What is a Cervicogenic Headache?
Its been over five years since the launch of Spriggs Chiropractic and Spriggs Nutrition. The clinic is evolving to provide better services for conditions we see most frequently, namely cervicogenic headaches, migraines, and Ehlers-Danlos syndrome. Over the next few months, I will be posting blogs and research studies about these conditions, along with several changes to the website coming soon. Keep up to date with changes at the clinic via our Facebook, Instagram and Twitter. For this post, I will be discussing with you cervicogenic headaches and what can be done to help manage and treat them.
Check out our short YouTube video on cervicogenic headaches here.
So what is a cervicogenic headache?
Bogduk and colleagues1 describe cervicogenic headaches as:
“…is a pain referred to the head from a source in the cervical spine.”
The medical term for the vertebrae of your neck is called the cervical spine. So the “cervico” bit refers to the cervical spine or your neck and the suffix “genic” means produced by or originating from. That, however, is where the simple part of our tour of cervicogenic headaches stops, so buckle your seat belts and hold on to your socks, because we are about to dive into neurology!
Neurology of Cervicogenic Headaches
We are taking a deep dive into neurology now, so take a deep breath. The sensation of your face comes from a cranial nerve called the trigeminal nerve. A cranial nerve arises from the brain and does not enter the spinal cord. There are twelve cranial nerves that fulfil different functions in the head and face including vision (the optic nerve), smell (olfactory nerve), taste and movement of the eyes. There are others with other functions, but to keep this blog as short as possible, I can discuss them with you in a later blog, if that is what the people want. However, whilst neurology is a fascinating subject, I can already hear your internal voices screaming “No” at me.
For clarity, referred pain is the phenomenon of experiencing symptoms such as pain in an area of the body that is caused by an issue elsewhere in the body. The best-known example of referred pain pattern is when someone experiences pain in their left arm during a heart attack. Your neck can cause you to experience pain in your shoulder, upper back, back of the head and shoulder blade regions1–3. The diagram below shows where each joint in the neck refers to (the grey areas) and where each overlaps one another (darker areas).
Figure 1: Pain pattern taken from Bogduk and Dwyer2
Here is the confusing bit, so we will take our time going through it. Cranial nerves start from a nucleus that will be located in the brain stem, which is made up of the midbrain, the pons, and the medulla oblongata (Figure 2). The medulla oblongata transitions into the spinal cord as it descends towards the base of the skull (the cranium) to the spine. It is a silly thing to say that this area of the spinal cord is crucial because all areas of the spinal cord are crucial. The spinal cord is your central nervous system, which controls and regulates all areas of the body and all bodily systems. So to label one specific area as crucial is absurd, however, the uppermost region of the spinal cord is where all the nerves and the information they are carrying converge before entering the brain. As a result of this tight convergence, there is significant overlap between different areas, which is where the phenomenon of cervicogenic headaches then starts to make sense.
Figure 2: Brain Anatomy with the brain stem labelled.
The trigeminal nerve’s nucleus is very long, starting in the medulla, descending down into the spinal cord, ending at the same place as the first three spinal nerve roots from C1, C2 and C3 (Figure 4). You can find out more about why these vertebrae are called C1 and C2 etc by reading our previous blog on the spine here. These three nerve roots synapse onto their nucleus they share with the trigeminal nerve. If there is damage, injury or dysfunction of C1, C2 or C3, this can result in stimulation of these neurons causing pain. Sometimes, or in some people, the brain is unable to tell if the pain is coming from the trigeminal nerve (the face), or the spinal nerves so it expresses this painful information as coming from the face or head resulting in a headache.
Figure 4: Taken from Bogduk1
Cervicogenic headaches are typically experienced around the eye and/or forehead, at the side or back of the head. Unfortunately, it is very difficult to tell if the symptoms someone is experiencing are coming from their neck or their head without a physical examination. Here at Spriggs Chiropractic & Nutrition, we see a lot of patients suffering from headaches and migraines, so we perform an in-depth physical examination to find out where the issue is coming from and start the appropriate treatment plan for each individual patient. This will include:
- A detailed medical and family history.
- A thorough physical and neurological examination, including the cranial nerves.
- X-rays of the cervical spine when clinically required. These are typically required if the patient has suffered a trauma to their neck before their headaches started. This might be a car crash for example.
The joints of the neck associated with headaches and neck pain.
To rule out eye conditions that may also present with pain around the eye and forehead, if a thorough eye test is required, a referral is made to Dr Valarie Jerome for further assessment. Dr Valarie and her colleagues are lovely and very professional optometrists who come highly recommended in Newbury and Berkshire.
In my clinical experience, there is a lot of confusion about cervicogenic headaches as patients may not have the opportunity to discuss the condition in any detail, so they are left with an incomplete picture of what the problem is and how to resolve or address it. In our next blog post, we will dive into how chiropractic can help with the management and treatment of cervicogenic headaches. The plan was to include treatment in this blog post, but I think you have probably had enough by now.
For those of your still reading, thank you so much for staying with me during this deep dive through the neurology of cervicogenic headches. I hope you have found it informative and helped clear up any confusion you may have had. Keep an eye out for our next blog post for treatment methods and how Spriggs Chiropractic & Nutrition can help you manage this condition.
Mark Spriggs DC, MChiro, MSc, FRCC
References:
- Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009;8(10):959-968. doi:10.1016/S1474-4422(09)70209-1
- Bogduk N, Dwyer A, Aprill C. Cervical zygapophyseal joint pain patterns I: A study in normal volunteers. Spine (Phila Pa 1976). 1990;15(6):453-457. doi:10.1097/00007632-199006000-00004
- Aprill C, Dwyer A, Bogduk N. Cervical zygapophyseal joint pain patterns II: A clinical evaluation. Spine (Phila Pa 1976). 1990;15(6):458-461. doi:10.1097/00007632-199006000-00005