Did you know that up to 20 percent of headaches have been linked to causes from structures in your neck? And for that matter Migraines too. The research is clear that dysfunction in your neck can cause a headache. However, it is actually a little fuzzy when it comes to understanding the exact structure in the neck that causes a headache. As you might know dehydration, sinus, vestibular system, trauma and the vascular system have all been linked to causes of headache too. But, why would the neck be a cause of headache?
The neck is more scientifically called the cervical spine. A cervical headache is hypothesized to be a dysfunction mainly from the upper three cervical vertebrae but lower areas have been linked as well. To understand why a headache would come from your neck you need to understand some basic anatomy first. Let’s first describe a vertebra. A vertebra is the boney structure in the neck and is sub-divided into regions that also have names. There is the vertebral body, the lamina and the articular facets to name a few. In-between the vertebral bodies are the well-know discs. Along the junctions of the back of each vertebra on the lamina are two sliding joints called facet joints. There is one on on the right and left side of each vertebral junction. See photos below for those structures on the vertebra.
There are several types of chronic headaches such examples include migraine without aura, tension headache, headache associated with Tempromandibular dysfunction, and cervical headache. Thus, accurate differential diagnosis is essential to pinpointing the proper treatment plan.
The structures that are usually associated with cervical headache include the sub-occipitals muscles (see picture below), and/or usually just one or two of the articular facet joints. The facet joints along the top three vertebrae and their associated soft tissues are usually the most involved; however, occasionally lower facet joints such as on C4-5 and/or C5-6 vertebral junctions can be related too. Examples of such nearby soft tissues that become strained include the inter-segmental muscles and tendons, which are small muscles between the vertebrae that make the facet joints move. When evaluating an articular facet joint special care must be made to assess the amount of movement expected at the joint, the joint thickness and the amount of tenderness to touch. Additionally, several other factors help a physical therapist determine if your headache is from the cervical spine. During your evaluation particular note should be made to the area of your symptoms, the times and manner of the onset of the headache, any precipitating and relieving features, any neurological symptoms, and the history of the onset. So, it is important to have a sit down conversation with your therapist before diving into treatment.
Additional evaluation should then be made to the anatomical structures such as the length and tautness of the sub-occipital muscles, the cervical ROM, gross strength, as well as flexibility of larger muscle groups. Moreover, the craniocervical ligaments need to be checked for any abnormality, the vertebral artery, and the neural tissues.
Furthermore, considerable attention must also be made to the larger muscle groups and postural function. Poor Posture is often a leading cause of pain and headache originating from the neck because poor posture can cause the aforementioned structures to become inflamed, irritated and aggravated. So, what happens when you‘re in a bad postural position, like let’s say, when you’re sitting at a computer desk. Well, our trunk leans forward and then we compensate by extending our neck backwards. This causes a shortening of the sub-occipitals muscles and a compression of the facet joints. When the sub-occipital muscles and facet joints are left in a shortened position for a long period of time, like for a 6-8 hour workday, they subsequently shorten in length. When we ask those structures to lengthen normally during other tasks, they consequently become easily strained causing irritation, inflammation, referred pain and eventually a possible neural irritation. All those scenarios are bad enough, but when that happens at the upper three vertebrae the pain is sometimes referred around to the front of the head. Many times it is felt above the eye, shooting around the ear or even at the base of your skull. Also in that chronic shortened position, especially along the upper three vertebrae, the facet joints receive abnormal wear and mechanical stress, which causes them to develop some arthritis. Resultantly poor joint gliding and ultimately complete restricted joint motion occurs. This sequela of events doesn’t stop there; in fact, if left unchecked the pathology will continue to degenerate and the symptoms will continue to progress and the problem becomes more and more complicated and involved.
So, as you can see the issue of cervical headache is fairly complicated and involves a good understanding of biomechanics, anatomy and posture to determine your exact cause. It is important to find a physical therapist that has a good working knowledge of the complexity of all the cervical spine intricacies and it’s relationship to headache to find a long-term solution and resolution to your problem.