A headache is not just a headache. Most people have heard of migraine headaches, tension headaches, and cluster headaches. Has anyone heard of a Cervicogenic Headache? The term "cervicogenic headache" was introduced in 1983 by a clinician who wrote about headaches that originated from the cervical spine. Over the years, the headache world has accepted the fact that some headaches are associated with a source in the upper cervical spine like the ligaments, joints, muscles and nerves. A headache is not just a headache when the cervical spine is involved.
A 54 year old woman, Heidi, always comes home from work with a headache. Sure, her job is stressful and the children at home give her some gray hairs; but this head pain is different than the migraines she used to get when she was younger. This head pain is always on the left side and seems to come from the base of her skull and spread towards the top of her head. Anytime she spends long periods of time working on the computer, the head pain gets worse.
Unlike migraine headaches, cervicogenic headaches usually have an onset during middle age and tend to get worse as one gets older. Unlike tension or cluster headaches, cervicogenic headaches are usually one-sided, rarely crossing the midline. Most importantly, cervicogenic headaches tend to get worse with certain neck postures or movements. In this case, the working woman is at a computer when the headaches start. If a computer screen is set in too high of a position, the user is forced to look up for sustained periods of time. This cervical extension can lead to headaches originating from the cervical spine. Cervical postures and movements that provoke head pain are a primary diagnostic clue for classifying cervicogenic headaches.
When Heidi sees her doctor, they both notice Heidi's inability to turn her head fully. The doctor also notes a lack of side-bending range of motion in the cervical spine. An x-ray confirms the presence of arthritic joints in the cervical spine. After carefully considering the entire history and exam, the doctor informs Heidi that her headaches are coming from the neck and are called Cervicogenic Headaches. Also during the exam, the doctor notes that Heidi holds her head in a "forward head" position with her scapulae abducted (her shoulders are rounded forward). With this in mind, he develops a treatment plan for her headaches.
Treatment of cervicogenic headaches should target the source in the cervical spine. Because posture and movements of the cervical spine have such a profound influence on the head pain, the mechanism of pain should be thoroughly evaluated. The "forward head" position is a huge factor for both neck and head pain. As the head juts forward, the neck compensates by increasing the natural cervical lordosis in order to keep the face pointed forward and not down at the ground. This compensatory, increased cervical lordosis forces the cervical spine into extension and place a great deal of stress on the facet joints particularly in the upper cervical spine. When these joints start screaming for mercy, the pain spreads to the head. When the upper cervical spine joints start screaming, the upper cervical nerves usually react in concert. Unfortunately, the upper cervical nerves intricately overlap and converge with the Trigeminal Nerve (a cranial nerve). As a result, cervicogenic headaches are often associated with drooping eye lids, face pain and jaw pain. The head and the neck are closely intertwined in many ways and that relationship is what leads to the cervicogenic headache. Since the cervical musculoskeletal system is linked directly to the head, treatment of headaches originating from a source in the neck needs to address the problem in the neck. Treatment must relieve not only the nerve irritation in the upper cervical spine, but also improve the abnormal postures that continue to provoke the headaches. Ultimately, the specific classification of headaches like cervicogenic headaches leads to better treatment because a headache is not just a headache.