ARTICLE COURTESY OF SPACE COAST MEDICINE MAGAZINE
Chronic headaches can be one of the most debilitating medical conditions, and severely impact the quality of life.
The causes of headaches are numerous, and can come from eye problems, sinus disease, temporomandibular joint disorder or jaw problems, ear problems, trauma to the head, concussions, migraines, diseases of the spine, and chronic muscle tension in the neck and head.
Sometimes, after thorough evaluation by one or more specialists, treatment with numerous medications, physical therapy, massage and acupuncture, a small percentage of patients just don’t seem to get better.
In these cases the cervical spine should be more closely examined. A headache caused by problems of the cervical spine is called a cervicogenic headache (CHA).
CHAs are seen in about three percent of the general population, but make up 20 percent of the headaches seen in an interventional pain clinic. CHAs are also four times more common in women. CHAs can be caused by trauma to the head and neck, osteoarthritis of the cervical spine joints, and motor vehicle accidents.
CHAs Mimic Migraines
The symptoms of a CHA can mimic those of a migraine, making the diagnosis difficult. However, there are some subtle differences. The pain of CHAs is usually on one side of the head and doesn’t change sides, is triggered by neck movement, or sustained or awkward neck positions (particularly looking up and behind).
On physical examination, pressure on the base of the head and upper cervical spine joints causes considerable pain and may trigger headaches. Loading the neck joints by pushing down on the head while it is extended and twisted, will reproduce neck pain and may also reproduce headaches.
There is also associated stiffness in the neck and decreased range of motion. CHAs are also associated with shoulder pain and occasionally arm pain on the side of the headache.
X-rays will often show degeneration or collapse of the disc and arthritic joints of the cervical spine called facet joints. The arthritic facet joint is the primary cause of CHAs, and the most amenable to treatment. Pain from each inflamed cervical joint is referred (felt at a site distant from the source of pain) to a specific place on the head, neck or shoulders.
Treatment for CHAs in our office consists of therapeutic ultrasound directly on the trigger point followed by electrical stimulation and heat on the associated muscle fibers, then neck spinal decompression to stretch neck and mobilize the discs and finally neck stretches and exercises.Treatment plans vary because all cases are unique and home exercise plans are always usually coupled with therapy to achieve optimal results.