-quality (pressing, throbbing etc.)
-intensity (mild, moderate, severe)
-location (unilateral, bilateral)
-response to routine physical activities
Cervicogenic/Cervical headaches
It is estimated that 15-20% of all chronic and recurrent headaches
can be traced to a cervical (neck) origin. They are more often than
not a persistent symptom following trauma to the neck (e.g. whiplash,
or other injury)
Signs and symptoms
Distribution:
The pain often begins at the top of the neck and under the
back of the skull. It may then spread up into the head, and radiate
to the temples, forehead, to the back of the head or behind the eyes.
The headache may be on one side or both sides of the head, but the
pain in usually predominant on one side, and it does not change sides
during an attack or between episodes
Occurrence:
The headaches often lack a regular pattern; the onset can
be at any age; there is no known familial tendency; cervical headaches
tend to affect females more than males.
Causes:
Typically, the cervical headaches are precipitated by sustained
neck postures or movement, but the sufferers often have difficulty in
recognising the aggravating factors. As the increasingly sedentary nature
of modern day work creates more postural strain, one should check that
posture and work ergonomics are not aggravating the headaches.
Following trauma to the neck
Degenerative joint disease (e.g. osteoarthritis)
Stress is certainly a precipitating factor, but it is not restricted
to cervical headaches alone. It is thus not an important diagnostic
factor, but it is vital for the successful treatment and management
of cervical headaches.
There are 3 main systems in the body that may be causing the cervical
headache. These are the Articular system, the Muscular system
and the Nervous system.
The Articular system
The headaches caused by the articular system, stem from a dysfunction
of one or some of the joints in the neck or thorax. The joints of the
first 3 neck (cervical) vertebrae are most commonly at fault. (these
are written C1, C2, C3) As the joints are not resting flush against
each other, they do not glide smoothly and easily over one another.
This can cause pain in the joint area, or refer pain up to the head
presenting as a headache. In addition to this, the surrounding structures
will be affected. The muscles may get stiff and overworked or go into
spasm, and the myofascia (a thin, membranous structure surrounding the
muscles) may contract, allowing the skin to become 'attached' to the
underlying muscles. You will be able to feel with your fingers if your
muscles have become 'hard' and tight, and by moving the skin over the
underlying structures, you will be able to feel whether your myofascia
is tight. Compare the neck area to your arms. (To be normal, the tissue
compliance would be similar.) With the joints being dysfunctional and
the soft tissue tightening up, there is almost always a loss in the
range of movement of the neck.
The Muscle system
The system of muscles concerned here involves the musculature of the
head, neck and shoulder girdle. The muscles not only allow for the movement
of the head and upper limbs, but they are also required to provide stability
of the head-neck system in any orientation. The system can be negatively
impacted on if the movement of the head or arms are strained (e.g. using
weights that are too heavy at the gym, or even maintaining your arm
elevated all day to use the mouse on your computer) or if the stabilizing
muscles of the neck are too weak. The deep neck flexor muscles
are primarily responsible for providing the stability to the neck region,
and they are vital for postural control. However like all stabilizing
muscles, they are inhibited if there is pain, or if the load required
of them is too great. (The stronger mobilizing muscles then take over).
One of the most common ways of overloading these muscles is by a sustained
position of poor posture. (see ergonomics).
Thus if one corrects their neck posture by keeping their head over their
shoulders and not out in front of them, then the neck stabilizers will
automatically be recruited, effectively improving the neck stability
and diminishing causative factors for neck pain. The postures of the
shoulder girdle are closely linked to head and neck postural control.
It is very common for the stabilizing muscles here to also be weak (lower
trapezius and serratus anterior muscles), and those muscles
that elevate your shoulders up toward your ears (levator scapularis
and upper trapezius) often become over-active and take on the
supporting role. In this case, one may find it physically difficult
to pull the shoulder blades backwards and downwards, or to lift the
arms up without lifting the shoulders up too. This state of poor posture
may aggravate the headache or neck pain as it increases the compressive
forces on the neck vertebrae and it encourages a state of stress or
tension. Another 'bad habit' that increases the neck tension is that
of grinding one's teeth.
The Nervous system
Pain that originates form here can be experienced if the nerves are
mechanically irritated (e.g. getting entrapped within a muscle or between
vertebrae) or if there is tightness of the nervous system. The latter
is known as neural tension. Just as your muscles get short and
tight if they are not stretched, so can your nerves. They often refer
a dim aching pain to regions along their length if they are short, and
neural tension can be a contributing factor in headaches.
Here are three stretches to relieve the pull along these nerves:
Median nerve: stand facing 45 degrees to the wall,
arm outstretched shoulder height, hand backwards and shoulders pulled
down, The pull should be to your middle finger. As the stretch becomes
less, gradually face further away from the wall
Radial nerve: 'Proter's Tip' position: Turn your hand as
far inwards as you can. Now keeping your shoulders down, try to touch
your wrist.
Ulnar nerve: Try to align your hands up the sides of your
ribs. Pull your shoulders down and bring your elbows forwards - you
should feel the pull in your little fingers.
For a good all-round nerve stretch, sit on the floor, put your hands
behind your back and slump down into the deepest slouch that you can,
tucking your chin down to your chest. (Again, shoulders down.) Now,
slowly straighten your knees out without leaning your body backwards,
and eventually try to pull your toes towards towards you.
Which area of my neck is involved?
If there is a joint articulation problem or nerve impingement in your
neck these are some of the signs that can guide you to locate the causative
area more precisely
C 0/1 (between the skull and the first vertebra)
If you have an articular problem here, some of the things that may help
you identify it are:
the pain often feels as though it is sitting underneath the skull posteriorly,
and the dull pain may extend to a headache that wraps over your head
and ends in your forehead or eye.
You may have difficulty in sticking your chin out forwards and tucking
it in again. (protrusion and retraction.)
Your jaw may ache or click, and you may experience pain there on opening
your mouth widely
You may experience ringing in the ears or earache, and the earache usually
sits on the bone behind the earlobe. It is very tender to touch here.
Your visual disturbances may be due to a lack of joint alignment or
stability here.
C2
This vertebra is often responsible for headaches.
Your hair roots may feel hypersensitive, and its is painful to brush
your hair.
C 5,6,7
These areas often refer pain elsewhere. The pain may be felt down
the inside edge of your shoulder-blade. And this in known as Cloward's
Referral of pain. The muscles in that area are often very tight and
painful to massage. The pain may also be referred down the arm, and
it feels as though you have strained or hurt a muscle there. It's
usually a constant ache that is exacerbated by some activities, but
you may find it difficult to identify them. You may find that a long
day in front of the computer or driving may make it worse.
Suffering from headaches is a dreadful affliction and it can seriously
diminish you quality of life. Treating the symptom with medication
is not effective, because it is treating the symptom and not the cause,
and vast quantities of tablets are very bad for your kidneys, liver
and stomach, and some tablets may become addictive over time. We therefore
recommend that if you have any of the symptoms described here that
you consult us and have yourself properly treated and relieved. If
you are unsure if you have a headache that is coming from your neck,
call us or come for an assessment and we will be able to tell you
in no time. Why suffer if help is at hand?
There
are various types of headaches and there are many different causative factors.
A patient may suffer from a mixed headache form, or even two types of headache
concurrently, so that it is often difficult to identify the source of the
headache immediately. Although pain is the dominant symptom, there may be
accompanying symptoms such as: