A headache is the most common pain complaint in our society. Tens of millions of people suffer from headaches every year. Chronic headaches can be divided into three categories:
- Migraine Headaches – are believed to originate in the blood vessels that supply the head.
- Muscle Tension Headaches – are caused from chronic contraction of the head muscles.
- Cervicogenic Headaches – are usually due to arthritis of the spine. The arthritis originates in the small joints of the neck or upper (cervical) spine called the cervical facet joints. This type of Headache is usually seen in older patients who suffer from arthritis, but may also be present in patients who have suffered neck trauma such as whiplash.
Arthritis is a deterioration of the joint caused by low-grade inflammation. This inflammation can spread to the nerves of the neck. The occipital nerves are formed in the upper levels of the neck and ascend to the back of the head where they provide sensation. When the joints of the neck are inflamed, it spreads to the occipital nerves and the pain is experienced in the back of the head.
Diagnosis
Patients with cervicogenic headaches will have pain in the back of the head, although some patients will also experience the pain behind the eyeballs. Usually there is a history of trauma and X-rays of the neck may reveal the presence of arthritis. When the doctor examines the patient, he or she may discover the neck muscles are tender and in spasm. The only way to absolutely document the presence of cervicogenic headaches is with a diagnostic injection of the joints under X-ray. During this procedure, a specialist in joint injections can put an anti-inflammatory drug into the joint, causing reduction in the inflammation. If the headache disappears after this procedure, the doctor can be relatively certain the headache is coming from the neck, and thus diagnosed as a cervicogenic headache.
Treatment
In the event of acute flare-ups, cervicogenic headaches can be treated with a combination of ice application to the neck, oral anti-inflammatory drugs such as aspirin or Motrin, and immobilization of the neck with a neck brace or soft collar. In most cases the headache will resolve with this treatment in relatively short time. If the headache fails to improve, the patient can be prescribed physical therapy. The physical therapist will apply ice, mobilize the soft tissue and also apply gentle traction to the head and neck to relieve the pressure on the joints. If this strategy fails to improve the patient, injections of the joints with anti-inflammatory drugs can be done. These injections are the same injections that are given for diagnosis, except they may be given as a short series of two to three injections over a period of months and can lead to long term relief.
Prevention
- Sleep with your head in a neutral position.
- Use a relatively firm, non-feather pillow that keeps your neck in good alignment with the rest of your spine when you sleep on your side.
- If you sleep on your back, use a relatively narrow pillow so that your head is not thrust too far forward.
- If you pay careful attention to your sleep posture, avoid sudden neck movements and take appropriate prescribed anti-inflammatory medications, most cervicogenic headaches can be prevented or controlled.
