Headache is both a complex and multi-factorial medical problem, which affects millions of people each day. This article will focus specifically on cervicogenic headaches (or those originating from structures of the neck). Common neck pathology lending itself to headache may include but is not limited to, muscular pain (from trauma or overuse syndromes), facet joint arthritis and occipital neuralgia.
Myofascial trigger points or muscular pain throughout the neck and shoulder girdle may initiate headaches. Specific muscle groups have unique referral patterns of pain throughout the head and neck that may help your CPM physician isolate the source. Muscular headaches are similar to tension headaches in that they tend to be absent upon awakening, but become more pronounced as the day goes on. Certain activities may induce headache such as prolonged sitting or standing, or excessive overhead activity. These headaches tend to be dull and constant in nature, rather than throbbing. Effective treatment may include any combination of physical therapy, local heat, massage, muscle relaxants or trigger point injections with local anesthetic o/r Botox to relieve spasm. Consideration should also be given to maintenance stretching exercises and ergonomic adjustments to the work environment as necessary.
A multitude of cervical joints may also contribute to neck pain and headaches. Degenerative facet joint disease, atlanto-occipital (AO) or atlantoaxial (AA) joint arthritis, or post-traumatic facet joint or capsule injury may all cause recalcitrant headaches. These headaches are commonly seen in the elderly or patients who have suffered a traumatic whiplash injury. They may be unilateral or bilateral in location, and are often associated with restricted motion, including pain on neck extension and rotation. They are usually associated with some degree of concomitant neck pain with palpation of the facet joints on physical exam. Facet mediated headaches may or may not be supported by findings on x-ray or MRI. In some cases, the accurate diagnosis can only be confirmed by fluoro-guided injection with local anesthetic. Treatment typically includes non-steroidals and muscle relaxants, as well as physical therapy for facet joint mobilization. If conservative measures fail, steroid injections may be considered. If pain recurs despite this approach, repeat injections may be indicated or RF denervation for more lasting relief may be achieved by eliminating the pain transmission pathway.
Occipital neuralgia (or compression of the greater or lesser occipital nerves) may occur as the nerves exit muscle groups along the scalp line. Compression of these nerves may result in a burning-type pain in the posterior region of the head with or without radiation behind the ear. Nerve compresssion can occur from cervical degeneration or post-traumatic compression of the C2 or C3 nerves. In many cases, effective treatment may be achieved with a simple occipital nerve block.
In summary, cervicogenic headaches may result from a variety of sources emanating from structures in the neck. These headaches may be perceived virtually anywhere in the head, but are usually associated with some degree of concomitant neck pain. You should discuss with your physician the diagnostic and therapeutic options that may be available to more accurately diagnose and effectively manage your pain.
Myofascial trigger points or muscular pain throughout the neck and shoulder girdle may initiate headaches. Specific muscle groups have unique referral patterns of pain throughout the head and neck that may help your CPM physician isolate the source. Muscular headaches are similar to tension headaches in that they tend to be absent upon awakening, but become more pronounced as the day goes on. Certain activities may induce headache such as prolonged sitting or standing, or excessive overhead activity. These headaches tend to be dull and constant in nature, rather than throbbing. Effective treatment may include any combination of physical therapy, local heat, massage, muscle relaxants or trigger point injections with local anesthetic o/r Botox to relieve spasm. Consideration should also be given to maintenance stretching exercises and ergonomic adjustments to the work environment as necessary.
A multitude of cervical joints may also contribute to neck pain and headaches. Degenerative facet joint disease, atlanto-occipital (AO) or atlantoaxial (AA) joint arthritis, or post-traumatic facet joint or capsule injury may all cause recalcitrant headaches. These headaches are commonly seen in the elderly or patients who have suffered a traumatic whiplash injury. They may be unilateral or bilateral in location, and are often associated with restricted motion, including pain on neck extension and rotation. They are usually associated with some degree of concomitant neck pain with palpation of the facet joints on physical exam. Facet mediated headaches may or may not be supported by findings on x-ray or MRI. In some cases, the accurate diagnosis can only be confirmed by fluoro-guided injection with local anesthetic. Treatment typically includes non-steroidals and muscle relaxants, as well as physical therapy for facet joint mobilization. If conservative measures fail, steroid injections may be considered. If pain recurs despite this approach, repeat injections may be indicated or RF denervation for more lasting relief may be achieved by eliminating the pain transmission pathway.
Occipital neuralgia (or compression of the greater or lesser occipital nerves) may occur as the nerves exit muscle groups along the scalp line. Compression of these nerves may result in a burning-type pain in the posterior region of the head with or without radiation behind the ear. Nerve compresssion can occur from cervical degeneration or post-traumatic compression of the C2 or C3 nerves. In many cases, effective treatment may be achieved with a simple occipital nerve block.
In summary, cervicogenic headaches may result from a variety of sources emanating from structures in the neck. These headaches may be perceived virtually anywhere in the head, but are usually associated with some degree of concomitant neck pain. You should discuss with your physician the diagnostic and therapeutic options that may be available to more accurately diagnose and effectively manage your pain.
