Cervicogenic Headache

Causes / Diagnosis / Symptoms / Treatment

What is Cervicogenic Headache?

A cervicogenic headache (CGH) differs from a standard headache in that it is triggered by an underlying condition in the neck. While a typical headache may develop for a range of reasons, a cervicogenic headache occurs when there is excess tension in the muscles and soft tissue at the base of the skull (called the sub-occipital muscles).

These muscles are anchored into the head, so any tightness that is present can be transferred into the base of the skull, where a cervicogenic headache may arise.

Tension in the neck muscles often comes about due to dysfunction of the joints in this area, either because their range of motion is limited or the vertebrae in the neck curve in the opposite direction due to poor posture. The latter of these issues is called a reverse cervical curve.

When this happens the weight of the cervical spine is not distributed evenly leaving the sub occipital muscles to work harder than they should. Overtime, this causes tension, tightness and hypertrophy of those overactive muscles, and eventually, chronic cervicogenic headaches may arise.

Naturally, the vertebrae in the neck are slightly farther forward than the rest of the spinal vertebrae. This is the natural curve of the spine, but a reverse cervical curve means these vertebra bulge outward in the other direction. This reverse curve usually develops over time due to poor posture, called forward head posture, or anterior head carriage.

Causes Of Cervicogenic Headaches

While a cervicogenic headache stems from underlying issues with the muscles and joints in the neck, symptoms can develop for other reasons. Other causes of cervicogenic headaches include:

- - Whiplash injury
  - A fall that involves someone hitting their head
  - High-impact sports injuries
  - Osteoarthritis or rheumatoid arthritis of the neck
  - Improper sleep positions, such as sleeping in a chair with your head hanging forward or tilted to one side
  - Tech neck or text neck
  - Herniated disc in the vertebra of the neck
  - The presence of a tumor in the neck or upper back
  - A fracture of vertebra(e) in upper cervical region (the neck)
  - Compression of nerve(s) located in the neck, also known as a pinched nerve

Some peoples’ jobs place them at an increased risk for experiencing a cervicogenic headache. For example, dentists and assistants, carpenters, and hairdressers must repeatedly or consistently look down to complete their job duties. Similarly, those who are seated for extended periods of time, such as office workers and truck drivers, are more likely to develop forward posture, which can lead to a cervicogenic headache.

Diagnosis Of Cervicogenic Headaches

Doctors begin the diagnostic process for cervicogenic headaches in much the same way as they do for other spinal conditions. Your doctor will have a discussion with you about the symptoms you’re experiencing. They will ask you where your pain is, when it started, previous traumas, what activities make it worse or help it improve, and injuries or surgeries you may have had in the past.

The Doctor will complete a physical examination by palpating the neck to check for any abnormalities such as tender spots or swelling. Your doctor usually will check your arms and hands to see if there are any range of motion or sensation issues there, since that can indicate nerve involvement and a more advanced case of cervicogenic headaches.

They will check your cervical range of motion which is usually done through a test called the cervical flexion-rotation test (CFRT). To complete this test, the patient lays down on their back and is asked to bend their neck forward (which lifts the head off the table).

They then should rotate their head slowly and gently from left to right and back. If this causes pain or is too difficult to do, it is usually a sign of limited cervical range of motion contributing to cervicogenic headaches. Other orthopedic tests may be performed at the doctors discretion to confirm a diagnosis.

If your doctor is having trouble diagnosing you with cervicogenic headaches based on your symptoms and the CFRT test, they may also complete x-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans. These imaging tests can’t diagnose cervicogenic headaches on their own, but they can give your doctor information that points toward the cause of cervicogenic headaches.

Another helpful test is a diagnostic nerve block, which involves using an x-ray to guide a needle in placing a numbing injection into the neck muscles. The injection acts on certain nerves in the neck, and this helps doctors identify what nerve(s) are causing the cervicogenic headaches and related pain.

Symptoms Of Cervicogenic Headaches

The most common symptoms of a cervicogenic headache are:

- - Persistent, dull pain on one side of the head that may also surround the eye, ear, and back of the head on that same side
  - Discomfort that worsens with sudden neck movement when coughing, sneezing, or taking deep breaths
  - Referred pain that extends to the neck, shoulders, arms, and hands (in more advanced cases 0f nerve compression)
  - A stiff neck that causes limited motion of the head and neck
  - Pain in the neck and below the neck in the upper cervical spine (upper back)
  - Vision changes, such as blurred vision in one eye
  - Tender spots on the neck
  - Difficulty swallowing (in more advanced cases of nerve compression)
  - Swelling around or near one eye (in more advanced cases of nerve compression)

Depending on the person, symptoms of a cervicogenic headache can last hours or even days. While a cervicogenic headache is not the same as a migraine headache, they can share some symptoms (though they are less common):

- - Dizziness or a feeling of being lightheaded
  - Nausea
  - Sensitivity to light or sound

Conservative Treatment For Cervicogenic Headaches

The good news is that cervicogenic headaches are very treatable if you see providers such chiropractors or physical therapists. A chiropractor will guide you through treatments such as spinal manipulation (specifically to the C1/C2 vertebrae), functional exercises and stretches that can relieve tension in the neck muscles, restore proper motion of the neck, and encourage appropriate curvature in the upper cervical spine.

Sub-occipital myofascial release is another treatment that targets the muscles at the base of the skull by directly breaking up the tension. An example of this is using ischemic compression, which involves applying sustained pressure to tender areas (called trigger points) in the neck in an attempt to decrease sensitivity.

Some chiropractors also use acupuncture to treat cervicogenic headaches. This involves placing small, sterile needles into the certain points on the neck muscles. There is some evidence surrounding the use of acupuncture to stimulate the nervous system and encourage the body’s natural healing abilities, particularly for the management of cervicogenic headaches.

Other Treatments For Cervicogenic Headaches

More invasive procedures such as surgery may be indicated if cervicogenic headaches are being caused by a tumor or fracture. By addressing the cause of the headaches, surgery can potentially help someone manage them. In mild cases that have not caused nerve damage, there is a chance that surgical procedures may even eliminate headaches.

A moderately-invasive procedure for treating cervicogenic headache pain is a cervical nerve block, which is also used to diagnose this condition. This involves injecting steroids into the cervical nerve at the base of the skull. Cervical nerve blocks are done in under an hour and people are expected to see results between three and five days after it’s administered.

Nerve blocks may relieve someone’s pain for days or even months, so this is a good option for people who do not respond well to conservative care.