Cervicogenic Headaches, Such a Pain in the Neck!

Dr. Gabriel Ariciu, DC

Dr. Gabriel Ariciu, DC

Last week, I talked about tension headaches and how it can be similar to other headaches. One of those headaches are cervicogenic headaches. It is a fancy term that just means a headache that starts in the neck. From my experience, it can be pretty prevalent.

Most of us have known someone who has experienced a whiplash, maybe even ourselves. Headaches associated with them are cervicogenic. That is probably the most common one. However, I think there is more nuance. So I will make some broad strokes here and include more than what is normally used in the diagnostic criteria.

Reductionism

In the medical world, we tend to reduce issues down to the components involved in a narrow area. If you have neck pain, we look at the neck. Or if you have knee pain, we look at the knee. Rarely do we step outside of this mindset to see if the cause is elsewhere.

This is problematic. Our body is interdependent. So if we reduce everything down to a small area, looking at only a few tissues we miss the giant piece of iceberg under the surface of the water. There is often more going on. That being said, there is a reason behind it: diagnosis and treatment.

Diagnosis

We all what to understand what is going on. And it has been instilled into us. If my neck hurts I want to understand what happened or at least what is injured. This is the job of diagnosing. So medical professionals spend a lot of time running various tests to rule in or rule out a diagnosis.

This is good in all, but once we have a diagnosis we still need to treat. Treatment can vary widely depending on the diagnosis. And sometimes we expend so much energy on the diagnosis all the while our treatments are subpar. What I mean to say is diagnosis matters only if it effects the treatment in a significant sense. I know this controversial. And I am by no means throwing it out. Let me explain further.

Treatment

Certain tests during the diagnosis are important as they can uncover a problematic area. Then we know what we need to focus on. If someone’s has a “weak” trapezius muscle or they have a “tight” latissimus dorsi (lat for short) this is problematic, but informative. Treatments will be based off of this.

However, if are evaluation is so narrow that we are only looking at the neck, we will miss the bigger picture. If we miss the big picture we miss what really is going on and the patient suffers accordingly. Our job is to get people better efficiently and effectively.

Sorry about the side note, but it is important. There is often more going on with cervicogenic headaches than issues that solely reside in the neck.

So What Is It?

It is a chronic headache where the pain often starts in the neck and then refers over one-side of the head. It can be quite painful. Often you can feel tenderness by pushing on the muscles just below your skull on the back side of your neck, just to the side of your spine. Sometimes that will cause the pain to refer into the head too.

The upper spine has several nerves that come into play. When your neck is injured or strained it signals these nerves. These nerves in turn signal another nerve in your spine that refers pain into the head. This nerve is also implicated in migraines and tension headaches. Hence, they can be similar.

A Broader View

Muscles around the neck, upper back, and shoulders can also contribute to this. I broaden my view because of the interplay of these muscles and from clinical experience. The body is made up of interdependent systems. You cannot affect one without affecting another. Maybe your neck is injured or maybe it is a long line of compensations that finally causes an issue.

Think of a group of workers and one by one they stop working leaving only one worker carrying the load. That person has a lot on them. As each of the other workers stopped, this worker had to work harder and harder. Finally, they are the last one working. At some point, they cannot take it anymore, and they give up. This is when the pain often starts. This is the straw that breaks the camel’s back.

Compensation

Our body is amazing at compensating. We need to move so we can survive. Survival requires it. So our body was amazingly designed to heal itself as well as compensate when needed. When an injury occurs, we compensate by shutting down some muscles and working around the injury. Why? So we can move and continue to survive.

The problem comes in when we accumulate too many compensations and we never healed the original injuries. Each compensation acts as its own injury. So it is an accumulation of many injuries that now need to be addressed. A lot of people heal on their own. Once they are safe at home and can rest, they can heal. Others do not.

Chronic Injury and Pain

When we can no longer compensate well, that is often when pain starts. Caveat, of course some injuries are abrupt, like falling off a ladder or a car accident. That being said, others may seem abrupt but they are not.

For example, a rolled ankle. We may think that is the cause of the injury. In part it is, but often the ankle was compromised before the injury even occurred due to the compensations. The rolling of the ankle resulted from years of improper movement, poor shoes, nutrition, etc. Finally, it was the last straw.

I hope this makes sense. It is not only important with headaches but almost every other injury imaginable. Now let me get into what I look for with these types of headaches.

Muscles Involved

I am going to mention several muscles that I find commonly problematic in these types of headaches. They are the rhomboids, levator scapulae, and trapezius. (See pictures below) However, these are not the only muscles at play nor are they the only tissues involved. Fascia is an incredibly important tissue that must be addressed.

Rhomboids
Levator scapulae
Trapezius

When we look at our body holistically, we need to take into account everything downstream from the neck. This includes the rest of the spine, shoulders, the pelvis, legs, feet, and supporting muscles and fascia. We also need to not forget the head and jaw. So in other words, everything matters and plays a role.

Posture

Posture gives us a clue of what might be working and what might not be. Most of us walk around with a tucked pelvis, hunched back, forward head, ducked feet, and so on. It comes from years of sitting and improper movement.

Each of these positions provide different loads on our body that effect the way we move. Some muscles become shortened, others weak. We often like to wear shoes with a positive heel on them. This changes the entire body’s mechanics. Our body responds to the shoes by activating certain muscles, shifting our pelvis forward, hunching our back, and sending our neck forward. It is almost as if you are falling forward but you are not.

So an issue in your neck can be because of the shoes you wear!

What To Do

  1. Start moving more. Start moving better. Go for walks.
  2. Try the two exercises listed below to see if they will help.
  3. Feel for and rub out tender spots in the muscles I mentioned above. Essentially, all the muscle between the shoulder blades, on the shoulders, and the neck. Well, you will probably need a friend to help you with this since they are hard to reach. Especially look at the areas they attach to the bones. But be thorough.
  4. If this doesn’t help, you probably need to come on in.

Exercises

This one I just call modified child’s pose. It very similar to the child’s pose from yoga. You get down on all fours and onto your forearms. Make sure your pelvis is untucked, in other words, don’t round your lower back. Now from this position sink your butt back towards your heels letting your forearms kind of drag on the ground. You should feel tension in your shoulders and it can be uncomfortable. Rest in this position for 30 seconds. You can do this multiple times per day. There is more nuance to it but hopefully this helps. See the pictures for help.

Starting position
Rest in this position (I got some work to do 😉 )

The other is a bit more difficult. It is called floor angels. This involves laying down on your back on the floor using a bolster to prop up your shoulders, neck, and head. The bolster can be a blanket, a pillow, or towels, whatever works. Then you reach your arms out to the side with them externally rotated. Your thumbs will be touching the floor. From this position you then essentially make the same movement as a snow angel. All the while keeping your thumbs on the floor and trying to pull your elbows towards the ceiling. It is difficult, so I will link a video I found on YouTube that can be helpful.

Starting position
Full exercise from MYogaMichelle

Conclusion

Cervicogenic headaches are painful. They are often due to our lifestyle. We sit too much and wear positive heels among other things. They are also caused by accidents, car accidents and whiplash being the most common. Although they can be frustrating there is hope even if it has been going on for years.

I hope this explanation and the tips help. Please reach out to us if you need anything. We are here to serve!

Sources:
1. Physiopedia contributors, “Cervicogenic Headache,” Physiopedia, , https://www.physio-pedia.com/index.php?title=Cervicogenic_Headache&oldid=236792 (accessed August 10, 2020).