• Dr. Donald Littlewood

Headaches can be such a pain in the neck

Headaches are somewhat of a mystery. A lot of people don't get them at all, while some get them all.the.time. Others just get the occasional one. Most headaches we don't know a ton about, but we do know that they can be very debilitating.


Helping you understand your headaches is where I come in. This blog post is all about cervicogenic headaches [which is one we do know about!], where we will talk about:


❓ What they are

🤓 Why/how we get them

💆🏽 How I can help you resolve them


❓ What are cervicogenic headaches?

The International Headache Society describes a cervicogenic headache as a "headache caused by a disorder of the cervical spine & its component body, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain."


In English, this means that a cervicogenic headache is one that is caused by the disc, joints and/or soft tissue [muscles/ligaments] of the neck.


In addition to that definition, the IHS has also come up with some criteria that helps us diagnose a cervicogenic headache. It has to have at least two of the following:

  1. headache has developed in temporal relation to the onset of the cervical disorders or appearance of the lesion

  2. headache has significantly improved or resolved in parallel with improvement in, or resolution, of the cervical disorder or lesion

  3. cervical (neck) range of motion is reduced and headache is made significantly worse by provocative manoeuvers

  4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply [NB: I have never actually heard of this being done for diagnostic purposes outside of an academic study]

This diagnostic criteria is great but it does leave some holes in describing what someone with a cervicogenic headache might be feeling. Let me break that down for you.

A 'typical' patient with a cervicogenic headache often presents with:

  • Pain in the head. Where this pain is located differs from person-to-person, headache-to-headache, but it is a hallmark feature.

  • Moderate-severe, non-throbbing pain made worse by movements or palpation of the muscles or joints of the neck

  • Lifestyle factors like stress, poor sleep hygiene & low levels of physical activity are also very common.

Cervicogenic headaches are actually quite common. Approximately 4% of the general population reports having cervicogenic headaches, and in the headache population that number jumps to 15-20%.


🤓 Why/how we get cervicogenic headaches

The why [or pathophysiology] behind a cervicogenic headache isn't the most understood thing on the planet, but we do have a general sense as to why these headaches happen. This is where a concept known as convergence comes in.

Convergence is when two nerves from different areas of the body come together in the spinal cord to transmit information back up to the brain. In terms of a cervicogenic headache, the convergence must happen between nerves that innervate both the head and the neck.


Convergence in cervicogenic headaches can happen between trigeminal [a cranial nerve] and nerves that come from the neck. The convergence can also happen between two nerves originating from the neck.


One example of this is the greater & lesser occipital nerve. These nerves both originate from the neck, but they supply sensation to the back of the head. It is because of convergence that we can feel pain in one area of the body but the actual problem is happening somewhere else.


In cervicogenic headaches, the most commonly involved structures are the joints of the upper neck, upper trapezius muscle, sternocleidomastoid muscle, suboccipitals, and the muscles that serve to keep your spine upright, of which there are many.


💆🏽 How I can help you resolve them

Resolving cervicogenic headaches is obviously the meat and potatoes of this blog. Before I go into it all, I do want to say: none of this is medical advice, just information. If you are experiencing cervicogenic headaches [or any other type of pain] I urge you to get it checked out, whether it is by me or another healthcare provider.


Soft tissue therapy

Soft tissue therapy comes in many forms, but at its core it is the treatment of muscles, ligaments & tendons done to reduce tightness, soreness & to improve range of motion and function.


Cervicogenic headaches always come with muscular pain of some sort that impedes range of motion and is often sore even at rest. Taking the time to relax these muscles & allow them to regain their function helps drastically in bringing down pain levels.

Soft tissue therapy also helps with nervous communication. Nerves run in between muscles all over our body & so improving the muscle & ligaments' function can help with nerve impulses and mobility as well.


Adjustments

Adjustments [or spinal manipulative therapy, SMT] is the pop or the crack you think of when you think of a chiropractor and is also the cornerstone to a lot of treatment plans.

The whole goal of the adjustment is to get the joints moving more than they can on their own. I like to think of it as a bit of encouragement. Once the adjustment happens, the joints are able to move a bit better on their own resulting in less pain.


The International Headache Society has deemed frequency of headache episodes as the most important primary measure in determining whether or not a treatment is effective. SMT provides significant short-term [more on that in a second] effects for pain intensity, frequency & disability in those with cervicogenic headaches.


Acupuncture

Acupuncture is a great tool to manage all sorts of musculoskeletal complaints & injuries. I’m not going to go into too much detail here [but I will in the next blog post!], but essentially acupuncture calms down trigger points, brings blood flow to the area & helps nerves fire more effectively.


There is lots of research done on acupuncture & tension type headaches, but I couldn’t find any specifically on acupuncture’s use in cervicogenic headaches. However, due to the nature of cervicogenic headaches, it stands to reason that acupuncture would be a reasonable & effective treatment option for them.


[NB: if any manual therapists are reading this post and knows of research around acupuncture & cervicogenic headaches, let me know; I’d love to look at it].


Exercise therapy

This is where you come in.


I said that SMT provides short term relief for cervicogenic headaches. The exercise part is what provides the long term relief. Exercises that strengthen the muscles of the neck and shoulder blade are really important when it comes to keeping your cervicogenic headaches at bay.


Shrugs are a really great starting exercise.


Shrugs strengthen the upper trapezius muscles which are main players in not only cervicogenic headaches, but tension type headaches, upper back pain & regular ol’ neck pains as well. I’m convinced that everyone’s upper traps could use some TLC.


Grab a couple of light weights [or cans of nonperishable food, water bottles, etc] and hold them with your hands at your side. Then all you have to do is bring your shoulders up to your ears, hold for 2-3 seconds and then bring them back down. Repeat this 8-10 times, 2-3 times a day.


Alternatively, if you have a resistance band, you can stand on the middle holding one end in each hand and do the shrug from there.


Shrugs are just one of many exercises you can do to help with your cervicogenic headaches. If you want more, and a great self-mobilization technique, you can download some more exercises here.


Final thoughts

Cervicogenic headaches are more common than people let on. They come from the neck and usually resolve as the neck pain resolves. Soft tissue therapy & adjustments can really help in the short term & in maintenance of the headaches, but doing the right exercises is imperative to their resolution.

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