Three Common Types of Headaches Exist
They include: tension type headaches, migraine, and cervicogenic headaches. Cervicogenic headaches start in your neck and radiate to your head; more specifically, they are typically one sided with pain radiating to the back of the eye, side of the face, or the jaw. We are now finding more overlap between these types of headaches and the treatment interventions they respond to. Sometimes these headaches mimic migraine headache symptoms. Initially, pain may begin intermittent, spread to one side of the head, and become almost continuous. Furthermore, pain can be exacerbated by neck movement or a particular neck position (e.g., eyes focused on a computer, looking overhead, swimming, or riding a bicycle).
Causes of Cervicogenic Headaches
The cause of a cervicogenic headache is often related to excessive stress to the neck. The headache may result from cervical osteoarthritis, a damaged disc, or whiplash-type movement that irritates or compresses a cervical nerve. The neck’s bony structures (e.g., facet joints) and its soft tissues (e.g., muscles and trigger points within the muscles) can contribute to the development of a cervicogenic headache. Numerous pain sensitive structures exist in the cervical (upper neck) and occipital (back of head) regions. The junction of the skull and cervical vertebrae have regions that are pain generating, including the lining of the cervical spine, the joints, ligaments, cervical nerve roots, and vertebral arteries passing through the cervical vertebral bodies. People with cervicogenic headache often have reduced range of motion of their neck and worsening of their headache with certain movements of their neck or pressure applied to certain spots on their neck.
Pain usually begins after a sudden neck movement, such as a sneeze, impact or trauma. Along with head and/or neck pain, symptoms may include
- Stiff neck
- Nausea and/or vomiting
- Dizziness
- Blurred vision
- Sensitivity to light or sound
- Pain in one or both arms
- Mobility difficulties
Assessment & Diagnosis
After a thorough history, a careful assessment is paramount to exclude other primary (migraine, tension-type) or secondary causes of headaches. Recognizing common patterns and presentations and performing a small number of key orthopedic manual test is typically all that is necessary to identify the source. Diagnostic testing is often not necessary but can include:
- X-rays
- Magnetic resonance imaging (MRI)
- CT Scans (rarely)
- Nerve block injections to confirm the diagnosis
Treatment
Treatment for cervicogenic headache should target the cause of the pain in the neck, and varies depending upon what works best for the individual patient. A recent study by Dunning et al. concluded that high velocity low amplitude manipulation of the atlas and the cervical thoracic junction resulted in long term symptom relief. Additionally, the Osteopractic approach would include western trigger point dry needling to address the muscle tension in the back of the head, neck and shoulders. These two primary interventions, combined with addressing any ergonomic concerns and providing strategies to remove any contributing factors from postural deficits will typically relieve the patient of all symptoms within 6-8 treatment sessions. Rarely are additional providers needed, but may include pain specialists for injections and sometimes neurosurgeons.
Precision Physical Therapy, LLC
Dr. Gregory Shea of Precision PT
This article was composed with contributions from:
The International Headache Society
Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8:959.
Gerard Malanga, MD Physiatrist
New Jersey Sports Medicine, LLC
New Jersey Regenerative Institute
Cedar Knolls, NJ
Dunning et al. BMC Musculoskeletal Disorders (2016) 17:64 DOI 10.1186/s12891-016-0912-3
