Referred (Cervicogenic) Headaches
A headache can be caused by a problem in the neck. This is called a cervicogenic headache. Most headaches do not come from the neck, most of headaches have a different source, but there is a very specific type of a headache that is called cervicogenic headache stemming from the cervical spine. Cervicogenic headaches usually starts in what we call the suboccipital area. The pain tends to radiate up into and around the cranium.
What causes a Cervicogenic Headache?
Synovial fluid, synovial capsule, and/or cartilage within the facet joints of the spine can become irritated and inflamed, causing pain. These joints are enervated at each level by a nerve called the medial branch. When referred headaches are suspected, the primary culprit is usually the third occipital nerve. This nerve crosses the C2-3 facet joints. C2-3 is crossed by the third occipital nerve, then continues onto the occiput and around the scalp. If there is irritation at this joint, this nerve tends to transmit pain along the nerve pathway - the pain that actually encompasses the occiput and the back of the head.
The most common cause of a cervicogenic headache is whiplash injury (acceleration/deceleration). Arthritis in that same joint can also cause irritation, inflammation, and irritation to that nerve, causing that cervicogenic headaches.
How is a Cervicogenic Headache Diagnosed?
Diagnosing cervicogenic headache can be difficult because the headaches resemble a number of different headaches and to complicate the matter, they can trigger other headaches: patients can have cervicogenic headaches as another trigger for a migraine, for instance. Cervicogenic headache in itself can cause tension headaches.
A fluoroscopy-guided nerve block at the junction of the third occipital nerve is the gold standard for diagnosing cervicogenic headaches, and can be performed quickly and easily. If the nerve block elicits pain relief, it is accepted that the condition is the root cause.
How is a Cervicogenic Headache Treated?
Reducing the inflammation at the joint and reducing the inflammation at that third occipital nerve is one of the first things to do. That can be done by placing medication right at the source of the inflammation and irritation, as mentioned above in the form of a nerve block. The next step in treating this type of cervical pain, should the nerve blocks prove effective, is radiofrequency rhizotomy. Radiofrequency rhizotomy demyelinates those feeding nerve fibers, disrupting their ability to transmit pain signals. This treatment is designed to last for 6+ months, until the myelin sheath of those nerves regenerates.
Manipulations of myofascial structures helps in addressing the muscle tension that is around the head, and can be of benefit to patients suffering from cervicogenic headaches.