Head and Neck Pain
Headaches and neck pain often come hand in hand, with the potential for each to cause the other. Establishing the causes of head and neck pain can be time consuming and stressful in itself, and realising the two are connected is often the first step towards diagnosis and treatment.
Physicians refer to headaches involving the cervical spine in some capacity as cervicogenic headaches. This is not a diagnostic tool, rather a descriptive one, under which tension headaches and migraines may also fall.
Chiropractors, osteopaths, doctors, and other practitioners all see an endless stream of patients suffering head and neck pain. It is a common clinical complaint and can be a major obstacle to living and working effectively and happily. Normally the headache is the primary factor in headache and neck pain and is not usually attributable to an underlying pathology or disease. In other cases the headache can be a sign of a more chronic and systemic problem. Tension headaches, migraines, cervicogenic, and cluster headaches all fall under the primary headache category.
Secondary headaches are associated with lesions which put pressure on the spaces in the head, including tumours, meningitis, and subarachnoid haemorrhage. Other conditions such as acute glaucoma, and temporal arteritis can cause these types of headaches too. All of these conditions warrant immediate medical care and should not be self-medicated/treated. The head and neck pain may be chronic or acute in these cases.
Symptoms of Head and Neck Pain
Pain of this kind may be experienced as acute, sharp pain on turning the head to one side, or as a constant dull ache in the neck and head. Different nerve fibers are responsible for conducting different types of pain sensation, with C Fibers transmitting the dull, burning, gradually increasing pain sensations, and Adelta fibers responsible for acute, sharp pain sensations (Shimizu, 2010).
An inability to turn the head to one side may also occur, and stiffness, shoulder pain, and jaw pain may be present. If trauma has occurred to the head and neck, such as whiplash, then this may explain the aetiology of the pain. Degenerative conditions, such as spinal stenosis, and arthritis, can also lead to head and neck pain.
Mechanisms at Work for Primary Headaches
To help categorize the causes of head and neck pain, physicians often look at four key areas: vertebrae, nerves, blood vessels, and muscles. Any pathology in these areas can cause referred pain in both the neck and the head. If circulation is being compromised, then nutrients cannot get to the area they need to, and oxygen deprivation will cause tissues to atrophy and die. Trapped or pinched nerves, cramped and tense muscles, and fractured, or uncushioned vertebrae can all contribute to head and neck pain.
Vertebrae and Neck and Head Pain
If the bones and joints in the cervical spine have degenerated or been damaged then they may have become compressed causing extra pressure on the other structures in the surrounding area. Nerves that pass the vertebrae on their way out of the spinal column may be pinched, leading ot head and neck pain. If disc damage has occurred then a bulging disc, herniation, or simply a worn away disc can also lead to compression of nerves and blood vessels. Decreased flexibility may lead to changes in muscle tone, and alignment problems which in turn put pressure on another area of the spine. Head and neck pain may continue despite these compensation mechanisms. Surgery, to open up the compacted cervical spine, or anti-inflammatories may be indicated if head and neck pain are chronic.
Nervous System Problems
Compression of nerves in the cervical area can lead to acute neck pain as well as chronic nec pain. If a degenerative spinal condition such as spinal stenosis, or arthritis, is present then treatments may include options to widen the foramina through which the affected nerves pass in order to relieve the pressure. If there is an infection causing neuralgia, or inflammation of the nerves, then anti-inflammatories and, potentially, antibiotics might be suggested to help the body heal. Alternative remedies to NSAIDs (which have potential side-effects) are available and may help some manage their condition independently. Chiropractors may also be consulted to aid in realining the spine so as to decrease compression (Rodine, 2010).
Blood Vessel and Circulatory Problems
If muscles in the neck are tense they may constrict the nerves and blood vessels leading to ischaemia, or reduced blood flow, to the head and neck. The reduced blood flow means less oxygen and nutrients available to the cells, which can cause acute and long term damage and pain. Specific conditions involving poor blood flow to the head due to anatomical irregularities, poor circulation, damaged blood vessels from high blood pressure, or sclerosis of the veins and arteries in the neck can also compromise cellular health and lead to neck and head pain.
Physical Stress and Muscular Issues
Physical stress also plays its part in head and neck pain, with awkward sleeping patterns, hunched keyboard posture, poor shoe choice, and uncomfortable, unsupportive, chairs leading to muscular strain. As the muscles in the neck are constantly active to support the head, any strain on these will lead to referred pain in the head and base of the skull.
Head and neck pain may also be due to poor vision, as people will naturally strain their head forward, particularly when driving, in order to achieve a clearer focus. It may be time for a sight test to rule this out as a potential cause of chronic head and neck pain.
Emotional stress can lead to head and neck pain as a person may unconsciously tense the muscles in their neck and shoulders. Often they will experience the onset of a headache and then realise how tense their muscles are. Relaxation techniques are beneficial if this is a persistent complaint, rather than relying on pain-relieving medications which do not address the underlying stressor and can add an additional stressor to the system.
According to Haldeman (2001), women are four times more likely than men to experience cervicogenic headaches, with 15-20% of those suffering chronic headaches suffering this type of condition. Almost every cervical spinal issue can be implicated in the aetiology of cervicogenic headaches as so many sensory inputs converge at this location within the trigeminal nerve.
Haldeman, S., Dagenais, S., (2001), Cervicogenic headaches: a critical review, Spine J., Vol.1, No.1, pp.31-46. PMID: 14588366
Shimizu, T., Suzuki, N., (2010), Biological sciences related to headache, Handb Clin Neurol, Vol.97, pp.35-45. PMID: 20816409
Rodine, R.J., Aker, P., (2010), Trigeminal neuralgia and chiropractic care: a case report, J Can Chiropr Assoc, Vol.54, No.3, pp.177-86.