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Some headaches are caused by neck problems

Sometimes migraineurs will experience headaches that don’t respond to migraine treatment. When this happens frequently, doctors may consider the possibility of another headache disorder. One such disorder originates with problems in the upper cervical spine. The problem isn’t actually in the head or brain; it’s in the neck. It’s called “referred pain.” The problem is in the neck, but the pain is felt in the head.

What is it?

It’s called cervicogenic headache (CGH) and is classified as a secondary headache because there is a known cause. Many times CGH will follow a specific pattern that gives clues to your doctor about where to start looking for the problem. For example, neck pain that radiates to the lower jaw or over the top of the head and into the eye may indicated the problem lies in the muscles, joints, or nerves of the neck. The pain from CGH is usually not throbbing. Symptoms also include tightness of muscles in the back, neck, shoulder, and upper chest. Look up these muscle groups for a better understanding: upper trapezius, scalene, levator scapulae, sternocleidomastoid, pectoralis major and minor, as well as the sub-occipital extensors.1

As you can see, a lot of symptoms overlap with other headache disorders. It takes a true headache specialist to determine if the problem is CGH, Migraine, Hemicrania Continua, or Occipital Neuralgia. To paint an even more complicated picture, most patients with Chronic Daily Headache meet the diagnostic criteria for more than one headache disorder. CGH typically does not respond to the same treatments as migraine. So, when migraine-specific treatments fail, CGH may be considered as an alternate diagnosis.1, 2

I am a good example of this complexity. Originally diagnosed with Migraine without aura in 1985, I now have multiple headache disorders: Migraine with Aura, Migraine without Aura, Chronic Migraine, Episodic Cluster Headaches, and Cervicogenic Headaches. It is common for me to experience attacks from two or more headache disorders at the same time as they tend to trigger one another.

How is it different from migraine?

Migraine is a primary headache disorder. Unlike CGH, there is no known cause for Migraine. While neck pain and stiffness can be a prodrome symptom of migraine, it is not necessarily an indication of CGH. Only about 18% of headache patients who report neck pain actually meet the criteria for CGH1. If it is present, sometimes the referred pain of CGH can be a migraine trigger. In that case, successful treatment should lead to fewer migraine attacks. Not all migraineurs experience CGH. Even if you are diagnosed with both disorders, one did not cause the other. Do not believe anyone who tells you that problems in your cervical spine are the cause of migraine attacks. There is no research to back up such a claim. However, some patients with CGH are misdiagnosed with migraine and treated for the wrong headache disorder for years. Since CGH does not respond to typical migraine treatments, it is very important to get an accurate diagnosis.

How is it diagnosed?

Diagnosis starts with a clinical interview and physical exam. If the doctor notices stiffness and muscle tightness in your neck, he or she may order an EMG and/or MRI to look for possible joint damage and/or nerve compression in the cervical spine (neck). The results of these tests will help narrow down where to use a nerve block. If the nerve block is successful at stopping the headache, then a diagnosis is confirmed. Relief from a diagnostic nerve block is usually immediate.1, 2, 3

How is it connected to migraine?

Diagnosis can be tricky if you have more than one type of headache. For example, let’s say you have CGH due to a bulging disc between C5 and C6. This damage and the referred pain happen to trigger migraine attacks. The bulging disc didn’t cause migraine, but it is certainly a trigger. In theory, if this were your only trigger, then getting treatment would reduce the severity and frequency of migraine attacks. This isn’t always the case.

How is it treated?

Nerve blocks are used to confirm a suspected diagnosis of CGH. They can also be used to prevent future attacks. Some doctors us x-ray guided epidural injections, Botox, physical therapy, or chiropractic adjustments. Lasting relief typically depends upon the long-term use of specific exercises to strengthen neck muscles and maintain healthy posture. In cases of intractable CGH, radiofrequency ablation of the affected nerves or an occipital nerve stimulator may be considered. Manipulative therapies (massage, chirorpractic, myofascial release, etc.) have been subjected to several studies to determine their effectiveness at treating various headache disorders. Only CGH has been shown to respond to such treatments.1

Personal experience

I started my journey of migraine treatment with chiropractic adjustments. Over many years I had x-rays and exams that confirmed bulging and degenerating discs as well as improper curvature of the cervical spine. One after another, a half dozen chiropractors claimed to know the cause of my “headaches” and promised to make me better. One by one they were defeated by my dysfunctional neurology. They would swear my spine was functioning properly yet I kept getting migraine attacks. Not a single one ever did more than produce temporary pain relief. Sometimes their treatments actually triggered a migraine attack. After many years I finally reached my limit when the last one started making treatment recommendations that were known triggers. He also made some claims about the cause of migraine that I knew to be incorrect. When I gently challenged him with the known scientific data, he refused to budge. That was the end of me and chiropractic care.

I also worked with a neurologist a few years ago who was convinced that physical therapy and continued exercises would eliminated many of my headaches. He was frustrated when I continued to experience the same 10-12 migraine attacks each month that I’d been getting all of my life. After physical therapy, my neck and shoulders felt a lot better. I had more strength and better range of motion, too. I don’t regret physical therapy – which was actually myofascial release therapy. It just didn’t stop me from getting both migraine and cluster headache attacks. Only a few of my headache attacks were actually a result of problems in my neck.

In my case, CGH has been a minor contributing factor to the frequency and severity of migraine attacks. For some patients, CGH plays a much larger role. If you have been diagnosed with Chronic Migraine or Chronic Daily Headache and are not responding to typical migraine treatments, then perhaps it is time for a second opinion to rule out CGH.3

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Hall, Toby MSc, Briffa, Kathy PhD, Hopper, Diana PhD, Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective, The Journal of Manual & Manipulative Therapy, Volume 16, Number 2, pp. 73-80.
  2. Jackson, Christy MD and Blumenfeld, Andrew MD, Cervicogenic Headaches, American Headache Society, retrieved 8/25/2015 from http://achenet.org/news/cervicogenic_headaches/.
  3. Yi, Xiaobin, Cook, Andrew J, Hamill-Ruth, Robin J, Rowlingson, John C. Cervicogenic headache in patients with presumed migraine: Missed diagnosis or misdiagnosis?, Journal of Pain, Vol. 5, No 10 (October), 2005, pp. 700-703, doi:10.1016/j.jpain.2005.04.005

Comments

  • maryanne59
    7 months ago

    I am a health care provider as well as a common migraine and cervicogenic headache sufferer. I’m astounded at how many of my colleagues aren’t even familiar with the concept of cervicogenic headache. Sad. We have such an uphill battle in light of stigma and ignorance.

  • Julie
    8 months ago

    I have been diagnosed with chronic migraine and cervicogenic headache. I wonder if the CGH aspect contributes to the fact that I am not finding relief from Aimovig. I know 20% of patients don’t, but you mention that CGH does not respond to typical migraine treatments… makes me wonder.

  • Joanne
    1 year ago

    I have had migraines since elementary school. At age 17 they began to uncontrollable and so was my neck pain
    MRI in 2004 shows a bulging disk and degenerative disk throughout my spine along with scoliosis. I have always said my neck is a trigger along with mot getting enough sleep, hormones, loud noises and bright lights Now I have Kaiser and they don’t want to do anymore MRI’s. I have two different types of migraines. What a revelation!!! Thank you so much!!!

  • Shani
    1 year ago

    I have identified numerous types of migraines in myself. I have had them for 30 years and continue to read and research “every new” scrap of hope. This year I was referred to a different chiro who did not promise a cure but was willing to work with me to find relief. I had been to two different chiros before and had little success. The migraines that were in my neck and radiated up my head and down into my shoulders could keep me in bed for days. I had nerve blocks, botox, massage, acupuncture, meds they all could not stand up to the pain or provided very little help. So what was different? He focused on the Atlas Orthogonal spinal correction or the correct positioning of the C-1 developed by Dr. Sweat.
    I was willing to try. He took xrays before and after to be sure everything lined up. He did say he did not know if the adjustment would stay(need to realign) mostly because after 30 years trying to get the body into a new position may take persistence. It has worked for me. At least this type of migraine. It made a lot of sense to me now why meds, massage and other treatments did not work they were not addressing the basic problem. I can say I do have chronic migraines and treatment differently. But having some relief from these neck related migraines has been game changing. Mobility is back as well as relief from nerve pain and numbness is greatly reduced. I may have to keep him as part of my repertoire on an ongoing treatment as long as it works. Being open to trying new things as well as retrying things in the past keeps me going. I say retrying because I have found that time has changed my migraines and triggers so I need to readjust.
    Hope this helps someone.

  • mammapeaches (Susan McManus)
    2 years ago

    It took years to get diagnosed with spinal stenosis and degenerative disk disease which were the cause of 80% of my headaches. Finally had ACDF surgery in June of 2016 (C4,5 C5,6). Recovery is difficult because the healing process causes headaches! This led to a cycle of MOH which was broken by a 5 day stay in December 2016 at Jefferson Headache Center in Philly. Now, I feel like I have my life back!! 2017 has been amazing!

  • vhd494
    3 years ago

    This describes me to a t. I’m getting Botox injections which help my migraines but I have this daily headache pain in my head, by my eyes daily. It does trigger a migraine at its worst. I’m now seeing a pain specialist. I feel like a cliche. People say, “aren’t those Botox injections helping?!” Chronic pain is no picnic. Thanks for providing insight to others who find it difficult to understand and a support system to those who suffer.

  • lerickson82
    4 years ago

    This is all pretty confusing to me as far what type or types of headaches I have. I have lots of problems with my neck – bulging disk, arthritis, bone spurs. My neck and shoulder muscles are always tight. I can press on certain areas of my neck and produce like a “mini headache” while still pressing. Yet, every headache dr or neurologist has diagnosed me with Migraines. I don’t have all the typical migraine signs. I very rarely even get nauseous except when it gets really bad. Lights don’t bother me except bright sunlight. Moving only makes things worse when it’s really bad. Triptans work well as long as I take it right away and DHE-45 works though I don’t take that anymore. My pain dr who is also a headache specialist at a famous h/a clinic said that my neck pain is only a trigger to my headaches, not the cause.

    I do PT, massage, chiro, etc but the affects are temporary – few days at best. I did have a cervical facet radiofrequency ablation last year and am getting another one in a week or two. That usually reduces my bad headaches from most days in a week to one or two.

  • Hari Emani
    4 years ago

    Dear Tammy,

    The moment I read your post I recalled my own symptoms – neck pain and head ache. For more than a decade between 1999 and 2013 I had headache, but my neck pain was from time time with varying intensity. But once I took some enzymes and probiotics in 2009, my neck pain was gone. Gradually in the next two to three years headache too. I am not sure if there was any link, but just wanted share. Thanks for the info.

    BTW, I am survivor of FMS and on the verge of surviving CFS. You may want to explore what I did to recover starting with the following…..

    http://www.cortjohnson.org/forums/threads/why-noni-juice-helped-me-to-gain-energy.3041/

    Based on my experience no one needs to suffer from pains. All of us can live healthy by developing a lifestyle and food habits that suits each individual.

    Have fun,

    Hari

    PS: I tried to use FaceBook connect, did not work. Please have someone check.

  • Trisha27
    4 years ago

    I agree with you completely. I had the same problem and went through physical therapy, as well as seeing a chiropractor. Botox and nerve blocks did not help me either. The doctor also blamed TMJ.(I have tried a mouth splint) I really believe that after getting a migraine, the pain is so intense, that I grind and clench my jaw, causing my neck pain. Ear pain also results I believe from the trigeminal nerve swelling.

  • Teresa
    4 years ago

    There is an app for this, lol. Seriously though, there is an app called Muscle Trigger Points where you can point to where you hurt and it shows you which muscles can cause pain in that area. It can really help pin down where your problem originates from, and it usually is not where you think. It is an amazing tool for acupressure or even amateur massage.

  • Alison
    4 years ago

    Hi Tammy
    This is one of my main migraine triggers and I have a lot of degenerative damage in my neck. I Have had many years of chiropractors, neurologists etc and am now awaiting nerve ablation my spine. Following injections of nerve block or Botox I have a few blessed weeks of reduced migraines, a relief from my usual daily migraines. Not a cure, but a few weeks of some relief. I am hoping the nerve ablation gives longer term relief. Thank you for this article, it explained more to me than the consultants ever have.

  • Tammy Rome author
    4 years ago

    That’s a difficult question to answer. For me, the pattern was pain in and around my right eye. It was in the same location as the cluster headache attacks I get, so I mistook it for the early warning of a cluster. The difference was that it never ramped up to cluster levels and would hang on for most of the day. I never had any nausea or light sensitivity with them and I could move around without making it worse. I also had tenderness in my neck and the back of my head on the right side. The pattern was shaped like a backwards question mark. I didn’t realize it until the PT pointed it out. After about 20 weeks of PT and a lot education on muscle groups, I finally started getting relief.

    Where you feel the pain really depends on what nerves are getting irritated. Some people feel it more in the face, jaw, or teeth. That’s why it’s important to get imaging studies and a nerve block.

    Do a Google search for “cervicogenic headache” and the click on the “images” link at the top of the page. There are some very good illustrations of the pain patterns available. I would have posted one with the article, but they are all copyrighted.

  • Luna
    4 years ago

    Thank you. That answer helps me to understand it better. Your article was just at the right time.

  • Luna
    4 years ago

    How does a Cervicogenic Headache feel? I just found out I have some definite cervical spine degeneration and arthritis so I’m really wanting to know what is the difference in symptoms between migraine and the Cervicogenic Headache.

  • Tammy Rome author
    4 years ago

    Lisa,

    I got my best relief from Myofascial Release Therapy and daily neck stretching and strengthening exercises. I will try to put together a piece on the specific exercises I use that may help you and others get some relief.

  • Lisa Robin Benson moderator
    4 years ago

    Hi Tammy, thanks for writing about this. I’ve had these headaches that don’t feel like they are migraines, because as you said, moving doesn’t make them worse and I don’t have any of my other symptoms such as photophobia or nausea. I had one this week that went on for a few days and was very painful. The problem does seem to be related to my neck, for which I have done both PT and chiro twice. My PCP has prescribed massage, and I will definitely ask my headache doctor about this type of headache.
    -Lisa

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