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chronic neck pain: tension headaches -vs- cervicogenic headaches; which is the more accurate description?


It’s estimated that about half the adults in the UK experience tension-type headaches once or twice a month, and about 1 in 3 get them up to 15 times a month.  About 2 or 3 in every 100 adults experience tension-type headaches more than 15 times a month for at least three months in a row. This is known as having chronic tension-type headaches. From the website of Britian’s NHS (National Health Services)

The Mayo Clinic describes Tension Headaches as, “a diffuse, mild to moderate pain in your head that’s often described as feeling like a tight band around your head“.  Wikipedia says, “The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body typically affecting both sides of the head.” 

Headache Australia goes a bit farther, describing tension headaches as, “a dull and persistent pain that may vary in intensity (mild to moderate) and is usually felt on both sides of the head or neck (some however experience jabs of sudden pain in the head), a constant, tight, heavy or pressing sensation on or around the head, tautness and tenderness of scalp, neck and shoulder muscles, neck movements (active or passive) restricted by muscular stiffness and discomfort, ache in the back or over the left side of the chest.

No matter who you look to, you’ll see that TENSION HEADACHES (oftentimes referred to as “Stress Headaches”) are the most common kind of headache — by far — affecting a significant portion of the population (not surprisingly, women more than men), as well as accounting for approximately 90% of all headaches.  But is “Tension” or “Stress” Headache the best or most descriptive name for these kinds of headaches?  In other words, are these terms accurately identifying what’s really going on in many, if not most cases?

After Yesterday’s discussion of ADRENAL FATIGUE and SYMPATHETIC DOMINANCE, it is hard to argue that stress or tension is not a factor — after all, it’s a factor in most aspects of our lives.  The kids, the spouse, the job(s), the mortgage, the car payments, braces, mom’s going in the nursing home, you just got served papers, etc, etc, etc.  Life can be crazy and I didn’t even begin to scratch the surface with this list.  The thing is, I know lots and lots of people who would not describe their lifestyle as particularly “stressful,” yet are plagued by chronic Stress Tension Headaches.  What does this really mean?

I have been saying for a very long time that a better descriptor of what’s going on in this situation (as well as a better name for the headache) might, at least in most cases, be “Cervicogenic Headache” — meaning that the headache was ‘generated’ or ‘birthed’ by the Cervical Spine (neck).  What would make me say this? 

When I see patients with headaches that start in the upper back or neck (often at the base of the skull) and then travel up the back of the head, settling in the area around the eyes, forehead, and temples —- sort of like the Lone Ranger’s mask — I always think neck first.  Sometimes these headaches encompass the ENTIRE SKULL as well.

Part of the confusion comes from the fact that there is already a specific type of headache labeled as “Cervicogenic”. The American Migraine Foundation (AMF) describes Cervicogenic Headaches thusly…..

“Cervicogenic headache is a secondary headache, which means that it is caused by another illness or physical issue. In the case of cervicogenic headache, the cause is a neck disorder or lesion.  Headache causally associated with cervical myofascial tender spots or pericranial tenderness.  Clinical features such as neck pain, focal neck tenderness, history of neck trauma, mechanical exacerbation of pain, unilaterality, coexisting shoulder pain, reduced range of motion in the neck, nuchal onset, nausea, vomiting, photophobia etc. are not unique to cervicogenic headache.

These may be features of cervicogenic headache, but they do not define the relationship between the disorder and the source of the headache.  To confirm the diagnosis of cervicogenic headache, the headache must be relieved by nerve blocks.  Treatment for cervicogenic headache should target the cause of the pain (in the neck), and varies depending upon what works best for the individual patient. Treatments include nerve blocks, Botox injections, and medications.  Physical therapy and an ongoing exercise regimen often produce the best outcomes.”

For those of you struggling with Chronic Headaches, there’s a lot of meat here.  The first thing to note is that all of the symptoms of the Cervicogenic Headache are the same basic symptoms seen in other types of headaches.  Secondly, while nerve blocks may certainly be “diagnostic,” they don’t constitute a good form of treatment; mostly because they are not solving anything, but only covering symptoms. It’s important to be aware many blocks contain CORTICOSTEROIDS along with the blocking agent — a ready way to destroy the collagen-based tissues of your C-spine (BONE, CARTILAGE, LIGAMENTS, TENDONS, MUSCLES, FASCIA, DISCS, etc). 

The coolest thing we see in their quote is that physical medicine and exercise seem to get the best results.  What does this mean for you, the headache sufferer?  We’ll get there momentarily.

I bring all of this up because I would argue that many, if not the majority, of the headaches that the average American is dealing with — headaches being diagnosed and referred to as Stress Tension Headaches — are actually mislabeled (or at the very least, misnamed).  While stress of all kinds can certainly cause tension (MENTAL STRESS, PHYSICAL STRESS, DIETARY STRESS, etc, etc), is it the stress itself, or is there an underlying mechanical issue with the cervical spine that is being aggravated by stress?  The only way to know to find out is to check.

While for the medical community, “checking” frequently involves lots of tests (CT & BRAIN SCANS, MRI, blood labs, etc) mostly to rule out rare causes of headaches such as brain tumors, there really is an easier way.  Rather than me trying to tell you what others are doing in their clinics, I will simply tell you what I do in mine. 

  • CHECK RANGES OF MOTION:  Yes, I do a short neurological and orthopedic exam, but I realize the average person seeing me for the first time for Chronic Headaches has already been to any number of specialists, and been through all sorts of tests and examination.  The most important question is does the patient have good ROM in their cervical spine or don’t they (HERE)?  Because it’s easy to do, make sure you aren’t fooled (HERE).
  • ARE THERE TRIGGER POINTS PRESENT?  Just remember that TRIGGER POINTS are only one side of the coin that is the MYOFASCIAL SYNDROME, but they can cause some ugly problems that refer pain to the base of the skull (I am getting ready to do a post on the dreaded “Levator Trigger Point” that I personally deal with at times).
  • IS THERE SCAR TISSUE / FIBROSIS / DENSIFICATION PRESENT?  Normal tissue is sort of like well-combed hair.  It’s nice and flexible, supple and soft.  SCAR TISSUE, FIBROSIS, or DENSIFICATION are just the opposite — they are like a matted, tangled, HAIRBALL that is both hard and inflexible.  If present, nothing else you do is going to work — or at least work for the long haul.  It’s almost like being perpetually “TETHERED“.  Sure the exercises, stretches, PT, adjustments, massage, etc, help you feel better.  But only for a short while.  The problem then returns exactly like it always has, to the same place, and with the same characteristics.  This is the classic “Modus Operandi” for Scar Tissue.
  • DOES THE NECK HAVE GOOD SEGMENTAL MOTION:  I don’t care how good the gross ranges of motion of the neck are; if there is SEGMENTAL DYSFUNCTION is the cervical spine, results will be compromised.  Again, all of this comes back to the whole PHASE I -vs- PHASE II thing.  It’s why adjustments can be so cool (HERE).  But it also explains why adjustments alone create the need for the next bullet point.
  • DOES THE NECK HAVE THE APPROPRIATE LORDOTIC CURVE?  The most important range of motion in your cervical spine is your ability to tip your head back into EXTENSION.  Extension is critical, and a loss of this particular range of motion or a case of Forward Head Posture (FHP) means that you’ll absolutely have to spend some time DOING THIS
  • HAVE YOU EFFECTIVELY DEALT WITH INFLAMMATION?  Along with the whole Scar Tissue thing, dealing with effectively DEALING WITH INFLAMMATION provides the solution to yet another “missing link” in the neck pain / headache conundrum.  This bullet is such a big deal that I actually could have (maybe even should have) put it at the beginning of the list instead of the end.  Inflammation is the very thing that causes both Fibrosis (Scar Tissue) and degeneration / deterioration of the affected area (HERE). Figure out what it takes to squelch inflammation, and not only have you made everything on this list work better — maybe way better — in some cases you may have actually solved your problem.  Although THIS POST has a lot of valuable information for dealing with inflammation, an ELIMINATION DIET is the best starting point.  If you ignore this bullet, you potentially compromise all the others.

What does all of this mean in relationship to Stress or Tension Headaches, Cervicogenic Headaches, and the best way(s) to deal with them?  As we saw in the quote from the AMF, DRUGS — by far the most common remedy the medical community has to offer — don’t change underlying pathophysiology. Plainly stated, they cover symptoms (HERE). 

If you’ve read this far, I already know that you are sick and tired of covering symptoms with drugs — literally sick and tired.  Pick up the phone today and call Cheryl at (417) 934-6337 to make an appointment.  HERE is exactly what that appointment will look like.  HERE are some very cool video testimonials of people just like you, who after living on the MEDICAL-MERRY-GO-ROUND, found rapid relief in our clinic.  You’ve got nothing to lose but the pain. And like, share or follow on FACEBOOK while you are at it!


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