Headaches affect almost half of the population. 15-25% of all headaches are referred from the cervical spine and are classified as “cervicogenic” (1,36). The pathophysiology of cervicogenic headache (CGH) is debatable, but the anatomical basis is thought to be a convergence of sensory neurons from the cervical spine (neck) and trigeminal nerve in the trigeminocervical nucleus located in the upper cervical spinal cord. This convergence allows bidirectional referral of pain between the neck and head. (2) Other less complex theories suggest mechanical irritation of the greater occipital nerve as it emerges from the suboccipital region.

Additionally, anatomists have identified myodural bridges connecting the dura to the suboccipital musculature, i.e., rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior. These bridges employ both passive and active tensioning of the spinal cord – with obvious implications for cervicogenic headache. (43,44,50) Biomechanical testing suggests that this myodural link can reduce the bulging of the dura mater into the spinal canal, caused during hyperextension, by 53.4%. (52) Similar connections between the nuchal ligament and dura have also been established. (64)

The mean age for CGH is in the 40’s, and the condition affects women more often than men at a rate of 4:1 (1,3). CGH can be as debilitating as tension or migraine headaches, and a loss of cervical spine function compounds the problem. CGH is common in patients who have experienced trauma, especially a motor vehicle accident or an earlier concussion (4). The level of neck pain intensity and disability, kinesiophobia, catastrophising and anxiety were all greater in people with acute WAD who presented with a headache compared to those without headache. (78) The condition is particularly prevalent in weightlifters (10).

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What we do in our office to help this condition:

1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the cervical region (neck) branch off and go to the head, face, neck, shoulders, and arms, improper alignment in any of these areas may be detrimentally affecting the structures in the head. This can compromise proper function and lead to potential symptoms.

2. As indicated, adjust areas of spinal subluxations (misalignments), restoring proper nerve system function which facilitates healing.

3. Apply electrical stimulation and heat to the muscles of the upper back and trapezius muscles. Applying an electrical current helps strengthen muscles, block pain signals, and improve blood circulation.

4. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the head and neck. This promotes better oxygen and nutrients to these tissues, which can relieve pain and facilitate the healing process.

5. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissue of the neck and shoulders.