Cervicogenic Headaches

One in every seven people experience cervicogenic headaches, which are caused by a joint, muscle or ligament dysfunction in the neck. Those who have suffered whiplash from a motor vehicle accident are especially susceptible to this type of headache.

The headache is usually felt as a nagging, non-pulsating pain, felt on one side of the head. These type of headaches occur in attacks which can last from minutes to hours to days. There is the possibility of nausea and vomiting, however these symptoms are more commonly found in people suffering from a migraine. There are some other clear differences between a migraine and cervicogenic headache, described in a review of cervicogenic headaches, published by the World Institute of Pain including:

  • a cervicogenic headache will remain on one side, while a migraine may shift sides throughout the headache attack.
  • a cervicogenic headache usually begins in the neck, while a migraine usually begins in the head.
  • a cervicogenic headache can be provoked by movement and pressure of the neck, while a migraine remains unaffected.
  • a cervicogenic headache usually results in reduced neck movement, while in a migraine the neck will remain unaffected.
  • a cervicogenic headache may also involve diffuse shoulder/arm pin on the same side, while a migraine is usually limited to the head.

A cervicogenic headache also varies from a tension headache, which is felt on both sides of the head; and a cluster headache, which is felt as a short bust of excruciating and disabling pain often associated with tearing, facial swelling and drooping of the eyelid on one side.

Although extremely rare, it is crucial that a cervicogenic headache be differentiated from a swelling of the arteries inside the neck, known as a ‘vertebral artery dissection’ or VAD for short. A VAD can also present with neck pain and headaches, however typically other features will begin to emerge such as: dizziness, double-vision, trouble speaking/swallowing/walking, fainting, nausea, numbness and jittery eyes. A chiropractor is trained to check for these signs, known as ‘red flags’ in order to rule out the likelihood of a VAD.

Cervicogenic headaches can be diagnosed by a chiropractor who will examine the neck to determine if movement or pressure provoke the headache; as well as whether there is reduced movement of the neck, or a difference between the movement of each side. A chiropractor is also trained to check for signs of various other causes of headaches and neck pain such as a VAD.

There are a number of pressure points that may be tender in people with cervicogenic headaches, as described, including:

  • the broad areas towards the back and sides of the head;
  • the bony prominence, directly behind the ear;
  • the 2nd and 3rd facet joints in the neck;
  • and the front and back, upper portions of the large trapezius muscle that sits on the tops of your shoulders.

A study which mapped specific headache locations found that dysfunction in the upper joints of the neck was most likely to refer pain to distant areas of the head (i.e. eyes, forehead and ear). Therefore, it is important to show your chiropractor the area in which you feel your headache, so they can determine the specific location in the neck that it is originating from.

Manual therapy and specific exercises for cervicogenic headaches have been shown to be significantly more effective in the reduction of headache frequency and intensity, than care provided by a general practitioner.

References:

Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20–59 years olds. Spine. 1995; 20: 1884–1888.

Lord S, Barnsley L, Wallis B, Bogduk N. Third occipital nerve headache: a prevalence study. J Neurol Neurosurg Psychiatr 1994; 57: 1187–90.

Hans Van Suiklekom et al. Cervicogenic Headache. Pain Practice. 2010; 2: 124-130.

Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Medicine 2007; 8: 344–53.

Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27: 1835–43.