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A Pain in the Neck: Cervicogenic Headaches

Wednesday, August 11, 2021 11:07 AM

Millions of Americans see a doctor each year for complaints about headaches, making headaches among the most common disorders of the nervous system.

Headaches can be painful, debilitating and worrisome, especially if you don’t know why you’re having them or how to treat them.

Cervicogenic Headaches

Daniel Hurley, MD, a NorthShore physical medicine and rehabilitation physician, includes in his expertise a specialization in cervicogenic headaches. These are headaches perceived in the head, but generated from a source in the neck.

Dr. Hurley treats these often ignored or undiagnosed headaches by looking for sources of pain in the neck, and treating them with therapies, medications, different types of pain injections, or other recommendations, depending on each patient’s situation.

Here, he answers questions about cervicogenic headaches:

Who might experience cervicogenic headaches?
Cervicogenic headaches are associated with anyone who has a history of head and neck injuries such as concussions, whiplash, history of physical abuse, or simply everyday chronic stress that many people experience in their necks and shoulders.

They can occur in patients who have had surgical neck fusions for herniated discs, where-in post-operatively more mechanical stress is transferred to structures of the upper neck, leading to headaches. Even patients with chronic migraine or tension headaches eventually get pain that involves the structures of the neck, and these structures can then contribute to and compound “ordinary” headaches, adding a hidden and untreated cervicogenic component.

How would a physician who has a patient with a headache know that their patient may be experiencing a cervicogenic headache?
Several key factors in a patient’s history can lead one to consider the neck as a potential source of headache pain: is there history of a head and neck injury; along with headaches is there associated neck and shoulder blade pain; are the headaches worsened by stress; is there a poor sleep pattern; are there postural challenges such as being stuck at a computer all day; is there sharp pain at the base of the skull and difficulty turning one’s head and neck? All of these are important clues to suspect the neck and its intimate connections to the skull, or cranium, as possible contributors to headaches.

Some people don’t perceive they have neck pain at all, but rather focus on the pain in their eyes or the backs of their heads, or even in their ears. This can be a phenomenon called “referred pain,” and there are numerous neck and shoulder sources of such referred pain to the front of the head or face.

How often does a sufferer get a cervicogenic headache? How long do they last?
Patients experiencing cervicogenic headaches can have a variety of patterns of duration. Pain onset can come on with fatigue, stress, poor or awkward posture at a computer, or turning the head wrong or holding it turned for a prolonged time, or simply sleeping wrong.

The most common trigger is often a combination of stress and fatigue, as so many people will say, “I put all my stress in my neck and over the top of my shoulder blade.” These transient stressors in life can cause a related headache that might last simply a day or couple days, resolved by going home, going to bed, getting a massage or taking over-the-counter meds, applying ice and heat, etc.

However, there are patients who have chronic emotional or mental stress or have to deal with daily long car travel, or computer work with poor sitting posture, or who have a chronic structural problem in their necks such as joint arthritis or disc degeneration. Or they may have had an injury such as whiplash or concussion. These cervicogenic headaches are much more likely to be prolonged, essentially daily, waxing and waning in severity, but often never fully resolving for weeks to months.

How are cervicogenic headaches treated?
Utilizing focused, directed physical therapy, highly specialized neck injections of various kinds, and certain types of medications can help lessen the debilitating pain of headaches that often have been resistant to traditional pure headache treatments because the neck has not been taken into consideration.