‘Cervicogenic headache’ is a name for a headache which originates from the tissues and structures in the neck. Typically, patients experience a persistent dull ache around either the back of the head, temple region, forehead or behind the eyes. It is common for these headaches to be accompanied by nausea, dizziness and sensitivity to light or sound.
Cervicogenic headaches are usually caused by activity which places excessive demands on the upper joints of the neck. This may be due to a traumatic episode such as whiplash but generally, is caused by a sustained or repetitive activity, such as poor posture, the lifting of carrying of heavy objects, non-ergonomic work place set up or excessive bending/twisting of the neck.
Individuals with cervicogenic headaches may experience the gradual onset of neck pain and headaches during the causative activity and may find symptoms are aggravated by neck movements.
Cervical spine facet lock/strain
Facet joints are articular surfaces in the spine of which the function is to guide and limit movement between each of the adjacent vertebrae. A facet sprain is typically caused by damage to ligaments, cartilage or capsule of the associated joint. During individual movements, stretch and compression type forces are placed on the facet joints, if these forces are too great, damage to the structures may occur. i.e. sleeping position – inadequate/excessive pillow use.
Patients typically present with an intense, localised area of neck pain distinct to one side. The sensation of pain may radiate to the head, shoulder, shoulder-blade and even to the arm of the affected side. Surrounding musculature will often go into spasm and neck movement may feel restricted and uncomfortable.
Lying between adjacent vertebrae and fibro-cartilaginous structures called discs. They consist of a tough, durable outer layer and a soft, jelly like centre. The prime function is to act as a shock absorber, protecting nerves and spine. A disc prolapse occurs when the soft jelly like centre bulges through the tough outer layer. This can be due prolonged, vigorous or repetitive activity. Symptoms can depend on the location of the prolapse, but in majority of cases, consist of a diffuse, consistent ache around the neck. Pain, pins and needles, numbness or weakness into the upper extremity may be observed. Typically symptoms are worsened by inactivity, mornings and coughing or sneezing.
The term whiplash is often used to describe an injury caused by the severe and sudden movement of the head and neck, in a forwards, backwards or sideways motion. Although typically associated with road traffic accident, the mechanism of injury can vary i.e. sports injury: boxing, rugby. The aggressive and forceful movement predisposes the ligaments and musculature of the neck to damage, causing severe neck pain and headaches. Symptoms may not always be apparent for up to 10 hours and have the potential to worsen over the following days.
Cervical spondylosis & degeneration
These conditions refer to wear and tear of structures within the cervical spine (discs, facet joints). Often a reduction of disc height precedes the degeneration of the joint itself. This occurs by reducing the approximation of the adjacent vertebrae and placing a greater demand on the bony articular surfaces. Commonly, the terminology used to describe this condition ‘neck arthritis’.
The condition is usually seen in older patient (60years+), predisposing factors may include and history of neck trauma or a lifestyle which placed excessive demands on the neck, i.e. plastering, boxing.
Symptoms may vary as changes in bony structure can place pressure on spinal cord and nerves. In the majority of cases patients experience no symptoms at all, however as the condition progresses, neck pain, stiffness and a reduced range of movement may be noted.
Thoracic outlet syndrome
Thoracic outlet syndrome is due to compression of the neurovascular bundle which supplies the upper extremity (arm and hands). There are various compression sites including muscles of the neck and torso, the first rib and clavicle (collar bone). Site, severity and nature of symptoms may depend on the structure involved, i.e. brachial plexus – nerves, or subclavian vessels – arteries and veins.
The most common symptoms associated with thoracic outlet syndrome are; pins and needles, numbness, pain or weakness into the arm or hands. Aggravating factors may include turning the head to one side for a sustained period ormovement of the arm and shoulder. This is often accompanied by neck pain on the same time.
Temporomandibular joint syndrome
The temporomandibular joint connects your jaw to the side of your head; located just in front of your ear. Temporomandibular joint syndrome can cause a range of symptoms such as facial and jaw pain, clicking, locking, grinding and localised tenderness, these symptoms are usually noted when eating or chewing.
Potential causes of the syndrome are due to hypermobility, trauma, teeth grinding, muscular spasm or poorly fitted dentures.