Have you ever had the weird sensation where your neck pain seemed to cause headaches, but was unable to describe why?
It is theorised that the pathophysiology of cervicogenic headaches involves a specific structure in the neck called the “cervicotrigeminal nucleus.” Essentially, the sensory input from this region coincides with both the head and neck, and the brain can sometimes confuse this input and interpret neck pain as headaches. However, neck pain of any type has been suggested to cause headaches regardless of location, so the exact reason is still unknown.
As with many other pathologies, there are different types of headaches. The one we will focus on today is “cervicogenic headaches” and neck pain. There are unique symptoms that arise with cervicogenic headaches, including:
- Headache originates from muscular, articular, osseous (bony), neurologic (nerve) or vascular (artery / veins) structures of the neck
- Neck pain should trigger or precede the headache
- Travels from the occipital area (see figure below) and spreads towards the front of the face
- It is usually unilateral (one-sided)
- Aggravated or worsened by neck movement
- May have some associated restricted range of motion in the neck or shoulder
- Potentially associated shoulder or arm pain
- Headaches can also cause:
- Photophobia (Light sensitivity)
- Phonophobia (Sound sensitivity)
In future posts, we will touch more on the different types of headaches and how each of them can affect you!
Treating the neck pain / headaches
Treatment of the neck can help with headaches and decrease the frequency and severity of symptoms of headache. This includes common treatment procedures such as massage, strengthening of associated muscles and stretching of involved muscles (Gallagher, 2007).
The combination of manual therapy (e.g. massage, trigger point release etc.) and exercise has proven an effective treatment for neck pain compared to many other alternative treatment types (Miller et al., 2010). The combination of these treatments is important, as mobilisation and manipulation only provides short-term relief. Exercise appears to have the added benefit of improving pain and function over long term (Miller et al., 2010). Therefore, the combination of both treatments can combine pain reduction with long-term changes (Miller et al., 2010). The exact type of manual therapy and manipulative treatments is still speculative and varies according to individual practitioners. Similarly, exercise therapy requires further research and the exact type of strengthening is difficult to determine.
Learning new behaviours associated with common tasks, such as sitting down and looking down to read a book or read your phone for long periods of time can also assist with treating your neck pain. As prolonged postures in a specific posture can increase neck pain frequency, and subsequently induce more headaches (Gallagher, 2007).
So what can we do?
Step 1: Postural Adjustments
Posture… Is really not that important. Now before you explode with utter outrage on the blasphemous nature of this statement, hear me out! There seems to be a lack of high quality evidence on the relationship between posture and pain (Mahmoud et al., 2019; Slater et al., 2019). However, what we do seem to know is that prolonged time in one particular posture is detrimental and can lead to increased pain and discomfort (Mahmoud et al., 2019; Slater et al., 2019).
Instead, what we should be focused on is regular postural adjustments. As discussed in my shoulder pain blog post, small postural adjustments in sitting, especially while doing desk work can provide many benefits to your pain and discomfort.
Step 2: Regular Movement
To reiterate the previous point, prolonged postures or positioning in one specific posture can be detrimental and lead to increased pain and discomfort. Therefore, to counteract this, regular movement is encouraged of the neck and shoulders. One particularly important structure that requires movement is the shoulder blade, and ensuring adequate movement of your shoulder blade during various movements.
A particular muscle is of interest when interpreting the link between neck pain and scapula function. This muscle is called the “Levator Scapulae.” This muscle originates from the transverse processes of C1-4 (your upper cervical spine), and attaches to the superior-medial border (top-middle) of the shoulder blade. Its role in shoulder function is the elevation and downward rotation of the shoulder blade.
Without getting too in depth in this post, the reason why this muscle and shoulder blade is important is that many individuals can get neck pain and tightness within this muscle. Which can subsequently lead to headaches to the neck pain nature. Fortunately, the fix for this is generally very simple, and only requires more awareness of the shoulder and shoulder blade region. Simple exercises that can fix this issue include:
- Neck rolls
- Ear to shoulder
- Shoulder roll
- Overhead arms stretch
There are not any specific repetition or set ranges for these exercises. Instead, they should just be performed when you remember or feel like you need some movement in your shoulders and neck!
Step 3: Strengthening of upper body and neck
General strengthening exercises of the upper body are extremely beneficial and important in treating neck and shoulder pain. However, what needs to be focused on in these situations is the positioning and the movement of the shoulder blades. This will be further explored within a gym setting in a future blog post.
For now, the general recommendations will be to be aware of shoulder positioning and scapula position during movements. Essentially, the scapula should have freedom of movement when performing any exercise, rather than being stuck onto the ribcage wall.
Neck pain can be the cause of a very specific type of headache called “cervicogenic headaches.” However, despite the complex sounding name, the treatment and prevention of further headaches is quite simple and can be resolved with proper diagnosis and treatment strategies. This includes strategies such as postural adjustments, continuous movement and upper body strengthening practices.
Do you think your neck pain is causing your headache?
- Gallagher, R. M. (2007). Cervicogenic Headache. Expert Review of Neurotherapeutics, 7(10), 1279 – 1283.
- Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The relationship between forward head posture and neck pain: A systematic review and meta-analysis. Musculoskeletal Medicine, 12, 562 – 577.
- Miller, J., Gross, A., D’Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., Haines, T., Brønfort, G., & Hoving, J. L. (2010). Manual therapy and exercise for neck pain: A systematic review. Manual Therapy, 15(4), 334 – 354.
- Slater, D., Korakakis, V., O’Sullivan, P., Nolan, D., & O’Sullivan, K. (2019). “Sit up straight”: time to re-evaluate. Journal of Orthopaedic & Sports Physical Therapy, 49(8), 562 – 564