Could your headaches be coming from your neck?
June 28, 2019 at 12:16 PM
What is a cervicogenic headache?
Most people have heard of migraine or tension headaches but the term cervicogenic headache was less well known and commonly missed until recently. Cervicogenic simply means coming from the neck. It is widely known that if you have lower back pain it may refer down your leg (sciatica) and that you can feel leg pain without back pain, even though it’s coming from your back. However, it is not as well recognised that the upper segments of your neck (C0/1, C1/2, C2/3) refer to your head and can not only produce headaches but also dizziness, nausea, visual disturbance and other adverse symptoms.
How do they occur?
Headaches arising from the neck may be associated with neck pain and stiffness or may be felt in the head only. The mechanism behind this is convergence of the sensory nerve fibres from the neck with the descending tract of the trigeminal nerve (one of the cranial nerves) at a point in the top of the spinal cord called the trigeminocervical nucleus. This basically confuses the brain into thinking that the pain is coming from the head rather than the neck.
Cervicogenic headaches can arise following injury, particularly whiplash type injuries or following periods of sustained loading of the upper cervical spine such as sitting for long periods with poor posture looking at a computer. The upper cervical facet joints may then become sensitised and on assessment we find that pressing over the joint can reproduce the headache and associated symptoms.
How do we know if your headache is coming from your neck?
Cervicogenic headaches are usually one sided, but can switch from side to side. You may notice neck or shoulder pain or stiffness prior to the headache starting (although in some cases you may not). The headaches may come on after long periods spent looking down, sitting, driving or using a computer or device. They may be getting worse over time and they may have started following an injury. They usually last hours to days and people often find that simple analgesia such as paracetamol or ibuprofen is not very effective.
How do we diagnose cervicogenic headaches?
We usually start by asking some more in depth questions to try and establish whether your headaches may be coming from your neck and we will try to differentiate them from other types of headaches such as migraine, tension or cluster headaches - although this can be difficult as headache types often overlap and some people with migraine or tension headaches also have sensitisation of their upper neck which can be treated with manual therapy. Then we complete objective tests to look for any loss of movement or dysfunction in the upper neck, this includes a test called the flexion rotation test where we often see a loss of movement to the side that the pain is most commonly felt. We will then assess posture and the strength of the deep neck stability muscles and scapular strength. Next we carefully palpate (touch) the upper neck to see if the symptoms can be produced, then reduced with sustained pressure. An Australian Physiotherapist Dr Dean Watson has completed extensive research on the phenomenon, read more about his approach here.
How can we help?
Treatment usually involves postural correction to offload the structures and a standing desk or lumbar support may be helpful to improve the spinal position at work. Then we often use a combination of manual therapy and soft tissue release to address joint dysfunction and muscle tightness and to desensitise the area. Next we prescribe home exercises to strengthening the deep neck stability muscles, correct movement patterns, relieve headaches or for desensitisation. These exercises are available on an app with pictures and videos so that our clients can exercise anytime and anywhere that suits them.
Other things that you may find useful:
Peppermint essential oil is a great one to keep on your desk and can be applied topically to the temples and forehead and has a long lasting cooling effect - read more about it here. Lavender is another great oil as it has a calming effect which is useful if your headaches are triggered by stress and can reduce migraine intensity. If you feel your headaches are triggered by food, dehydration or your menstrual cycle you may benefit from seeing a nutritionist.
If you have any questions about headaches or if you would like to speak to us to find out whether your neck may be causing your headaches feel free to book a complimentary phone consultation or email through your questions.
** If you have had a recent head or neck trauma please consult your doctor, or if you feel a pain “like no other” in your head or neck that comes on suddenly for no apparent reason please seek urgent medical care.
Written by: Katy Street, Masters trained Physiotherapist & director.