Is Your Neck or Spine Out of Alignment? It May Be Causing Your Migraine
Cervicogenic Headache or Migraine
Have you ever woken up with a headache AND a nasty "crick" in the neck? The two are probably related! A neck ache and a headache could indicate a cervicogenic headache or migraine.
Cervicogenic comes from "cervico," meaning "neck," and "genic" meaning "relating to." These headaches are caused by the neck and by some definitions the spine.
Is it a Migraine or a Tension Headache?
To distinguish it from the more common tension or migraine headaches, a cervicogenic headache is generally caused from a neck vertebrae being partially out of alignment (subluxed.) In other words, if you have a neck pain and a migraine or headache, it's probably cervicogenic.
This causes irritation of nerves, especially the occipital nerve. Nerve irritation can be caused by muscle spasms which may accompany the subluxation or be independent of it.
People with hyper-mobile joints can experience these headaches often as neck, shoulder, ribs and pelvis sublux easily and often. So while the pain is in the head and neck, there may be other places where the instability started.
So Many Nerves and Bones - So Little Space!
How Can This Cause So Much Pain?
The neck and base of the skull is a very complex area full of bones, muscles, blood vessels, and nerves. With so much going on, it's easy to see why one little spasm or misalignment can cause problems - like a tipped over truck in Manhattan traffic.
Either the subluxed joint or the angry muscle can put undesired pressure on blood vessels and sensitive nerves, especially the occipital nerve.
According to the National Institute of Neurological Disorders and Stroke, the pain caused by the occipital nerve starts at the base of the neck and spreads upwards to the scalp. Sometimes the pain will also include the scalp, forehead, and behind the eyes.
A Headache (and more) in the Making!
What Causes This Cervicogenic Headache?
Whiplash or other neck injury can certainly be the cause. But a crooked spine, bad crick in your neck, arthritis, and in my case Elhers-Danlos Syndrome can also be causes. More commonly though, it can be caused by our lifestyle.
Modern life includes computers, driving, hand-held devices, and watching TV; all create severe stress on our neck and shoulders. While we know we should take constant breaks from these activities, we "forget!"
Holding our arms out in front of us and/or cocking our necks to see the screen properly, we put pressure on our neck and shoulders that our body wasn't built for. It sets us up for muscle and joint strain and pain.
This often causes tension headaches. But repetition of the poor posture can weaken muscles that normally hold our necks in alignment. When they weaken over time, the cervical bones can move around in ways that they shouldn't, pinching, squishing, and generally wreaking havoc. The muscle spasms also caused by long term bad posture can do the same thing.
Is it a Migraine, a Tension Headache, Sinus Headache or a Cervicogenic Headache?
About 42 million Americans suffer from headaches, 20% of chronic headaches are said to be cervicogenic. Four times as many women as men experience these.
There are many kinds of headaches including migraine, tension, and sinus headaches. There can also be a lot of reasons for them - poor posture, chemical or food sensitivity, vision changes, colds, hormones or stress. Sometimes, it's even a combination of these factors.
However, migraine and tension headaches most closely mimic a cervicogenic headache. Unfortunately, you are much more likely to be diagnosed with the migraine or tension headaches because so many of the symptoms are the same. For instance they all can affect one side, consist of severe throbbing pain, nausea, a sensitivity to sound and/or light.
Because diagnostic tests (blood work, x-rays, and MRIs) are mostly ineffective in this case, cervicogenic headaches are still widely under-diagnosed. According to the National Institute for Health, they are even considered controversial. In other words, many doctors don't believe in them.
If a practitioner does suspect a cervicogenic headache, the traditional way of diagnosing it is to do a neural blockade in the neck. However, according to The Journal of the American Osteopathic Association, diagnostic criteria have been developed which provide "a detailed, clinically useful description of the condition." This allows for a diagnosis without the need for the neural blockade.
How Are these Headaches Treated?
Generally cervicogenic headaches are treated most effectively with a multi-faceted approach. Since no real studies have been done, this information is gleaned from anecdotal evidence.
- Pain Medications - Although considered a temporary fix, pharmaceuticals can be helpful to survive a headache and relieve the stress the pain causes. Generally a combination of medicines for migraine headaches, NSAIDs, and perhaps anti-convulsive, antidepressant, or muscle relaxants can be helpful. Narcotic medicines are not considered effective in this case. Important: You must discuss these medicines with your primary care practitioner as the side affects need to be monitored with regular blood work.
- Manual Therapy - Manipulation of the muscular-skeletal system can help correct the misalignment. Reputable chiropractors, Osteopathic doctors who specialize in manipulation, and physiotherapists can help realign the joints, often permanently after a series of visits.
- Physical and Occupational Therapy - These are important modalities to help you correct posture and other lifestyle habits that created the misalignment and muscle spasms in the first place. Long term results are the goal and achievable for most people.
Approaching Your Healthcare Provider about Your Headache
As I always recommend for a condition that is uncommon or at least not commonly diagnosed, do your research. Spend time looking for information about your headache. When you find information that rings a bell, print it out. Highlight the information that resonates with you.
If you find that your headaches fit into the cervicogenic profile, make an appointment with your health care provider to discuss this. When you schedule the appointment, be sure to ask for a consultation so you have adequate time to talk without either of you feeling rushed.
Bring copies of your printed information that you can give them along with a cheat sheet with your particular symptoms and experiences. This helps keep the consultation on track. It's also helpful if you know which direction you'd like to go for treatment.
IMPORTANT: Be sure your information is from a reputable source which your health care provider is probably familiar.
If your practitioner seems skeptical, give them time to digest this new information and do their own research, and make another consultation appointment. No practitioner can know everything. If they are not willing to listen or become your partner, search for another practitioner.
Remember, this is your body and you deserve the best care you can get. But it is your responsibility to take proactive steps to get the care you need.
I Even Travel with This!
Things You Can Do To Prevent a Cervicogenic Headache
Prevention is always the best medicine. By preventing shoulder stiffness and misalignment of my neck, I get far fewer of these headaches.
For instance, I have found that when I sleep with my head flopped to the right, I'm sure to wake up "in trouble". So, I have a few methods to prevent this:
- Prop my pillow up slightly on both sides - usually just using towels under it.
- If I've been getting mild headaches that I know are caused by misalignment, I wear my cervical collar to bed. It's not the most comfortable thing, but is way better than the really severe headaches these mild one's can turn into.
- I have several different pillows that work well depending on my needs. Sometimes I need something more firm, other times soft.
I also try to spend 15 minutes a day on my Real Ease Neck and Shoulder Relaxer. I have prevented cervicogenic headaches that were immanent by doing this, even in the middle of the night if I wake up with one starting.
I get regularly treated by an osteopath who does low-impact manual therapy. Most people won't have the chronic problems that I have due to my Ehlers-Danlos Syndrome and will be able to "straighten out" the problem with a few visits.
Work on your posture and ergonomics. Be sure that when you work at your computer, for instance, you are practicing good ergonomics - customize the keyboard and monitor height to your needs. And SIT UP STRAIGHT. Our teachers and parents were right. It will hurt at first if you are improving bad posture, but the effort will be well worth it.
Get up regularly and move around. We used to spend more time standing and walking than we do now. If you are at work, walk over to others' desks instead of calling or emailing. Drink water - refilling and going to the rest room will get you away from your computer. Take a walk around your house, inside or out. Get up and look out the window.
Many wearable fitness devices (like a Fitbit) encourage 250 steps per hour. This corresponds with the simple advice my Physical Therapist has given me. If you are goal or numbers oriented, these devices can be great tools.
Another activity I've noticed can cause or exacerbate these headaches is my smart phone. Swiping uses muscles that tense the area around the neck and shoulder. This is a hard one, but the headaches that can result remind me not to play those addictive games so long!
All of these things will prevent or lessen muscle tension.
Trigger Point Therapy Might Help!
I wanted to add information about my discovery of Trigger Point Therapy. This is therapy I can do myself when I need it most. I don't think I'm being too dramatic by saying that this has been a game changer for me.
While the physiology of trigger points isn't well understood, we can all find spots on a muscle that hurt more intensely than the rest of the muscle. By searching for these spots and rubbing them, the muscle can often be coaxed into letting go of the stored energy that is causing it to contract painfully. For cervicogenic migraines, there are specific trigger points that definitely help.
For instance, you can get amazing relief from finding the trigger points on the sternocleidomastoid muscle. This is a very large muscle attached to the clavicle bone in the front and the base of the head towards the back.
However, there are major nerves and arteries located in this region of the neck. It's very important that you do research on properly finding and massaging the trigger points and not the nerves and arteries. Putting pressure on the wrong place is bad.
Trigger point charts and books are important starting points. However, you must get familiar with your own trigger points and the muscles involved with your pain. For example, trigger points in my gluteus maximus and minimus muscles are sometimes the key to relieving my cervicogenic migraine!
The best part about trigger point therapy is that it's something you can do to help yourself when you probably feel the most desperate and helpless. There are lots of charts. guides and books. And the tools needed can be a finger, knuckle, or tennis ball. This therapy is well worth a try.
Trigger Point Therapy
Useful Links for You and Your Medical Professional
- Cervicogenic Headache - American Migraine Foundation
Here is a great article from the migraine experts themselves.
- Physical Therapy Works For Cervicogenic Headaches And Occipital Neuralgia
While you may not live in this area, there is useful information about this kind of headache and Physical Therapy techniques to help treat it.
- Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies
Information from the Journal of the American Osteopathic Association. I've found this most useful and it's a great resource for your medical professional.