How is a migraine different to a cervicogenic headache?

We tend to use the term “migraine” fairly commonly to describe an intense headache, and certainly a true migraine can involve intense pain in the head.  However, it is possible to have very strong pain as result of a problem with your upper neck, rather than something happening inside your head.

It can feel like the problem is inside your skull – because that’s where you feel the pain, right? – but this may be referred from your upper spine and not due to intracranial issues.

There can be a variety of reasons why you have pain inside or around your head.  Stress, tiredness, eyestrain or trauma (like suffering whiplash in a car accident or sporting collision) can all cause changes inside your head and cause pain.  Some people are more prone to true migraines, requiring medication and special methods of management, due to biological and behavioural tendencies towards things like fluctuations in blood flow inside the skull.

Cervicogenic headaches are different from migraines because they are caused by problems with the nerves, bones, or muscles in your neck.  Like sciatic pain, where a lumbar spine problem causes pain to be referred down the leg, cervicogenic headaches are referred from the upper spine, around the rear base of your skull and possibly extending to your eye or face.

 

What are symptoms of a cervicogenic headache?

In addition to a head pain, which may be sharp or throbbing, symptoms of a cervicogenic headache may include:

  • pain usually on one side of your head or face
  • a stiff neck
  • pain around the eye(s)
  • pain while coughing or sneezing
  • a headache with certain neck postures or movement

Cervicogenic headaches can also cause symptoms similar to migraine headaches, such as light sensitivity, noise sensitivity, blurry vision, and an upset stomach.

 

What causes cervicogenic headaches?

Cervicogenic headaches can arise from degenerative conditions like osteoarthritis, a prolapsed disc in the neck, or a whiplash injury. Having a fall or playing sports where collisions occur or blows to the head are involved, can also cause injury to the neck and trigger these headaches.

A common cause we see in the clinic is sustained postures while sitting or standing at work. Hairdressers, jewellers, people who work sitting at computers, drivers, people who look down for long periods such as when doing craft, knitting, crosswords – all tend to cause the head to poke forward into ‘protraction’.  If sustained, this position can cause stress in the area immediately below the base of the skull, effectively squashing down on joints and nerves of the upper neck and causing the muscles to become excessively tight and experiencing poor blood flow.

One-off causes may also be to blame: for instance, falling asleep in an awkward position – say, on a long trip, sitting upright but with your head falling forward, backward or to the side at an unnatural angle.

 

Treating and managing cervicogenic headaches

A cervicogenic headache can be debilitating and recurrent, but several techniques can help you manage pain and prevent further occurrences.

Your physio will first aim to confirm that you have a cervicogenic headache. They may apply pressure to the base of your head or different parts of your neck to determine where your pain originates, and to see if your headache is triggered from a particular spot. Your physio may also see if different neck positioning provokes a headache to occur. If either of these things cause a headache, this means the headache is cervicogenic and remedial positioning may be suggested.

 

Medication

Since inflammation and other problems with the nerves, muscles, tendons, or joints can cause these headaches, your doctor or therapist may recommend over-the-counter medications or prescribe an oral medication to relieve pain. These include:

  • anti-inflammatories
  • a muscle relaxant to ease muscle tightness and reduce spasms
  • a corticosteroid

 

Physiotherapy

Manual therapy including massage, spinal mobilisation or manipulation, dry needling or acupuncture, even cognitive behavioural therapy, and relaxation techniques – can all be employed to provide relief. Improving muscle strength and endurance and learning stretches and self-mobilising methods may be a great way for you to take charge of your problem for yourself.  Other options for managing pain include:

  • avoiding activities that worsen pain
  • if avoidance isn’t possible, learning to take regular breaks
  • applying ice or heat for 10 to 15 minutes, several times a day
  • using a neck brace when sleeping upright to prevent bending your neck forward
  • practicing good posture when sitting, standing, or driving (stand or sit tall with your shoulders back, and don’t lean your head too far forward)
  • learning specific exercises that lengthen the neck and open up the squished spaces (check out our video on how to Self-SNAG using the humble tea towel!)

 

Injections and Surgery

Spine surgery is rarely needed to relieve cervicogenic headache but in severe cases that have failed other non-invasive techniques, it may provide relief.  Surgery would be a last-resort option.

Your doctor (ideally a neurologist) can also diagnose (and treat) a cervicogenic headache with a nerve block. This involves injecting a numbing agent and/or a corticosteroid into or near the nerves in the back of your head. If your headache stops after this procedure, this confirms a problem with the nerves in or near your neck. Sometimes, doctors use imaging tests to take pictures of the inside of the neck to check for problems with the joints or soft tissue. These tests can include an X-ray, a CT scan, or an MRI.

Just be aware that it is likely most things seen on x-ray (even if described as ‘severe’), they likely existed long before your pain came on and will exist after your pain resolves using conservative methods.  Degenerative conditions including disc bulges are very common and do not always cause symptoms – they are actually normal.  So don’t panic if imaging shows something up – you are probably a normal human being with a temporary problem!

 

Prevention

Conditions like osteoarthritis are not generally preventable.  They occur as a natural part of aging.  However, staying generally active, avoiding sustained postures, or finding alternative ways to enjoy things that may involve sustained postures, can mean you still get to enjoy things without getting a headache.

Try some of these:

  • Using a pillow to elevate a book or crossword puzzle. Rather than looking down at it you will be looking forward.
  • Use a lumbar support in the car – pop it below your ribs so your belly button is pushed forward, supporting the natural inward curve of your lower back. This will bring you into a more erect posture, ‘opening up’ the neck joints.
  • Avoid using too-bulky pillows…or too-flat pillows for that matter! A pillow that keeps your spine aligned is less likely to cause you problems.  Adjustable pillows are quite good, and even unusual options like buckwheat husk pillows (which can be fluffed up or flattened out, and can be moulded to fit your neck) can be effective.
  • Get your eyes checked if you find yourself leaning toward the computer monitor – you may need glasses or to have your prescription upgraded.

 

Prognosis

Cervicogenic headaches can be severe and debilitating if left untreated.  If you have a recurrent headache that doesn’t respond to medication, come and see us. The outlook for cervicogenic headaches varies and depends on the underlying neck condition. However, it is possible to alleviate pain and resume an active lifestyle with medication, home exercises, posture modification, alternative therapies, and (very rarely) surgery.