What are Cervicogenic Headaches?
Cervicogenic Headaches
Cervicogenic headaches are headaches that come from the neck. Pain from structures in the upper neck is felt, or “referred,” to the head. Headaches in general are among the most common neurological problems, and millions of people deal with them often.
Some headaches need emergency care. Call 911 or get emergency care right away for a sudden, severe headache; a headache with fever and a stiff neck; a headache with weakness, numbness, vision loss, trouble speaking or trouble walking; or new neck pain and headache after an injury, especially with dizziness or other neurological symptoms.
How Common Are Cervicogenic Headaches?
About 0.4% to 2.5% of people are estimated to have cervicogenic headaches, and they are more common among people being treated for chronic pain and chronic headaches (1).
What Causes Cervicogenic Headaches?
Cervicogenic headaches come from the muscles, joints and deeper structures of the neck. The neck has many tissues that can produce pain. These headaches can be caused by whiplash, sports injuries, inflamed muscles and joints, or irritated nerves. They are often linked with reduced neck movement, which can lead to stiffness that limits motion even more. Pain usually spreads from the neck to the back and sides of the head, and sometimes to the forehead and around or behind the eyes. Over time, people often notice the headache more than the neck pain, so the neck can get overlooked.
What Are the Symptoms of Cervicogenic Headaches?
Along with head and face pain, common symptoms include neck tension, limited neck movement, and headaches triggered by certain neck movements or positions. Other symptoms can include nausea, vomiting, sensitivity to light and sound, dizziness, neck, shoulder or arm pain, and blurred vision (1). A headache brought on by coughing or sneezing should be checked by a medical provider, since it can have other causes.
How Do Cervicogenic Headaches Affect Your Life?
Headaches are a major cause of disability and lost productivity. About 157 million workdays are lost each year in the U.S. because of headaches, costing about $50 billion in missed work and medical costs (2).
Headaches can also take a heavy toll on mental health. Chronic headaches are closely linked with depression and anxiety (3). Cervicogenic headaches have been linked with poor sleep, which can feed a cycle of low mood, more sleep problems and more headaches (4).
What Happens in the Brain With Cervicogenic Headaches?
Most people think of pain like an on-off switch: either something hurts and something is wrong, or it doesn’t hurt and everything is fine. But that’s not really how your pain system works.
A better comparison is the strength-tester game at a carnival. You swing the hammer, the puck shoots up, and if you hit hard enough, it rings the bell at the top. Your pain receptors are the hammer, and your pain threshold is the height of the bell. Ideally, the hammer hits softly and the bell sits high, so it takes a lot to ring it.
Pain signals from your head and face travel through your trigeminal nerve (5), which also carries pain signals from the blood vessels and membranes surrounding the brain. When pain receptors are pressed on or irritated by inflammation, they send signals to a group of nerve cells in the brainstem called the spinal trigeminal nucleus (6). This is the striker in our carnival game. It constantly receives input from the trigeminal nerve, from movement, from chemical byproducts and more.
Even when nothing is wrong, pain-sensing nerves have a natural background level of activity, and that activity rises when tissues are injured. If your brain didn’t manage this input, you’d be in pain all the time. So the brain has pathways that send signals down to calm the trigeminal nucleus, making sure normal background activity doesn’t register as pain. When this system works well, the bell sits high, and it takes a hard hit to feel pain.
The trigeminal system doesn’t only receive input from your head, face and brain. It also receives pain input from the top three segments of your neck, including the area at the base of your skull. If there’s enough pain input from your upper neck, the bell can start to ring and you feel a headache.
If that input is strong enough, pain can spread through the trigeminal system. You may feel pain not just at the base of your skull, but behind your eyes, in your forehead, in your jaw and in other areas served by this nerve. This is a kind of crosstalk, much like how a heart attack can cause pain in the left arm even though nothing is wrong with the arm. Many of the pain receptors around the brain surround blood vessels, so when the trigeminal system is highly activated, you may feel throbbing pain with every heartbeat.
Your pain system works like the rest of your nervous system: the more it’s used, the better it gets at its job. Unfortunately, that means if the bell keeps ringing for a long time, the bell gets lower, and it takes less to trigger a headache. Eventually, even normal background input can be enough to set one off.
Your neck can contribute to pain in many ways, and the causes aren’t always easy to find without careful testing. Tight muscles at the base of the skull can come from injured tissue, but they can also come from something as subtle as eye movement problems, mixed signals from the inner ear, trouble holding your eyes steady on a target, or trouble coordinating your eyes and head to follow a moving object. When your nervous system adapts poorly in these ways, the upper neck muscles can become tense, contributing to headaches (7).
How Are Cervicogenic Headaches Usually Treated?
Cervicogenic headaches are treated in many ways, from physical therapy and manual therapy to prescription pain medications, injections and procedures that disable pain nerves (8). Many people improve with treatment, but some continue to have symptoms. Many people spend years searching for answers, seeing many providers and trying many treatments.
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician and other providers, never in place of them. Please don’t change or stop any medication without talking with your prescriber.
We evaluate the many factors that may be contributing to your headaches. This includes the muscles, joints, ligaments and nerves of your neck and jaw, the nervous system pathways that control them, and the brain and brainstem systems that normally calm pain. We bring all of this together into a personal plan aimed at the factors driving your symptoms.
Manual therapies for the upper neck have been studied for cervicogenic headaches (9), and spinal manipulation has been shown in studies to help reduce cervicogenic headache pain (10). Your program may include chiropractic adjustments and other manual therapies when appropriate, after a careful exam to make sure they’re safe for you.
Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (11, 12, 13, 14). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just your spine.
Balance and inner ear function. Research shows that people with cervicogenic headaches often have reduced balance while standing, suggesting problems with the inner ear (vestibular) system and how it works with signals from the neck and body (15). Computerized balance testing can be useful after neck injuries such as whiplash, and it can also help show whether a concussion may have happened at the same time, which can change how care is planned (16). Inner ear balance problems are also common after whiplash, which supports the idea that whiplash may affect the brainstem (17). Vestibular rehabilitation is often an important part of our care.
Eye movements. Eye movement problems are common after whiplash. Because the eyes and neck muscles are so closely connected, we pay close attention to eye movement testing and training. Research has found that eye movement and neck problems often occur together after whiplash, and that combining eye movement training with neck rehabilitation can improve both (18).
In some people with chronic neck-related headaches, eye movement problems may reflect a brain injury that was never recognized. Many people don’t realize they had a concussion at the time of their neck injury. Studies of fast eye movements called saccades have found problems in people with chronic whiplash. Reflexive saccades were normal, but saccades that require deliberate control, especially the ability to hold back an automatic eye movement, were impaired, suggesting involvement of the brain’s frontal lobes (19).
Neck control and eye-head coordination. Whiplash can disrupt the posture control system by scrambling the position signals coming from the neck (20). The reflexes that control the deep muscles that steady the neck can be affected. Coordination between neck muscle activity and eye movements at different speeds has been found to be disrupted after whiplash, which may contribute to many common whiplash symptoms (21).
Gaze stability, your ability to keep your eyes steady on a target while your head moves, also matters. Problems with gaze stability and eye-head coordination after whiplash have been linked to disturbed reflexes, reduced neck movement and neck pain (22).
Many people continue to have disabling symptoms, called whiplash-associated disorders, for months or even years after an accident. Research suggests that abnormal head and trunk movement, abnormal results on tests of the inner ear’s gravity sensors (the otoliths), and abnormal balance tests may help predict whether cervicogenic headaches become chronic after whiplash (23). Our testing looks at each of these factors.
Depending on your needs and test results, your program may also include non-invasive electrical stimulation of the trigeminal nerve (24), vagus nerve (25) or occipital nerve (26), which have been studied for headache pain; and light therapy, also called photobiomodulation (27). Transcranial magnetic stimulation (TMS) has been studied for headache (28). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you. Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions.
No two people are alike, and no two NeuroRescue Programs are the same. The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to help reduce how often and how intensely your headaches happen, so you can move more freely and get back to more of the things you enjoy.
Your Next Step
Living with cervicogenic headaches can be draining, but you don’t have to keep searching alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
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