Archive for September, 2012


After a thorough evaluation, and diagnostic tests as indicated, treatments should begin with the least invasive (conservative) and progress to more invasive, depending on the individual.

  • The first line of treatment may be an exercise program focused on muscle strengthening and range of motion. This is generally directed by a physical therapist.  Some people may benefit from cervical traction (device that uses a small halter attached to a weight) under the guidance of a physical therapist.
  • Work and activity modifications may be helpful, especially for those who have jobs that involve heavy labor.  Bedrest is not generally recommended, and may make the pain worse. Adjusting chair/desk height, computer station adjustments, or other ergonomic considerations may also help with the pain for those who work primarily at desk type jobs.
  • Alternating ice and heat to the neck can be helpful if the pain is triggered by certain activities. Caution should be used when using an electric heating pad or microwave heat wraps, as these can result in significant skin burns. A good rule of thumb is to set a timer to 15 minutes, and alternate ice, then heat.
  • Medications such as NSAIDs (ibuprofen, Aleve, naproxen), and muscle relaxers can be very beneficial. Chronic use of narcotics is generally not indicated, as this can lead to dependency. Some people can benefit from other types of medications prescribed by a provider.
  • Injections of steroids (Epidural steroid injection) or local anesthetic blocks can often help with nerve type pain that originates from pressure on the nerves in the neck. Although the injection does not cure the disc degeneration, or slow the arthritis process, injections can help by providing temporary pain relief. In some cases the effects of the injection can last for many months.
  • Occipital nerve blocks: If the pain is from pressure on the occipital nerve, a specific block in the nerve can result in considerable relief. Sometimes, a nerve block is used as both a therapeutic (help the pain), as well as a diagnostic test (if the pain is helped by the block, there may be a better understanding that this is the source of the pain). If the patient has very good relief of the pain from a block, a nerve root ablation (“burning” the nerve) may be a more permanent solution.
  • Surgery- when other less invasive treatments have failed, some people may need cervical surgery. The type of surgery is based on the neurologic examination and the findings on the imaging studies.

If you think you have CERVICOGENIC HEADACHE, one of the providers at the

Neurosurgery Center of Colorado may be able to help- call today for an appointment.

There are many risk factors for developing Cervicogenic Headache. Many are factors that you can control, such as smoking, poor posture, exercise and rest.

Some tips for healthy neck habits:

  • Smoking and the use of tobacco products can significantly accelerate the rate of drying out of the discs. If you smoke, either quit or begin a smoking cessation program as soon as possible.
  • Get plenty of rest at night, as a good night’s sleep can help with muscle tension in the neck. Place a pillow under the head when lying flat.
  • Some people benefit from a special pillow (cervical pillow) that is curved on the edges to give the neck additional support
  • If you notice that you have neck pain when looking down (at the computer/paperwork/books) for long periods, explore a different height of the computer or chair that you use. Raise the height of your work such that you are looking straight ahead.
  • Maintain good posture while sitting or walking
  • Do not “pop” your neck or allow anyone else to
  • Move frequently- if you have a job that requires long periods of time in one position, stand up and do stretches, or relax the shoulders and gently rotate your head back and forth.
  • Exercise daily- walking is a good way to stretch the muscles,  maintain healthy weight and reduce stress
  • If you note pain that progressively gets worse, or if there is pain/numbness/tingling that radiates down the arm, or if you notice weakness in the hands or arms, consult your primary care provider.

Check back next week for common treatment options for Cervicogenic Headache!

The causes of cervicogenic headache are varied and typically depend on the problem in the structure of the neck. Various causes are described below:

  • Degenerative changes: The most common cause of cervicogenic headache is degenerative change (arthritis) in the neck (cervical spine). These are natural aging changes that cause bony spur formation, pressure on the nerves, and laxity/hardening of the ligaments.
  • Kyhposis (reversal of cervical curvature): The neck normally has a gentle C-shaped curve (lordosis) that allows the neck to curve slightly backwards. This normal position keeps the head in balance and reduces neck strain. As our discs dry out, they lose some of their height , resulting in straightening of the neck neck.  In some cases, the neck angles forward instead of backward. This causes greater strain on the muscles at the back of the neck, and results in occipital headache.
  • Whiplash: This is an injury that occurs from the head being “whipped” back/forth quickly. The mechanism of injury is from the head moving in a flexion/extension motion. The most common type of Whiplash injury is due to motor vehicle crash or contact sports injury (such as football or soccer). Headaches following whiplash are very common and have been reported in 80% of persons at 2 months following whiplash injury. Even 2 years after a whiplash injury, 20-25% of persons will still have headaches
  • Nerve compression: A common cause of nerve compression is degenerative disc disease, or arthritis in the neck. As the spine ages, and the discs lose their height, the small joints on the sides become more narrow. The nerves then have less room to travel through the joint, resulting in pressure on specific nerves. Another cause can be from a herniated disc in the neck that causes pressure on a specific nerve. Less commonly, nerve compression may be due to other causes such as tumors or abnormal fluid cavities in the spinal cord.

Tune in next week  to read about the risk factors for causing CERVICOGENIC HEADACHE.

Cervicogenic headache is a common type of head pain that occurs in approximately 2.5% of the U.S. population. Occipital (back of the head) headaches generally occur from problems in the neck, especially the upper part of the neck. The pain originates in the neck, but it can radiate up to the head and cause head pain- called cervicogenic headache.

The headache usually radiates from the neck to the occipital area (back of the head), to the temples, or around the eyes. It can be on one side of the head (unilateral) or both sides (bilateral). The pain is often described as dull, aching, and is aggravated with head/neck movement. Poor posture, looking up, or looking down for long periods of time can trigger or worsen the head pain. Some people who have desk jobs or look up or down for long periods of time can have cervicogenic headache. Generalized muscle tension can also result in headaches that radiate from the neck up to the head.

The pain of cervicogenic headache can be due to problems in the neck, such as cervical discs disease, facet joint degeneration (arthritis), ligaments that become less stretchy, or from muscle spasm. The pain can come from any area of the neck, but commonly originates from the upper (C2-3, C3-4) joints or discs.  Pain can also occur from unstable areas in the upper two joints (atlanto-occipital and atlanto-axial joints), and is called “atlanto-axial instability”.

For causes of cervicogenic headache, please check back next week for part II.