Cervicogenic headaches – What are they and how do they happen?

We have all heard about headaches being caused by the muscles and joint of the neck but why does this happen and how do we prevent it?

Cervicogenic headache is a term to describe a headache which is caused by the cervical spine (neck).

It originates from both the joints and the associated muscles of the neck and jaw.

It’s predominately one sided and presents as either a dull ache at the base of the skull or a referred pain into the front/side of head and face.

Other symptoms can be decreased neck range of motion, dizziness and upper arm/shoulder pain.

It 4 x more likely to occur in women and can be acute or chronic.

Approximately 44% of patient with cervicogenic headaches have associated jaw (TMJ) problems.

The common causes are:

• Previous trauma e.g. whiplash
• Mechanical neck issues – joint stiffness, muscle tension
• Sleeping position and pillow
• Sitting and standing posture
• Sustained uncomfortable neck positions
• Clenching jaw and/or grinding teeth

How can you prevent this?

• Good posture – both sitting and standing. Take breaks from the computer!
• Regular exercise
• Stretching the neck and shoulders
• Updating your pillow and mattress

Can physiotherapy help me?

Physiotherapists can assess your neck and jaw to find the specific cause of your headache.

They will use techniques such as massage, trigger point release, active release therapy, joint mobilisations, postural training, pillow assessment, ergonomic assessment and dry needling.

If you’re concerned that you are experiencing cervicogenic headaches or something similar see your physiotherapist to determine the cause and effectively manage the problem.

The same procedure may reproduce the headache repeatedly.

Particularly unfortunate may be a non-tolerated position of the head/ neck during sleep.

When the patient finally wakes up, the triggering event may already have passed the point of no return, since the patient has been unable to notice the initial warning during sleep.

The pain – occasionally also an attack (if the pressure exerted is strong enough) can also be reproducibly provoked, iatrogenically, by external pressure applied to various tender, circumscribed areas of the neck, such as over the tendon insertions in the occipital area on the symptomatic side or over the occipital nerves.

Since most attacks probably are mechanically precipitated, the temporal pattern can vary even within a single patient, and a non-continuous pattern may sometimes be present in the early stages.

Eventually, a chronic-fluctuating pattern develops in most patients.

The severity of the pain and the duration of the solitary episode/exacerbation may vary, depending upon the patient, the situation, and the duration of exposure, the pain ranging from mild to severe.

Diagnostic criteria have been established by several expert groups, with an agreement that these headaches start in the neck or occipital region and are associated with tenderness of cervical paraspinal tissues.

Prevalence estimates range from 0.4% to 2.5% of the general population to 15% to 20% of patients with chronic headaches.

CGH affects patients with a mean age of 42.9 years, has a 4:1 female disposition, and tends to be chronic.

Almost any pathology affecting the cervical spine has been implicated in the genesis of CGH as a result of convergence of sensory input from the cervical structures within the spinal nucleus of the trigeminal nerve.

The main differential diagnoses are tension type headache and migraine headache, with considerable overlap in symptoms and findings between these conditions.

No specific pathology has been noted on imaging or diagnostic studies which correlate with CGH. CGH seems unresponsive to common headache medication.

Small, non-controlled case series have reported moderate success with surgery and injections.

A few randomized controlled trials and a number of case series support the use of cervical manipulation, transcutaneous electrical nerve stimulation, and botulinum toxin injection.

There remain considerable controversy and confusion on all matters pertaining to the topic of CGH.

However, the amount of interest in the topic is growing, and it is anticipated that further research will help to clarify the theory, diagnosis, and treatment options for patients with CGH.

Until then, it is essential that clinicians maintain an open, cautious, and critical approach to the literature on cervicogenic headaches.

Cervicogenic headaches: a critical review (PDF Download Available).

Available from: researchgate.net/publication/9032895_Cervicogenic_headaches_a_critical_review [accessed May 10, 2017].