as you normally would. It can be easy to mistake a cervicogenic headache for a migraine, tension headache, or other common types of headaches.
To properly identify a cervicogenic headache, there are certain factors that must be present:
1. The headache needs to originate from the neck and be felt in the head or face.
2. There needs to be proof that the neck is the source of the pain. This could include showing signs that point to the neck as the source of the pain, or seeing the headache go away after medical treatment is applied to a certain part of the neck or its nerve supply.
Once the root cause of this type of headache is treated successfully, the pain usually goes away within three months.
What Causes Cervicogenic Headache (Neck and Headache)?
A cervicogenic headache is believed to be a type of pain that comes from irritation in the neck area, specifically, from parts connected to the C1, C2, and C3 spinal nerves. So, any part connected to these spinal nerves could potentially cause a cervicogenic headache.
Risk Factors and Frequency for Cervicogenic Headache (Neck and Headache)
Cervicogenic headache is a rare type of chronic headache that typically affects people between 30 and 44 years old. Despite its rarity, affecting only between 0.4% and 4% of patients with headaches, it impacts both males and females equally. Generally, it starts to appear in the early 30s, but people typically seek medical attention and get diagnosed around the age of 49.4. One distinct symptom is a tenderness in the muscles around the skull on the side that hurts, accompanied by a noticeably less severe headache.
Signs and Symptoms of Cervicogenic Headache (Neck and Headache)
People usually report one-sided pain that doesn’t change sides. This condition is more common in women. The pain often starts in the neck and spreads to the area around the eye and front side of the head. This pain can come in episodes or it could be a steady, continuous pain that gets worse with head movement. The pain can range from moderate to severe, but it isn’t extreme or pulsating.
The pain can be similar to headaches caused by tension or migraines. However, sufferers are less likely to report being sensitive to light and sound like with migraines. The pain could be accompanied by limited neck movement or pain on the same side of the neck, shoulder, or arm. Common headache medications such as triptans, ergotamine or indomethacin might not relieve the pain. Symptoms like light sensitivity, sound sensitivity, nausea and vomiting are less common.
Testing for Cervicogenic Headache (Neck and Headache)
If you have a headache that’s believed to originate from the neck, or a “cervicogenic” headache, imaging tests of the cervical spine, such as an MRI or CT scan, might not be enough to confirm that diagnosis. Recent studies have not been able to pinpoint specific abnormalities that consistently show up on these tests for people with this type of headache. Past research has only noted a straightening of the upper spine or disc protrusions. However, functional imaging (a lesser-used approach) can show an abnormal amount of movement in a certain part of the upper spine.
Sometimes, doctors might order different types of imaging to rule out other conditions that might resemble a cervicogenic headache, like nerve root damage, spinal cord disorders, or Chiari malformations, which is a problem with the area where your skull and spinal cord connect.
There are established criteria for diagnosing a cervicogenic headache, which include: the headache’s connection to a lesion or disorder in the cervical spine or neck tissues; the headache’s appearance, improvement, or resolution in relation to the disorder or lesion; a limited range of motion in the neck which can worsen the headache; and the headache’s disappearance after the problematic cervical structure is blocked or its nerve supply is cut off.
In special cases, doctors might use diagnostic anesthetic blocks, a process that requires specialized skills, to confirm the diagnosis of a cervicogenic headache. However, this isn’t a standard procedure that’s widely used.
Treatment Options for Cervicogenic Headache (Neck and Headache)
Physical therapy is typically the first treatment for cervicogenic headaches, which are headaches caused by issues in the neck. Exercise treatments and manipulative therapy, which involves adjusting the joints in the neck, are effective for managing the condition. Following a specific study, it was found that after one year, over half of the patients experienced fewer headaches, and some reported a high degree of relief. These treatments work by stimulating natural pain-inhibitory systems in the spinal cord. However, physical therapy can sometimes initially increase the headache. In such cases, the treatment should be slowly increased, combining mild stretching exercises and manual neck traction. To help with pain relief and make physical therapy more tolerable, a temporary anesthetic may also be used.
Patients can also be treated with interventional therapy, which is a type of treatment based on the specific cause of the headache. Interventional therapy can involve injections to diagnose and treat the headache when it’s due to joint inflammation from advanced age or injury. In some cases, a cervicogenic headache may result from arthritis of a specific neck joint or nerve, often following a whiplash injury from a car accident. Injections into this joint can decrease pain, and temporary pain relief can also be achieved by blocking this nerve. For long-term pain relief, a treatment involving the use of heat on the nerve, called radiofrequency ablation, is available. Surgery is only considered when all other treatments have failed.
Steroid injections into the space around the spinal cord in the neck, called cervical epidural steroid injections, can be beneficial too, especially if pain continues to sensitize the nerve roots in the neck, resulting in inflammation and micro-injuries. These injections are considered relatively safe compared to other invasive neck treatments and can reduce daily usage of pain-relieving drugs.
Medications such as pregabalin, duloxetine, and gabapentin have had mixed responses in treating cervicogenic headaches. Other treatment methods like coblation and neuromodulation, which involve technologies to destroy tissue and alter nerve activity respectively, need more study to assure their effectiveness.
What else can Cervicogenic Headache (Neck and Headache) be?
It’s essential to distinguish between conditions such as occipital neuralgia, a type of headache, and similar pain that originates from certain neck or head areas. Occipital neuralgia can mimic a type of headache known as a cervicogenic headache. Usually, occipital neuralgia causes sharp pain in the back of the head. The main nerves involved in this type of pain are the greater and lesser occipital nerves.
Occipital neuralgia treatments may include certain types of nerve blocks, a procedure known as cryoneurolysis, radiofrequency ablation (a technique using heat to reduce pain), and neuro-ablation procedures such as dorsal rhizotomy where certain nerve roots are cut to alleviate pain.
When diagnosing cervicogenic headaches, doctors need to consider other possible conditions, such as:
- Tension headaches and migraines
- Conditions involving the internal carotid or vertebral arteries
- Arnold-Chiari malformation (a condition where brain tissue extends into the spinal canal)
- Disc herniation
- Tumors within or outside the spinal cord
- Spinal nerve compression or tumors
- Malformations in the blood vessels
- Neck-tongue syndrome (a condition causing neck pain and changes in feeling in the tongue)
What to expect with Cervicogenic Headache (Neck and Headache)
Treatments for cervicogenic headaches often serve to manage symptoms rather than completely cure the condition, meaning that regular check-ups may be necessary. Certain factors are associated with better outcomes for patients suffering from these types of headaches. These factors include being older in age, experiencing more intense headaches when moving, and having stable employment.
Possible Complications When Diagnosed with Cervicogenic Headache (Neck and Headache)
Cervicogenic headaches can become extremely bothersome if not taken care of properly. Sometimes, these headaches can become a continuous or a recurrent issue. If this happens, it’s crucial for the person experiencing this to get in touch with their healthcare provider for an accurate diagnosis and proper treatment.
Preventing Cervicogenic Headache (Neck and Headache)
Patients might need to have detailed discussions with their doctors because the treatments recommended often do not completely cure the condition. Regular check-ups may also be necessary to keep track of their symptoms. It’s also crucial to incorporate suitable physical therapy into their treatment plan. However, patients should be made aware that their headaches might initially get worse with this therapy. This can sometimes lead to patients not following the treatment plan properly.