Cervicogenic Headache – Causes, Symptoms, Diagnosis, and Treatment

What is Cervicogenic Headache?

Cervicogenic headache is a secondary headache, meaning it is a symptom of an underlying condition. The pain originates in the cervical spine (neck) and is typically caused by an issue in the neck's muscles, joints, or nerves. This condition often results from injury, degeneration, or inflammation in the neck and upper back. The headache usually affects one side of the head but may radiate to the forehead, temples, or behind the eyes.

Unlike other types of headaches, cervicogenic headaches are typically associated with neck pain or stiffness, and often worsen with specific neck movements or positions.

Causes of Cervicogenic Headache

Several conditions in the cervical spine can lead to cervicogenic headaches. Common causes include:

1. Cervical Spine Degeneration:
   The natural wear and tear of the intervertebral discs and joints in the neck, which occurs with aging or overuse, can cause nerve irritation, leading to referred pain in the head.

2. Whiplash Injury:
   A whiplash injury, often caused by car accidents or sports-related trauma, can result in muscle strain, ligament sprain, or joint dysfunction in the neck, triggering cervicogenic headaches.

3. Poor Posture:
   Poor posture, especially when sitting for long periods or slouching, can lead to strain on the muscles and joints in the neck, contributing to cervicogenic headaches.

4. Neck Muscle Tension:
   Overuse or tension in the muscles of the neck can lead to referred pain in the head. Stress, anxiety, or improper ergonomic positions can contribute to muscle tightness, worsening headaches.

5. Cervical Spine Disc Herniation or Protrusion:
   A herniated disc in the cervical spine can put pressure on the nerve roots, leading to pain that radiates to the head. This may be due to injury or degenerative changes in the spine.

6. Joint Dysfunction:
   Dysfunction in the small facet joints of the cervical spine can lead to localized neck pain that radiates to the head, causing cervicogenic headaches.

7. Nerve Compression or Irritation:
   Compression of the cervical nerve roots or irritation of the trigeminal nerve, which carries sensation to the face, can also contribute to cervicogenic headaches.

Symptoms of Cervicogenic Headache

The hallmark of a cervicogenic headache is pain that originates in the neck and radiates to the head. Other common symptoms include:

• Pain on One Side of the Head:
  The pain is typically unilateral (on one side) and may be felt in the forehead, temples, or around the eye.

• Neck Pain or Stiffness:
  Most people with cervicogenic headaches report a noticeable ache or stiffness in the neck or upper back that accompanies the headache.

• Pain Worsening with Neck Movements:
  The headache may worsen when turning the head, tilting the neck, or looking up or down.

• Pain Triggered by Pressure on the Neck:
  Applying pressure to certain areas in the neck or upper back can exacerbate the pain.

• Tension or Tightness in the Neck Muscles:
  Tension in the neck muscles is common and may contribute to the pain.

• Referred Pain in the Face or Jaw:
  In some cases, the pain may radiate to the jaw, face, or even the shoulder.

• Sensitivity to Light or Sound:
  Some people with cervicogenic headaches may experience sensitivity to light (photophobia) or sound (phonophobia), similar to migraine headaches.

Diagnosis of Cervicogenic Headache

To diagnose cervicogenic headache, a healthcare provider will typically conduct the following:

1. Medical History:
   A detailed history of your symptoms, including when the headaches started, their severity, and any activities or positions that trigger or relieve the pain, will be taken.

2. Physical and Neurological Examination:
   A physical exam will include tests to assess the range of motion in your neck, palpation of the cervical spine to identify areas of tenderness or dysfunction, and neurological tests to rule out other causes of headache.

3. Imaging Tests:
   An MRI or CT scan may be recommended if there is suspicion of an underlying issue such as a herniated disc, spinal degeneration, or joint dysfunction.

4. Cervical Spine Evaluation:
   Special diagnostic blocks or nerve root injections may be used to confirm that the pain originates from the cervical spine. If a local anesthetic temporarily relieves the headache, cervicogenic headache is often diagnosed.

Treatment for Cervicogenic Headache

Treatment for cervicogenic headache typically involves a multidisciplinary approach that addresses both the underlying cervical spine issues and the pain associated with the headache. Common treatments include:

Physiotherapy

Physiotherapy is one of the most effective treatments for cervicogenic headaches. Palms Physiotherapy & Allied Healthoffers a range of physiotherapy treatments to relieve neck pain and reduce headache frequency, including:

• Manual Therapy:
  Techniques such as joint mobilization or manipulation can help improve the mobility of the cervical spine, reduce stiffness, and alleviate pain.

• Postural Correction:
  Posture correction exercises can reduce strain on the neck muscles and improve alignment, helping prevent headache triggers.

• Neck Stretches and Strengthening:
  Specific exercises to strengthen the neck muscles and improve flexibility can reduce pain and prevent future episodes.

• Trigger Point Therapy:
  Manual techniques targeting muscle knots in the neck and upper back can help relieve pain and improve movement.

Exercise Physiology

Exercise physiology focuses on using exercise to improve muscle strength, endurance, and overall function. For cervicogenic headaches, this includes:

• Strengthening Exercises:
  Exercises aimed at strengthening the muscles of the neck, upper back, and shoulders to support the cervical spine and prevent pain.

• Aerobic Exercise:
  Aerobic exercises can help reduce overall stress levels, improve circulation, and enhance healing.

Pain Management

If the pain from cervicogenic headaches is severe, medications may be used to provide relief. These may include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
  Over-the-counter pain medications such as ibuprofen or paracetamol may help reduce inflammation and alleviate pain.

• Muscle Relaxants:
  Medications such as baclofen or tizanidine may be prescribed to relax tense muscles in the neck.

• Corticosteroid Injections:
  In some cases, corticosteroid injections may be used to reduce inflammation and provide longer-term relief.

Surgical Interventions

In rare cases where other treatments have not been effective, surgical intervention may be required. This may include:

• Nerve Decompression Surgery:
  Surgical decompression may be performed to release pressure on the cervical nerves that are causing pain.

• Spinal Fusion or Disc Replacement:
  In cases where there is significant degeneration or herniation of cervical discs, spinal fusion or disc replacement may be necessary to stabilize the spine.

Lifestyle Modifications and Prevention

There are several lifestyle changes that can help reduce the risk of cervicogenic headaches or prevent future episodes:

• Ergonomic Adjustments:
  Make sure your workstation is set up properly to reduce strain on your neck and shoulders, particularly if you spend long hours sitting.

• Regular Stretching and Movement:
  Perform neck stretches and take regular breaks if you are sitting for long periods. Moving your neck and shoulders regularly can prevent stiffness and tension.

• Stress Management:
  Practice stress management techniques such as relaxation exercises, yoga, or meditation to reduce tension in the neck muscles.

• Avoiding Sudden Neck Movements:
  Avoid jerking or twisting your neck suddenly, as these movements can trigger pain and exacerbate headaches.

Treatment for Cervicogenic Headache

Treatment for cervicogenic headache aims to relieve pain, restore normal function, and address any underlying causes. Common treatment options include:

Medications

1. Pain Relievers:
   Over-the-counter pain medications such as ibuprofen, paracetamol, or NSAIDs may be used to manage mild to moderate pain.

2. Muscle Relaxants:
   Medications such as baclofen or cyclobenzaprine may be prescribed to relax tense muscles in the neck and upper back.

3. Tricyclic Antidepressants (TCAs):
   Amitriptyline or similar medications may be prescribed to manage chronic pain and reduce headache frequency.

4. Corticosteroid Injections:
   Corticosteroid injections into the cervical spine or surrounding muscles may be used to reduce inflammation and provide pain relief.

Physiotherapy and Manual Therapy

At Palms Physiotherapy & Allied Health, we offer a range of physiotherapy treatments to manage cervicogenic headaches:

• Cervical Spine Mobilization: Gentle manipulation or mobilization techniques can help restore mobility to the cervical spine, alleviate pain, and improve function.

• Postural Training: Correcting poor posture and encouraging proper alignment can help reduce strain on the neck muscles and joints.

• Muscle Stretching and Strengthening: Stretching tight muscles and strengthening weak muscles in the neck and upper back can help reduce the frequency and intensity of headaches.

• Trigger Point Therapy: Targeted release of muscle knots or trigger points can reduce pain and improve muscle function.

• Dry Needling: In some cases, dry needling may be used to release tension in the muscles and reduce pain.

Exercise and Rehabilitation

Exercise therapy, guided by a physiotherapist or exercise physiologist, can help improve neck strength and flexibility, which can alleviate the pain and prevent future headaches. Cervicogenic headache rehabilitation may include:

• Neck Exercises: Strengthening exercises for the neck and upper back muscles.

• Stretching: Focused stretches to improve flexibility and reduce muscle tension.

• Aerobic Exercise: Low-impact aerobic activities like walking or swimming may help reduce overall stress and muscle tension, reducing the frequency of headaches.

Surgical Treatment

In rare cases, when conservative treatments do not provide relief, surgical intervention may be considered. Surgical options may include:

• Nerve Decompression: Surgical procedures to relieve pressure on the nerves in the cervical spine.

• Spinal Surgery: In cases of severe spinal degeneration or herniated discs, surgery to remove or repair damaged structures may be necessary.

Conclusion

Cervicogenic headache can significantly impact daily life, but with early diagnosis and appropriate treatment, the pain can be managed effectively. At Palms Physiotherapy & Allied Health, we offer tailored physiotherapy treatments, exercise programs, and pain management strategies to help you manage and reduce the impact of cervicogenic headaches. Contact us today for a consultation and start your journey toward a pain-free life.