RSSMigraine Headache or Cervicogenic Pain?
Posted Under: Education,headache,neck pain,Stress
How do you know if it’s really a migraine?
Learn more: watch the video or read the transcript below
Transcript of Video:
Migraine Headache or Cervicogenic Pain?
Hello, I’m Dr. Shawn Phelan. I’m here to speak to you about head pain, primarily migraines, and another condition called cervicogenic headaches. In the general population, there is often some confusion about head pain. We often assume, or are being told, that we are suffering from a migraine, because we have a severe headache that is causing us nausea, sensitivity to light, ringing in our ears, a funny taste in our mouth, or funny things happening in our visual field. That is not always the case.
Migraine headaches are considered to be something that is either of vascular origin, something that’s caused by a chemistry issue in the brain, usually in the serotonin pathway, neurologic issue, or sometimes a combination of some of all of these issues. Migraine headaches caused by a serotonin imbalance, vascular, or neurologic issues are really rather rare. A true migraine sufferer should only have about seven migraines per year. If you are having more than seven migraines per year, there’s a pretty good chance that there’s an overlay of some sort.
Figure 1
Different conditions can cause overlays. The one am speaking about today is called the cervicogenic headache. So the question is, if we are suffering from migraines, is it truly a migraine that we’re suffering from, or is it possibly a cervicogenic headache?
So, let’s take a brief look at the anatomy. Figure 1 (left) shows the skull and two nerves that are coming out of the upper cervical spine. The first is the greater occipital nerve, and the second is the lesser occipital nerve. They exit the spine at the level of the upper cervical spine, and then they transit up into the head. Irritation of those nerves will cause head pain.
Figure 2
Figure 2 (right) shows us the skull with nerves traveling up into the face. That is another area that we often see pain generated from. Consider the fact that cervicogenic headache can cause all of the same symptoms that a migraine will cause. It will cause visual field disturbances, a funny taste in mouth, ringing in the ears, nausea, and sensitivity to light, called photophobia, but it is not really a migraine headache. It is a problem with the upper cervical spine.
So, if the upper cervical spine and the joints are irritated, inflamed or causing irritation to the nerves then it can cause all of the symptoms that a migraine sufferer will be familiar with. Yet, it is not a not a serotonin imbalance, vascular or neurological issue. It is simply a mechanical compression or mechanical irritation of the nerves in the upper cervical spine that is causing the headache.
Figure 3
Figure 3 (left) shows you the upper cervical spine and the facet joints that can become symptomatic and cause cervicogenic headaches. If you are a migraine sufferer, you should be examined by a professional to determine if there is a situation that is driving the cervical spine problem for you. Cervicogenic headaches can be fairly easily treated, and can help you get control of your symptoms, so that you are not at the whim of the migraines.
If you would like further information on cervicogenic headaches or migraines, please go to our website, http://www.wakeforestchiropractic.com. If you would like to make an appointment to be examined at our office so that we can determine whether or not you are not you are suffering from cervicogenic head pain versus migraines, then please get in contact with us by calling 919-562-0302. We would be happy to help you. Thank you.
Wake Forest Chiropractic
851 Wake Forest Business Park, Suite E
Wake Forest, NC 27587
919-562-0302
March 04, 2009
© copyright 2009-2010 Wake Forest Chiropractic. All rights reserved.
Reader Comments
Dr. Phelan,
Is cervicogenic pain the same as a tension headache?
If not, then where do tension headaches fit in?
Thanks for the great information.
- – Lori
The term “Cervicogenic” comes from the words Cervico (cervical) and Genic (generated from), so it encompases the neuro-musculoskeletal system of the neck and therefore the muscles effecting it. The upper trapezius and levator scapulae muscles have origins in the upper back and insertions on the neck. Tension headaches typically refer to reactions to stress where people will elevate their shoulders and get “tense”. This impacts the cervical spine because of the muscle insertions and the tension will eventually cause myofascial trigger point activity. These are areas of muscle hypertonicity that cause scar tissue to form and can refer pain to the head and neck, hence the “Tension” headache. Both of these scenarios can produce these Tension headaches and both can be corrected with a course of manual therapy.
Hello Dr. Phelan,
I’ve been suffering with what I think are migraines since I was 12 (Im 33). I have neck problems as far as muscle knots, stenosis of two discs (car accidents with the same injury), mixed connective tissue disesas that’s in remission, and fibromyalgia that isn’t really that bad at all (both appeared at age 12). I should note that when I was younger than 10, I was getting out of the back of a two door Oldsmobile and my brother’s friend didn’t know I was behind him and slammed the door, hitting me in the head and knocking me backwards. Also, my suboccipital area on the side I usually get my migraines is often in spasm. Anyway, I take Migranal Nasal Spray to abort my migraine headaches, along with an anti-nausea pill. Sometimes, it seems the migraine doesn’t budge with just the Migranal as the suboccipital is spasming so bad. When I push in a certain area of the subocciptial, I can feel a line of pain up the back of my head on the “migraine side”. It’s the same line of pain that is intensely painful and throbbing during a migraine. My question is, if the Migranal works for most of my migraines, does that mean that they are migraines and not cervicogenic headaches? Could I have both? I’m sure they must be related. It seems that way.
I know I sent you a lot of information and it probably sounds like I’m miserable, but I’m not. I’m very happy and content. I thought background information would hep answer my question. I do see someone for migraine.
Thank you,
Mary Olson (My maiden name is Phelan!)
Mary,
Chronic headaches are usually caused by the layering of musculoskeletal and non-musculoskeletal problems. The short answer is that migraine medication is designed to reduce head pain and will usually work on both migraines and non-migranous pain. So, just because it works on the headaches; that does not mean that your “migraines” are not cervicogenic. Because deep palpation of the sub-occipital musculature and the spasms in that area reproduce the distribution of the head pain, that is pretty good evidence that you have at least a cervicogenic overlay. The key to successful treatment of a patient with your health history is developing an intervention plan and then being very consistent with it. That typically includes a referral for massage therapy, a course of manual manipulation, home stretching, evaluation for food sensitivities and environmental allergies. This approach addresses the “layering” of problems. This may seem overwhelming, but it really isn’t. This approach typically yields results within the first week or two, though full recovery can take several months, or longer depending upon the degree of complication. The good news is: the person begins to feel back in control of their health very quickly, though it is a process and the treatment plan must be developed around the person’s capabilities. Essentially, true migraines that do not respond to anything but medication are quite rare. More often than not, they are caused by the above factors and are resolvable.
I do not know where you live, but if you need help I may be able to find a provider in your area that can help. Also, it is good to hear from a member of the Phelan Clan. It is a pretty unusual name and goes a long way back to Ireland of course.
Take Care,
Dr. Phelan
I have a history of migraines. I’ve recently been back & forth to my family Dr for neck pain that he first diagnosed as neck sprain and wanted me to go for some PT. They also said some of the symptoms are migraine related. I hardly ever have migraines and they certainly didn’t go on for wks like this. At my first PT session the therapist said he felt my problem was cervicogenic rather than migraine. I’ve had recent eye exam and all is fine. My main complaints are the neck pain and nausea. I have appt with neurologist on Monday. My concern is the nausea, is that typically associated with cervicogenic issues? I forgot to mention the family Dr wants me to start taking topamax too.
Cervicogenic headaches, if they are severe enough can cause all the prodromal symptoms of a migraine — including nausea. Another thing to be aware of this time of year is allergies. The symptoms of airborne allergies have changed. Often the sneezing, red eyes and runny nose are absent. Instead the symtpoms of the histamine reaction going on is long term fatigue, headeache and muscle aches. I am not sure what has changed but it has. If the neurologist finds no pathology, be sure to pursue the mechanical drivers of the cervicogenic headache and consider some over the counter allergy medication.