Headache (cervicogenic) in Women
Headache mainly starting from soft tissues or nerves or bony structures in the
neck is called cervicogenic headache.This can be confused with other forms of
headache like Migraine. It is one of the common causes of headache often
confused for other forms of headache. However the treatment is different and
very effective in providing permanent resolution of symptoms.
Causes of Cervicogenic headache:
- Injury to the neck like automobile accidents.
- Trauma associated with sudden jerky movements of the neck like
whiplash injuries.
- Blunt trauma like falling on the back head hitting the floor.
- Rheumatoid arthritis.
- Herniated cervical disc.
- Systemic diseases.
Out of all these trauma is the most common cause even though all the patients
may not remember the traumatic incident.
The anatomical structures mostly responsible for these headaches:
- Cervical facet joints
- Occipital nerves
- Degeneration of the Discs
- Neck muscles
Studies have shown that cervical facet joints are the single most common source of pain in patients with neck pain following whiplash injuries.
History:
Patient may present with headache starting on the back of the neck and radiating
to the front of the head. More often it is one sided. They may also complain of
muscle tightness or tender muscles. They may have difficulty in moving the neck
to one side. They may complain of pain between shoulder blades or one of the
shoulders. These symptoms vary depending upon what is causing the pain
(nerve or facet joints or primary muscle problem).
They may also experience
headache shooting to the front and to behind the eye.
Physical examination:
Careful history taking is the most important part of the exam. History most of
the time point to the diagnosis and also helps to exclude other conditions .This
helps to focus the treatment.
Physical examination will help most of the time for
the diagnosis.
X-ray/lab investigations:
X-ray: Simple plain x-rays will help to rule out any fractures, arthritis involving
facet joints
MRI /Ct: may or may not help to identify pain originating from cervical
facet joints. However they will help to rule out other pathologies including
herniated discs, tumors etc.
Treatment
Treatment varies depending upon the cause of headache.
Occipital neuralgia:
Pain originating from two nerves on the back of the head .Headache starts on
the uppermost part of the neck and shoots to the top and sides of the head
depending upon which side nerve is involved. These can be treated by
blocking the Occipital nerve. Usually one or two blocks resolve this type of
headache. In case of recurrence or for long standing pain Radio frequency
or Percutaneous implantation of stimulator effectively controls the pain.
Patients will be able to sleep better .Their job performance improves and they
see improvement of their relations with family members.
Headache coming from Cervical Facet joints:
Studies have shown that cervical facet joints are the single most common
source of pain in patients with neck pain following whiplash injuries.
C2-C3 and C5- C6 are the most common joints involved.
Diagnoses:
This is done by blocking the nerves supplying these joints called medial branch blocks. These are done under Fluoroscopy.
Treatment:
once the diagnoses established that the source of pain is Facet joints we can proceed for the treatment. The most effective treatment is Radiofrequency. Following the Radio frequency one should actively participate in physical therapy.
Cervical discs:
Degenerative discs can cause headache eventhough they are less common than Facet joints.Herniated dicsc can cause neck pain.However they also can cause radiating pain /numbness shooting down one or both arms.
Diagnoses:
- MRI/CT of the cervical spine helps for the diagnoses.
- Cervical discography: in difficult cases where the diagnoses is not clear
Discography will help to rule out the discogenic origin of the pain.
For more information please call our office 219.838.1100
Ref:Lord S.BarnsleyL,Wallis BJ,Bogduk N:The prevalence of chronic Cervical zygapophysial joint pain after whiplash .Spine 1995;20:20-26
Last update Sept 2008
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