This article is by the osteopath in Islington at the Angel Osteopathic Clinic. This article looks at:
• What is cervicogenic headache
• Where is the pain from cervicogenic headache
• Neck pain as the cause of cervicogenic headache
• Nerves of the neck and where they refer pain
Types of headache
There are a number of different headaches, tension headaches, common migraines, classical migraines, trigeminal neuralgia, and occipital neuralgia, cluster headaches and cervicogenic headaches.
Where does the pain come from
Cervicogenic headaches are caused by referred pain from both the bony and soft tissue structures of the neck and can obviously result from trauma to the neck such as from a whiplash injury or other trauma but also and more commonly from poor postural habits and even front sleepers who spend a good percentage of the night with the head in rotation.
The pain in a cervicogenic headache can mimic that of a migraine or a tension headache and as such diagnosis can be difficult and so the Cervicogenic Headache International Study Group came up with criteria to make diagnosis easier.
Diagnosis of cervicogenic headaches
Diagnostic Criteria for Cervicogenic Headache by The Cervicogenic Headache International Study Group Diagnostic Criteria. (Modified from Biondi DM: Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl):S7-14. Source: Sjaastad 0, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache. 1998;38:442-445.)
Neck related headache must have at least one of the following:
1. The head pain must be preceded by:
Neck movement or
Prolonged awkward head position
Pressure over the upper half of the neck or base of the skull on the headache side
2. Restricted motion of the neck
3. Neck, shoulder or arm pain
If all three are present, the likelihood of neck related headache as the cause is most likely
Characteristics of Neck Related Headache
Often, a history of neck trauma (whiplash, sprain, strain)
One sided headache that does not change sides
Occasionally, the pain may be on both sides
Pain located at base of skull, front of head, sides of head or around the eyes
Pain may last hours or days
The headache usually begins in the neck
The headache is moderate to severe in intensity
The headache is not throbbing
The pain is not sharp
Other features which may be noted:
Sensitivity to sound
Sensitivity to light
Blurred vision on the side of the headache
Tearing on the side of the headache
Swelling around the eye on the side of headache
A good postural evaluation should be carried out with anyone with a headache as it is common for there to be altered neck posture and a decrease in rotation of the cervical spine with pain on passive extension and rotation. There may also be point tenderness over the facet joints on the side towards rotation. Trigger points may also be found at the base of the head in the region of the sub occipital muscles and in the shoulder musculature and these may refer pain over the head when stimulated.
Nerves of the neck and where they cause pain
The nerve roots of the first three cervical nerves can refer pain over the head:
C1 nerve: the sub-occipital nerve innervates the joint between the neck and the skull. Injuring this joint can cause pain over the sub-occipital region or back of the head.
C2 nerve: this supplies the joint between the first and second neck vertebrae. Damage to this joint or surrounding structures can cause head pain over the temples and into the region around and behind the eyes
C3 nerve: supplies the joint between the second and third cervical vertebrae and damage to this joint can cause pain in a similar location to the C2 nerve. The joint between C2 and C3 is the most common area of the neck damaged in a whiplash.
Other relevant articles
If you get headaches you may have a problem with your neck. To make an appointment with our osteopath in Islington at the Angel Wellbeing Clinic click below.