Can neck problems cause headaches? What are cervicogenic headaches?
Headaches are quite common. Within a given year 90-95% of individuals will have at least one headache. There are basically 2 types of headaches: Primary and secondary. Primary headaches includes tension headaches, migraine headaches and cluster headaches. These are the most common, accounting for at least 95% of headaches. Secondary headaches are headaches due to problems such as diseases of the brain, infections, circulation problems and disorders of the eye, ear and nose. Somewhere in between these 2 major categories may be headaches related to disorders of the neck portion of the spine. However, how frequent these so-called “cervicogenic headaches” are is uncertain. The basis of the uncertainty is that they are difficult to diagnose and there is a lack of well-defined diagnostic criteria. The manifestations of cervogenic headaches may overlap with migraine and tension headaches and they may also occur in combination..
The possible sources of cervicogenic headaches include structures in the neck which have a rich supply of nerve input. These structures include the facet (zygapophyseal) joint, the intervertebral discs as well as ligaments and muscles of the neck. It is often theorized that the most important structural basis for cervicogenic headaches may be the facet joints. These joints have been demonstrated to be the single most common source of pain after neck whiplash injuries. This has been determined by tenderness on examination and manipulation as well as diagnostic tests consisting of local anesthetic blocks to the joints. The connection of headaches and painful structures of the neck is probably related to the overlap of the nerves which sends signals to the brain from both the back of the head and the neck region. The nerve cells of the trigeminal nucleus extend from the brainstem to the upper neck area and relay sensory information about the face and head. In extending down to the neck portion of the spinal cord, there is overlap with the sensory nerve centers of the upper 3 or 4 cervical (neck) spinal cord segments.
Treatment for these headaches is directed to the area thought to be the likely pain source. For some, this may be excessive muscle tension or irritation of the fascia investing the muscle tissue. For those instances modalities such as physical therapy, acupuncture , biofeedback , low level laser therapy and massage therapy may be useful. For others the basis could be injury or degeneration of the facet joints which could respond to selective anaesthetic nerve blocks. Recent observations show promising results with the use of nerve stimulators to stimulate the occipital nerve at the back of the head for relief of some types of headaches and upper neck pain. This is will be the topic of another post in the future.