If you suffer from headaches, whether triggered by an injury or not, you may be wondering why I am talking about the neck (here and throughout the site). You may have headaches and neck pain or just headaches without the neck pain. In either situation, the neck could be contributing to your headache intensity, duration, and frequency. When headaches are actually caused by referred pain from the neck, they are referred to as cervicogenic headaches.
Anatomy
Ligaments, joint capsules, discs, muscles, vasculature, and nerves in the upper cervical spine can all contribute to headaches. The reason for this is that nerves that supply all of these structures converge onto something called the trigeminocervical nucleus, located in the brainstem, along with the trigeminal nerve. The first division, the ophthalmic portion, of the trigeminal nerve supplies sensory input into the face. The current theory is that signals from cervical structures cross with the trigeminal nerve at the trigeminocervical nucleus. This crossing of signals, allows cervical structures to refer pain up into the head. Research shows that the upper cervical spine is most likely to refer up into the head, so this area should always be assessed if you have headaches.
Pain
Sometimes the type of pain you are experiencing can clue you in to which structure is the problem. For example, burning, shooting or electrical type pain, is typical of nerve pain while deep aching, constant pain is more common with muscle dysfunction. Sharp pain with quick turns of the neck, on the other hand, can indicate a facet problem. No matter the structure involved, cervicogenic headaches have some common characteristics. They tend to be unilateral, meaning on one side of the head or the other and they are side locked, that is, they don’t switch sides. The pain intensity tends to be mild to moderate and these type of headaches can last hours to weeks.
The Stats
Cervicogenic headaches are present in only a small percentage of the general population, about .5-2.5%, however, some studies indicate that its prevalence rate could be upwards of 13%. It is thought to be responsible for headaches in 20% of the population with chronic headache. Additionally, it is the cause of over 50% of headaches in those that have had a neck injury. The take away from these number is, if you have had headaches for a long time and have a history of neck injury, your neck should be examined as a possible source of your headaches.
Treatment
Manual therapy, exercise, and mobilization/manipulation have all been found to be effective at treating cervicogenic headache. Combining manipulation with exercise appears to be the most affective. These are general recommendations. A good detailed examination will reveal your deficits and allow your physical therapist to develop a customized treatment plan. There can never be a treatment protocol as each person’s needs and impairments are unique.
The Headache Therapist 