Headache is a very common symptom that we have all experienced at some point. Occasionally, headaches appear simultaneously with neck pain, and my patients consult me about this; they themselves relate one pain to the other. However, are they always related? Do they have a common cause, or are they two different pains? The answer is sometimes yes, and sometimes no…
The factor consistently linked to both headache and neck pain, and which exacerbates their episodes, is STRESS.
Below, I will differentiate three common types of headache. I want to make it clear that this description is generic and does not constitute a definitive diagnosis, nor does it replace a visit to a neurologist:
- Tension headache: characterized by a pressing pain (as if being squeezed) on both sides of the head, which can radiate to the neck and shoulders. It is strongly associated with stress, overwork, anxiety, poor lifestyle habits, and inadequate nocturnal rest. Generally, this pain, despite being bothersome, allows daily activities to be performed and improves with paracetamol or ibuprofen and rest.
- Migraine: the pain usually moves from the front to the back of the skull, is often pulsating and on only one side of the skull (although it can vary sides), and may be accompanied by symptoms such as nausea, light sensitivity, and noise sensitivity. Migraine severely interferes with an individual’s activities and can be very debilitating. Neck pain can be a prodrome (warning of a migraine attack), can appear during the attack, or afterward.
- Cervicogenic headache: this is pain in the posterior neck and skull area, referred from the upper cervical vertebrae. Its origin is the inflammation of neck structures (ligaments, muscles, zygapophyseal joints), it appears fixed on one side of the skull and usually radiates from the posterior to the anterior area. The headache is accompanied by decreased cervical mobility and sometimes worsens with certain neck movements.
The diagnosis of cervicogenic headache, as we discussed with cervicogenic dizziness, is one of exclusion; that is, other causes of headache must first be ruled out with a visit to a specialist, in this case, a neurologist. Furthermore, for a headache to be considered of cervical origin, it must appear simultaneously with neck pain.
TREATMENT OF CERVICOGENIC HEADACHE
Once neurological compression, cervical instability, or a significant cervical lesion as a cause has been ruled out, treatment is usually conservative with:
- Massages
- Cold compresses
- Exercises for cervical postural correction
- TENS
- Anti-inflammatories
If the pain does not respond to the above, Minimally Invasive Techniques such as facet blocks and occipital nerve blocks can be performed, and in recurrent cases, cervical facet radiofrequency.
Here is a video with three simple exercises to correct cervical posture:
Occipital neuralgia and cervicogenic headache: diagnosis and management. Current neurology and neuroscience report (2019)
