Headaches related to your neck (cervicogenic headaches) are more common than you think and are often misdiagnosed as migraines. A migraine is a recurring headache that causes moderate to severe throbbing and pulsating pain on one side of the head. Migraines are usually (but not always) associated with other symptoms like nausea, sensitivity to light and/or sound or an aura and can last from hours to days. Historically migraines are managed by medications that aim to affect the suspected cause which can include chemical, hormonal, neural or vascular sources. Neck pain associated with migraines is common and may start before the migraine attack or occur during a migraine attack.
Cervicogenic headaches, on the other hand, are related to the structures and function of the upper cervical spine such as underlying damage, degeneration or dysfunction to the neck structures like the discs, joints, muscles, or nerves. These headaches usually begin as a dull ache in the neck and radiate upwards along the back of the head, almost always affecting just one side. Pain may also spread to the forehead, temple, and area around the eyes and/or ears. Another type of headache related to the neck is tension headaches which are caused by excessive tension and loading of the neck muscles from poor postures or heightened stress and emotion levels. These headaches are characterised by moderate to severe non-throbbing pain in the forehead, scalp, and neck.
Does the source of the headache affect how I manage it?
In the past, it was thought that each type of headache responded to different treatments. However, it has recently been recognised that there is an overlap of symptoms across the different headache types, pointing to the possibility of a common cause. Recent research shows that oversensitivity of an area of the brain at the top of the cervical spine called the brainstem is a common factor in all headache types. This region receives nerve input from the nerves around the face and head as well as the nerves of the upper three cervical vertebrae. When this area is ‘sensitised’ or ‘over stimulated’ it can cause the pain sensations experienced with headaches. Research shows that this area is constantly irritated in recurrent headache sufferers and that in 80% of cases the neck is responsible for this overstimulation. If triggers like certain foods, drinks, smells, light, sound or hormones are added the stimulation can be heightened and the intensity of headache or migraine worsened. The mechanical sources of cervicogenic or tension headaches can therefore be sources of sensitisation.
How can this sensitisation and my headache be managed?
Luckily we also know that this sensitivity can be ‘turned down’ by treating the neck in all types of headaches. Cervicogenic or tension headaches are very treatable with appropriate physiotherapy management by affecting the underlying structures as well as exploring lifestyle, psychological and social factors that may be contributing to the over sensitisation of the upper cervical region. And the better news is that physiotherapy intervention can commonly even help to improve some migraine-related symptoms helping to reduce the intensity, frequency or distribution of your migraine.
Speak to a physiotherapist at Optimus Health if you a keen to learn more about how we can help with managing your headaches. Your physiotherapist at Optimus Health will work with you in partnership with your GP to establish the type, source(s), triggers and appropriate treatments to improve your headaches.
