Is my headache coming from my neck?

Up to 90% of all headache and migraine types have a neck contribution, so yes, it is very possible that your headache is actually coming from your neck! The term we use to describe these headaches is “cervicogenic” with “cervico-” meaning Cervical Spine (or neck!) and “-genic” meaning “from”- so a headache coming from the neck.

The International Headache Society classifies a cervicogenic headache as a secondary headache that has its source in the neck and is perceived in one or more areas the head or face. This includes the back if the head, the temples, behind the eyes, even more traditional “tension headache” or “sinus headache” locations. This means that you can even have a headache that originates in the neck without any symptoms in your neck!

Headaches with a neck origin usually start in the back of the head and upper neck and spread over to the front of the head, face or temples. They often fluctuate in intensity and are perpetuated by poor neck postures (such as prolonged use of a mobile device, laptop or improperly set up desk) or pressure to the upper neck and occipital area (where the neck meets the head).

The joints involved are limited to only the top 3, referred to as C1, C2 and C3. The other vertebrae in the neck have referrals to the shoulder, arm and hands.

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ATLAS and AXIS are the names given to the top 2 vertebrae of the neck!⠀ These bones form just 2 of the 7 neck vertebrae! They work together to protect the spinal cord and facilitate neck movement. ⠀ ⠀ There are 33 vertebrae in your vertebral column. But by the time you're an adult there are 24- you're born with 33, but the sacrum and coccyx fuse to the rest of the spine, making it 24 by the time you're an adult.⠀ ⠀ The atlas is the top-most bone (or C01), sitting just below the skull with the axis (C02) sitting just underneath it. Unlike the other vertebrae, the atlas does not have a spinous process, and the axis has a boney protrusion called the Dens that slots into C01 making these joints best friends. Meaning, they have to work together! When they don't they can throw off a range of symptoms ranging from headaches and dizziness to problems turning your head from side to side. As such, each and every neck assessment at City Physio (including treatments for headaches and dizziness!) starts at the base of the head, and move down over these 2 vertebrae first!

A post shared by C I T Y P H Y S I O (@cityphysio) on Jul 19, 2020 at 3:15pm PDT

So how exactly does the neck give you a headache?

A dysfunction occurs in the neck between vertebrae 1-3 causing muscle spasm which in turn stresses the joints and refers pain to the head. This can be a simple rotation or shift in the vertebrae caused by muscle imbalances, any injury (whiplash, concussion etc) or just poor posture that sets off this chain of events. What also happens is that if this dysfunction persists your body starts to adapt causing sensitization of the brainstem meaning less and less dysfunction set off the same chain of events more easily. This usually means that chronic headache migraine sufferers find that some medications are not as effective (or don’t work at all), and they have to be more diligent with avoiding “triggers” such as red wine, computers or delicious cheeses!

Treatment

Initial treatment is focused on narrowing down the specific origins of the headache while also assessing any contributions from the rest of the body- muscle imbalances, posture, desk setup, exercise etc. Our goal is to not only treat the nociceptive (pain producing) cervical joint, but to ensure that it is placed in a position to be supported for complete resolution and prevention of headache and migraine in the future.

With experienced and targeted manual therapy we narrow down the specific joint or joints that are dysfunctional and restore their movement. This can only be done with experienced hands as often the asymmetry is small or very very subtle! Treatment of these specific segments is the used to restore the movement between the segments, settle any muscle spasm and ‘rebalance’ the upper cervical spine. This then reduces the headache and unloads the sensitized brainstem. In time (usually in 1-3 sessions) it will be noted that the headache or migraine is occurring less frequently, with less intensity or settles quicker with medications.

Treatment then moves into phase 2 which is about maintaining the neck positioning while balancing the muscles around the neck and trunk, improving posture and control.

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Some TLC for @matt_cityphysio’s upper cervical spine!

A post shared by Nicola Michell (@nicola_cityphysio) on Apr 5, 2020 at 11:38pm PDT