Neck-Related Headache

What is a Cervicogenic / Neck-Related Headache?

The term Cervicogenic Headache (CGH) means neck-derived or neck related headache.  The prevalence is both widespread and likely underreported as it is thought to affect up to 80% of the population¹. Women are four times more likely to suffer from CGH and a large number with CGH also suffer with migraine.

Like many headache types, patients with CGH often report neck pain or stiffness preceding the headache pain.  CGH sufferers also frequently have concurrent jaw/TMJ issues and occasionally tinnitus (ringing in the ear).  There may also be nerve root issues or nerve pain, shoulder or arm pain present.

Research by Jull et al. (2007)² looking to differentiate between Cervicogenic headaches, tension-type and migraine headaches, discovered some findings were more specific to Cervicogenic headaches:

• Decreased Neck range of motion, especially active extension,

• Pain with palpation of upper neck joints (C0 – C3/C4 joints)

• Poor deep neck flexor muscle coordination and endurance.

Further research by Zito et al. (2006)³ also found a number of characteristics specific to Cervicogenic headaches:

• Pain and/or stiffness on palpation of C1/C2 neck joints

• Gross decrease in range of motion throughout the cervical spine, especially flexion/extension,

• Pectoralis minor muscle shortening.

What is the Cause of Cervicogenic / Neck-Related Headache?

The main contributing factors in causality are most likely what you may intuitively know already, namely; neck stiffness and pain or feeling “out” in the neck from prolonged or poor postures, stress, tension, fatigue, or trauma to the neck like whiplash for instance.  In reality though, these mechanical causes are just the start of the problem.

Why then do only some and not all people who have poor posture or neck trauma have CGH? Well, the answer lies in what effect that neck dysfunction has on the local nerves and the nervous system.   Even more specifically…what is happening to the upper neck joints, especially C2-3 where it is postulated a disc disturbance drives local (inferior obliquus capitis) muscle spasm causing noxious nerve input that fires up the brainstem.

So what is the real cause of CGH pain?

Thankfully, science is now revealing what every chronic headache sufferer knew all along, namely it’s not “all in your head!” In fact, it is most likely in your NECK! What is emerging from the research is the fact of a common pathway or “headache headquarters” in the brainstem where multiple neurons converge.  This specific region is called the Trigeminocervical complex (TCC) and is a “holy grail” of sorts for researchers, clinicians and sufferers alike. Furthermore, recent studies have revealed that one of the most powerful causes of brainstem sensitivity is the upper neck or Cervical spine^4,6,7.

Even between an episode or attack, research shows that chronic headache patients exhibit a sensitized brainstem.  Once this portion of the brainstem is fired up enough, even normal everyday stressors (like prolonged or poor posture) trigger an already sensitized brainstem leading to an attack of nasty pain.  Therefore, the real cause of the pain of CGH is a combination of mechanical factors in the neck driving and perpetuating this underlying neurological condition.

The Solution

The good news is research emphatically reveals that the neck dysfunction and brainstem sensitivity it causes CAN be treated with an integrated and combined therapy approach, with a critical first step being expert screening of the upper neck as a primary contributor of sensitivity in the brainstem^3,4.

A high level research Cochrane Review ⁸ found “both neck exercise (low intensity, endurance training) and spinal manipulation are effective in the short term and the long term” for CGH.  Moreover, in a 2002 study by Jull et al.⁹ with similar combined interventions they demonstrated statistically significant decreases in neck pain, headache frequency and intensity at follow-up at 7 weeks and 12 months, ranging from 50% better to complete resolution.

Also interestingly in this study, medication use decreased in the combined therapy group by an impressive 93%, underlying the efficacy and importance of physiotherapy and a combined therapy approach in the treatment of Cervicogenic headaches (CGH).

Our unique combined therapy approach is logical and evidence-based and aimed at decreasing the sensitivity in the brainstem at the “headache headquarters” with a number of safe treatment options individualized to your headache type.

Click the links for more information on how we perform Our Assessment or Our Treatment or to learn more about our revolutionary 4 phase  S.T.E.P. into FREEDOM ^TM  program to help you live life headache free!