Arguably, everyone has had a headache at one time or another and at this moment in time more than 10% of the UK’s population is currently suffering from a headache of one form or another and this is why headaches are the main reason for seeking advice from your GP.
There are several different types of headache. Over 90% of these types of headache are known as primary headaches which have no underlying medical condition. These include all tension-type migraines, cluster and cervicogenic headaches.
What is a cervicogenic headache?
Cervicogenic headaches are headaches where the pain originates in the neck and upper shoulders and are neatly clinically defined as “pain that is present in the head, but which originates in the cervical spine”.
However, cervicogenic headaches, like other types of headaches are different for different people and, depending on who you are, some are more severe and some are less severe, some are present in the head and others have pain behind the eyes.
The ‘classic presentation’ of a cervicogenic headache is where pain starts in the occipital region (the base of your skull at the back) and in the cervical spine and then progressively spreads upwards into the head.
Commonly, with cervicogenic headaches, there will be muscular trigger points in these suboccipital muscles of the neck and in the shoulder muscles. These trigger points can also send shooting pain to the head when they are physically manipulated and will be very, very tender.
Helpfully, there are two key symptoms that are generally exclusive to cervicogenic headaches. Firstly, the headache can be made worse or actually initiated by head or neck movement or passive neck positioning, especially when extended towards the side that is prone to pain and secondly, there is marked tenderness in the suboccipital region.
Who is likely to get them?
In our experience nearly all patients with cervicogenic headaches have abnormal neck posture (this is nearly exclusively Anterior Head Carriage) or have restricted range of neck motion.
And they are caused by?
We see these on a daily basis and in our experience at C1 Chiropractic Health Centre is that these headaches are a by-product of trauma (such as whiplash), neck injury, intervertebral disc disease, progressive joint arthritis, chronic tension or muscle trauma due to poor prolonged posture or severe stress with this last one being the most commonly encountered headache in our clinic.
How’s it treated?
Unlike many common forms of headaches, such as migraine, and cluster headaches, they often do not respond well to over the counter medications such as analgesics or common pain medications such as Panadol. Although the cervicogenic headache sufferer will note some relief from the symptoms of pain experienced when taking a pain relieving medication, once the preparation has worn off, the symptoms, and pain will return. In order to gain relief treating the symptoms simply isn’t enough and a more holistic approach must be taken for long-term pain reduction.
One of the most effective ways of relieving cervicogenic pain is with Chiropractic treatment using Chiropractic Manipulative Therapy (CMT). We manipulate the bones in the neck area that have moved out of alignment to reduce inflammation and irritation and so reduce pain.
A major spine care review was published in 2008. The authoritative report by the Bone and Joint Decade 2000 – 2010 Task Force on Neck Pain and its Associated Disorders which built on the impressive report produced Quebec Task Force on Whiplash. This report follows seven years of literature review and original research from more than 50 researchers and the editor of the Spine journal described it as a “milestone” report.
It covers all aspects of neck pain, including headaches, arm-pain and other neck generated symptoms. Tellingly, it states that neck pain is a “multi-factorial and episodic or recurring problem” and adds that because patients have many differing personal factors underlying their problems best management requires informing and educating patients on their options and respecting their preferences.
It then goes on to add that most patients have grade 1 or 2 neck pain (so low grade and therefore ‘primary headaches’) and that treatments, with similar evidence of safety and effectiveness, are education, exercise, mobilization, manipulation, acupuncture, analgesics, massage and low-level laser therapy. But treatments NOT supported by the evidence are surgery, collars, ultrasound, electrical muscle stimulation, TENS, most injection therapies including corticosteriod injections for the cervical joints.
According to recent studies published in the Journal of Manipulative, And Physiological Therapeutics, the results indicated that spinal manipulation had a significant positive effect in cases of cervicogenic headache. In this study, 53 participants who were sufferers of cervicogenic headaches were studied closely. Half of the subjects were given chiropractic manipulation as treatment, while the other half of the subjects received deep friction, and low laser massage. The study lasted over the course of a three-week period. While the two groups of sufferers did notice improvement with the care given to them, the group that were involved in the soft tissue treatments noted only a significant decrease in the hours per day that they were experiencing headache. The manipulation group showed improvement in all three of the measurement criterion being studied. Those who received chiropractic treatment in the study noticed a 36% decrease in their pain medication usage; their headache hours were decreased by 69% and their headache intensity had also decreased by 36%. At the 12 week point, one month after the trial ended, there was “a clinically important and statistically significant” advantage in pain reduction for the patients receiving chiropractic manipulation. The patients receiving 8 treatments had a 9.4 advantage in pain reduction. Those receiving 16 visits had a 17.2 pain reduction advantage. However, the difference was not statistically significant because of the small trial.
Haas w Peterson et al. (2007) Dose-response of spinal manipulation for cervicogenic headache: short –term outcomes from a randomised trail, Abstract in Proceedings of the WFC’s 9th Biennial Congress, 161-162
If your head hurts on a regular basis, and you suffer from headaches continually, especially if the pain seems to radiate from your spine or upper shoulder area, this may be a sign of cervicogenic headache. This is especially true is you have suffered trauma to your spine or neck such as whiplash or injury. And you should see your Chiropractor, get it diagnosed and sorted and stop complaining.