Introduction
Headaches are a common and often very painful condition, affecting a large percentage of the population. A headache is the sensation of pain in any part of the head, with the type of pain ranging from dull or aching, to very sharp in nature.
There are a wide variety of causes of headache, in fact the International Headache Society recognises more than 200 different types.(1) One of the most common varieties people suffer from is called a Cervicogenic headache, which we regularly see and treat at Spine Sport Feet clinic.
What is a Cervicogenic Headache (CGH)?
A cervicogenic headache is defined as pain in the head that is being referred from a source in the cervical spine (neck). Referred pain simply means that pain is felt in a part of the body other than the true source of the pain.
CGH is considered a secondary headache, because it is the result of another primary condition found in the cervical spine.(2)
It is thought that about 47% of the world’s population suffer from a headache at some point, and that as many as 15-20% of that total could be cervicogenic.(3)
What is the anatomy of Cervicogenic Headache?
Cervicogenic headaches arise due to injury or problematic function with structures in your neck. The neck (cervical) region is home to many types of tissue that may refer pain to the head.
Examples include:
- Cervical facet joints
- Cervical muscles
- Cervical intervertebral discs
- Facet joint capsule tissue
- Spinal ligaments
- Vertebral and internal carotid arteries
- Vertebral bone tissue
- Upper spinal cord dura mater
The above tissues send sensory information from the upper three spinal nerves in the neck to a special cluster of nerves on the lower brain stem called the Trigeminocervical nucleus. The Trigeminocervical nucleus also receives sensory information from areas in the face and head via the Trigeminal Nerve. This complex convergence of neurological feedback is what allows pain from a neck problem to be experienced in the head and face.(4)
Causes of cervicogenic headache and risk factors
Cervicogenic headaches can be caused by any issue creating damage and dysfunction to pain sensitive structures in the neck. They are the result of neck injury.
This can happen over a long period of time and be linked with poor work or life posture creating changes in how our head and neck are being held. This abnormal postural pattern places more stress on muscles, discs, and joints in our cervical spine.
The onset can also be traumatic such as with a fall or whiplash injury or take many years to become symptomatic as is the case with more degenerative conditions. In some cases, CGH may be due to pathology such as fractures, infection, tumours, and rheumatoid arthritis of the upper cervical spine.
The prevalence of CGH is thought to be up to 4.1% of the population and as high as 53% in headache patients following whiplash injury. The average age of sufferers is 42.9 years of age, and it is 4 more times likely to be seen in women.(5)
Symptoms of cervicogenic headaches
The Cervicogenic Headache International Study Group and International Classification of Headache Disorders have defined CGH as (5)
- One sided, non-throbbing, dull head pain with varying levels of severity and duration.
- Pain is aggravated by head movements or by long periods spent not moving the head.
- Pain radiates from the occipital region (base of the skull) to the front of the head.
- Pain may also be felt on the same side in the neck, shoulder, or arm.
- No change in symptoms with exercise, food or diet.
- No aura or pre-headache symptoms as seen with migraine.
- Aggravated by side movement and rotation of neck.
Cervicogenic headaches can be difficult to diagnose as they can mimic other conditions such as tension headaches and migraine. Many patients can in fact suffer from more than one type of headache.
Treatment of cervicogenic headaches
Treatment with manual therapy such as chiropractic has shown favourable outcomes in the treatment of cervicogenic headaches, particularly when combined with exercise. (7,8) Once detailed history taking, examination, and diagnostic imaging (if required) have been performed, treatment may involve some of the following:
- Diagnosis of the primary neck issue causing CGH
- Spinal manipulation/mobilisation therapy
- Massage and muscle release
- Low Level Laser therapy
- Exercise prescription to support reduction of postural stresses
- Lifestyle, ergonomic advice
- Stretching and strengthening program.
- Multifaceted management of CGH in acute, sub-acute and chronic stages.
If you suffer from headaches or would like to know more about cervicogenic headache, please call us on (07)5580 5655 or visit our website to make an appointment with one of our chiropractors. Our practitioners use conservative, non-invasive treatment modalities and take the time to understand you. They are also well-trained to refer you to other health professionals when necessary and liaise with your doctor in such cases.
References
- www.healthdirect.gov.au : Headaches. Extracted 04/04/2022
- www.spine-health.com : What is Cervicogenic Headache? Published 12/04/2018. Extracted 04/04/2022
- Cervicogenic Headaches: An Evidence-Led Approach to Clinical Management. Phil Page, PhD, PT, ATC, CSCS, FACSM. The International Journal of Sports Physical Therapy. 2011 Sep 6(3) 254-266.
- Cervicogenic Headache: Anatomic Basis and Pathophysiologic Mechanisms. Bogduk N. Curr Pain Headache Rep. 2001 Aug; 5(4): 382-6
- www.now.aapmr.org : Cervicogenic Headache. Michael J Mehnert MD. Updated 24/07/2020. Extracted 05/04/2020
- www.spine-health.com : Treatment of Cervicogenic Headache. Zinovy Meyler, DO. Published 12/04/2018. Extracted 05/04/2020
- The Use of Manual Therapy and Exercise in the Treatment of Chronic Cervicogenic Headaches. A Series of Case Studies. Lance Whorton R, Kegerreis S. Journal of Manual and Manipulative Therapy. 2000; 8(4), 193-203
- A Randomised Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. Spine, 2002; 27(1), 1835-1843
If you suffer from headaches or would like to know more about cervicogenic headache, please call us on (07)5580 5655 or visit our website to make an appointment with one of our chiropractors. Our practitioners use conservative, non-invasive treatment modalities and take the time to understand you. They are also well-trained to refer you to other health professionals when necessary and liaise with your doctor in such cases.
