Headaches arising from the neck are very common. Cervicogenic means ‘of neck origin’. Tightness or spasm in the neck refers pain into the head, forehead, over the eyes or temples.
The headaches are often aggravated by certain postures or neck movements. A vice-like feeling can be reported and the headache may ease when lying down, as the neck muscles can relax with head supported.
Top of the Neck at the Base of the Skull “Suboccipital Muscles”
The head, which is quite heavy (5-6kg or 10-15lbs) rests and balances on the ‘Atlas’, the top vertebra at the base of the skull, along with a network of small postural muscles, called the ‘sub-occipital muscles’, and larger muscles attaching down the neck to the upper back. When these muscles are tight, or the vertebrae are fixed or not moving correctly, they can cause headaches.
There are nerves underlying these deep neck muscles, that when irritated or pressured can cause pain up over the head and around to the back of the eyes.
Symptoms of cervicogenic headaches
- Reduced neck range of motion
- Pain on one or both sides of the head
- Pain and stiffness of the neck, shoulders or upper back
- Pain around the eyes
- Head pain that is triggered by certain neck movements or positions
- Sensitivity to light and noise
- Nausea
- Blurred vision
A really good example is a decorator Martin (see also Testimonial Video for Martin) whom I have treated for over 15 years. He is pain-free for a while, even several months, then after ceiling work extending his head back, looking up painting or papering ceilings, even for an hour the headaches start. Sometimes he just has tension at the back of the neck, or sometimes with further symptoms of dizziness and what he would describe as a ‘muzzy head’. He then invariably calls in for a treatment.
Treatment consists of deep massage to the base of the neck and suboccipital muscles and sometimes adjustment or manipulation of the cervical spine if the neck is particularly tight, or the symptoms are more severe. Whilst he is not keen on having the manipulation, he realises that sometimes it is necessary to help the effects of the treatment last longer. I give the manipulation after deep massage to help him relax fully. Sometimes I give only deep massage and the headaches settle. The combination of treatments is most effective at settling the headaches for a longer period of time.
Cervical headaches are commonly reproduced or triggered during treatment by pressing, even gently, into the neck muscles (especially suboccipital muscles at the top of the spine) which are often tender and this is a good sign the headaches are likely to respond well to treatment. There is often a stiffness or reduced movement in the neck, with pain sometimes radiating down into the arm or top of the spine in the Trapezius muscle area, an area which most clients call the shoulder, but is in fact closer to the spine or ribs.
Occipital Neuralgia – Headaches from the base of the skull -suboccipital muscle spasm
Occipital Neuralgia is inflammation of the nerves that run up from the base of the skull, through the scalp and to the back of the eye. It is often caused by Suboccipital muscle spasm or trigger spots which are just below the base of the skull or occiput at the top of the neck. It is a sensitive area with postural reflexes and sensory nerve endings lying beneath which can easily be pressured.
Anatomically, the greater and lesser occipital nerves arise from between the first and second cervical vertebrae. They have a thick covering and emerge from below the suboccipital triangle under the obliquus capitis inferior muscle and pass through the semispinalis muscle before rising to innervate the skin and scalp to over the top of the head and to behind the orbit.
Tightness and pressure on these suboccipital muscles is a common cause of headaches.
Symptoms of occipital neuralgia include:
Often times patients will point to the base of the skull and say ‘this is where I feel the tightness’
The pain can be described as migraine-like, or patients will say they have migraines which are really headaches as the symptoms can be so similar to migraines or cluster headaches.
- Continuous aching, burning and throbbing
- Intermittent shocking or shooting pain that generally starts at the base of the head and goes to the scalp on one or both sides of the head.
- Patients often have pain behind the eye of the affected side of the head.
- Visual disturbances or nausea, which are more common in migraine type headaches.
- Gently brushing hair can trigger the pain.
Lifestyle and work causes of Cervicogenic headaches.
Stress and tension
Trauma, such as whiplash
Grinding teeth, tension in the Jaw (TMJ or Temporo-Mandibular Joint)
holding the head in sustained positions:
Looking down too much, working at a desk that is too low.
Sitting on the sofa looking down at an ipad, laptop or phone.
Holding or pulling the head down, (chin tucking) whilst typing, writing or using tablet/phone.
Manual jobs, like painting ceilings.
Habitual pulling of the head back with tension in the suboccipital muscles, when working at a computer monitor, causing suboccipital muscle tension.
Headaches arising from the Upper Back -the Dorsal or Thoracic spine
I have had many cases where the headaches have been caused by tension not just in the neck but also the upper Thoracic or Dorsal Spine or ribs which are the base or insertion of the larger neck muscles. There is often a tender region or spot, which when treated helps the symptoms.
Treatment of cervicogenic headaches
Chiropractors are specialists at treating neck conditions, so are very well placed to treat cervicogenic headaches. As I explained earlier a combination of manipulation and deep muscle releasing can be very effective, not just to relieve symptoms, but also to cure the headaches. Personally I have found so many clients have been helped over the years and it gives me huge satisfaction when I can make a profound difference to their quality of life. Further treatment information can be found under the treatment of headaches