Cervicogenic headache | Health of Narayana

Cervicogenic headaches are 2-3 times more common in women. Many years ago, it was more middle-aged and elderly people who were affected, but due to poor ergonomics in handling technology, more and more people of all ages are diagnosed, especially adolescents and young adults.
A cervicogenic headache is a common type of headache caused by structures in the neck. Cervicogenic headache is usually one-sided, starts in the neck and spreads to the eyes, forehead and temples.
Cervicogenic headaches are caused by diseases of the spine or surrounding joints. It can also cause irritation to the occipital nerves, which are the nerves on the back of the head. Usually it is the upper 3 cervical vertebrae that are affected.
Headaches can also be caused by involvement of the trigeminal nervous system, which are the nerves in the front of the head. The spinal root of the trigeminal nerve carries the sensory and pain fibers of the face and meninges. They are connected to the neck nerves. Therefore, diseases such as migraines can also be associated with neck pain.
Neck pain per se can also be caused by long periods of sitting work, looking at the phone / tablet or driving a car.
These lead to a muscle imbalance in the neck and back muscles, also known as upper-crossed syndrome.

Symptoms:

• Neck pain
• Restriction of head and neck movements
• Pain over or behind the eye
• Facial pain
• Temple pain
• Forehead pain
• Shoulder pain
• Temporomandibular joint pain

Some of the following conditions pose an increased risk of cervicogenic headache:

• Degeneration of the cervical spine
• Disc problems
• Problems with alignment of the cervical spine
• Vertebral involvement in rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis)
• Head and neck trauma
• Traffic accidents (whiplash)
• Non-vehicle accidents (direct neck trauma, secondary fall trauma)
• Head trauma (falling on your back, falling on your head)
• Problems of the neck and shoulder muscles
• Bad posture
• Sedentary work
• Keeping your neck in uncomfortable positions (e.g. place the phone between your head and shoulder while talking)
• Carrying heavy bags on one side

Physical exam can

Restriction of neck movements and pain when moving

• Pain made worse by moving your head
• Sensitivity of the neck muscles with manual pressure
• Trigger points in the neck and shoulder muscles
• Tension in the neck, back and shoulder muscles
• Weakness of the deep neck muscles (muscles that tilt your head forward)
• Triggering / intensifying pain by applying pressure to the neck or neck
• Posture problems such as upper crossed syndrome

Treatments:

• 1. Posture correction
  2. Strengthening the core muscles
  3. Neck stretching and strengthening

• Full body workout with low intensity
  1. yoga
  2. Pilates
  3. Go
  4. Tai chi
  5. swim

• Solving sleep problems, observing sleep hygiene, correcting the posture and changing the sleeping environment such as a hard bed, a low and soft pillow
• Stress management with:

• 1. psychotherapy
  2. Cognitive therapy
  3. meditation
  4. yoga

• Physiotherapy such as TENS, manual therapy, cryotherapy, laser
• Medication

• 1. Simple pain relievers, for short term worsening
  2. Muscle relaxants
  3. Neuropathic pain relievers

• Targeted injections: facet joint injection, trigger point / myofascial injection, occipital nerve block
• acupuncture
• Botulinum toxin injections

Tips for daily life

• Avoid one-sided, heavy handling (bag, baby)
• Sit in the correct position at your desk

• 1. Feet and knees on the floor at a 90-degree angle
  2. Armrest on chair armrests
  3. Shoulders back, sitting with your back straight
  4. The monitor should be slightly below eye level
  5. The chair should support your back

• Frequent breaks for those who work at the desk; walking around or doing stretching exercises
• While calling, hold the phone in your hand and switch from one side to the other or use headphones / bluetooth; do not place it between the shoulder and the head
• Reduce Technology Addiction; Take a quick look at the phone, hold it at eye level while using it
• Protect your neck and shoulders and keep them warm in cold / air-conditioned environments

Avoid wearing high heels / wear low-heeled shoes (as high heels bring the set point of body weight forward, the knees are bent to allow the body to stand upright, increasing the back and neck hollows and causing neck pain)

Dr. Pravin Thomas | Consultant and Clinical Director – Headache and Interventional Headache Neurology Services | Mazumdar Shaw Medical Center, Bommasandra, Bangalore