Neck pain and headaches are often closely connected and can make life a real misery for sufferers. The cause of cervicalgia headaches may be the compression of nerves or blood vessels which innervate or supply the head and neck. Pinched nerves sometimes occur due to a chronic neck condition like spinal stenosis, spondyloarthritis (spondylitis or spondylosis), or facet joint disease following whiplash injury. When a person’s head aches and neck pain is present there may have been an acute muscle strain or muscle tension causing inflammation or cramping and subsequent cervical spinal nerve compression or ischaemia if one or more blood vessels are also obstructed.
Neck pain and migraines are very common and, in some cases, the migraine itself may end up causing the neck pain by creating tension in the cervical spinal muscles. Other conditions, like fibromyalgia, brachial plexopathy, thoracic outlet syndrome, or even meningitis may be responsible for cervicalgia and headaches with the severity, onset, and duration of the pain providing diagnostic clues for a physician.
Chronic neck pain can, however, lead a person to over-medicate resulting in painkiller-withdrawal symptoms, including headaches. The treatment in such cases can be difficult as a person may simply start taking pain medication for both the neck pain and the headache without recognizing the pathology at work. Cessation of all pain medication may not be an option and, as such, alternative treatments as an adjunct to analgesics is likely to provide a good course of action. Reducing tension through physical therapy, yoga, and relaxation techniques can be effective for both neck pain and headaches, as can the use of thermotherapy (heat packs) when there is no inflammation present.
Causes of Cervicalgia Headaches
Cervicalgia headaches can also represent a longstanding issue from a previous traumatic injury such as whiplash. Damage to the nerves, bones, joints, and discs incurred at the time of the initial injury can cause degeneration of the cervical spine and lead to hypermobility or hypomobility where ligaments become calcified or osteophytes (bone spurs) develop. Ligament calcification and osteophyte growth then increases the risk of spinal stenosis and nerve compression.
Patients with rheumatoid arthritis, degenerative disc disease, or even fibromyalgia are more prone to postural problems, cervicalgia, headaches, and tension in the neck. Working to achieve and maintain good posture, carrying out daily exercises for the neck, and receiving adequate social support from friends, family, or health-care workers are all vital to minimize the impact of neck pain and headaches on a patient’s quality of life.
Cervicalgia headaches sometimes coexist with light-sensitivity, stress, nausea, vertigo, motion sickness, and sensitivity to smells and/or food. Migraine-sufferers are often able to sense the start of a migraine and take steps to avoid the worst symptoms by ensuring that they are hydrated, that blood sugar is stable, and by removing themselves from any stressful situation, bright lights or pungent odors. For others, the headaches that come with neck pain are a more constant dull ache that feels like pressure and tension in the neck and head. This may be made worse when bending forwards or when moving the head quickly in any one direction as the cervical spinal nerves can be irritated or compressed by these movements. Care should be taken not to carry out any neck exercises until cleared to do so by a physician as these might make their situation worse. Spinal stenosis, cervicalgia, and headaches are often tied together and diagnostic imaging may be required to determine if there are pinched nerves at the root of the problem.
Temperomandibular joint syndrome is another potential cause of cervicalgia headaches as this involves referred neck and head pain originating from problems with the nerves innervating the jaw. In some cases both neck pain and headaches may be linked to tooth problems with a dental examination providing an explanation and suggesting a remedy. Some patients grind their teeth or clench their teeth subconsciously, causing stress and strain in the jaw, deterioration of the disc in the jaw joint, and leading to cervicalgia and headaches. Persistent chewers of pens, fingernails, or even chewing gum might also find that the continuous work carried out by the jaw is a factor in their headaches and cervicalgia and that avoiding the habits allows the temporomandibular joint to rest and recuperate, thus reducing other symptoms and the possibility of permanent damage.
Diagnosing Cervicalgia Headaches
Working out what causes cervicalgia and headaches can be extremely difficult as there are numerous nerves in the head and neck which have overlapping areas of sensitivity. Pain maps can confuse the situation and cause misdiagnosis when working in such a small and complex area and when the pain is frequently multifactorial. Cervicogenic headaches are defined as those where the head pain is referred from the cervical spine, be it spinal stenosis, arthritis, degenerative disc disease, or other cause of spinal stress. Patients will usually undergo a number of diagnostic tests, including imaging and physical examination to try to discover the source of the pain. Cervicogenic headaches are thought to account for as many as 20% of cases of severe chronic headaches, with around a third of sufferers having experienced some form of neck trauma in the past.
Diagnosis, and treatment, of cervicalgia and headaches may comprise injections of anaesthetic into the areas of the cervical spine. Where such injections are administered to the medial branches of the dorsal ramus with a resulting reduction in neck pain and headaches this likely demonstrates diagnostically that the condition is related to facet joint pain. Those with rheumatoid arthritis in the cervical spine may develop nerve compression, and even spinal cord compression, where the atlantoaxial joint in the neck sinks and causes stenosis. Back surgery may be needed to address facet joint syndrome, atlantoaxial subluxation, osteophyte growth, and nerve impingement, including spinal fusion in some cases.
Physicians need to consider the possibility of a number of different diagnoses for cervicalgia headaches, including relatively rare abnormalities such as chiari malformation, posterior fossa tumors, and syringomyelia. Immediate medical help should be sought if there is pain at night that wakes a patient, pain when resting, fever, unexplained weight loss, or where malignancy has previously occurred. In most cases there will have been previous neck trauma, whether acute or chronic, and possible tension and postural issues exacerbating the problem. Cervicalgia headaches are not always straightforward to diagnose or treat and patients may discover a lengthy process of trial and error is involved in effectively recognizing and treating their condition.