Headaches that can be the result of an injury or disease. Do you know how to tell the difference between a migraine and a cervicogenic headache?
Types of headaches
Headaches are the most common form of pain and nearly everyone gets them at some point in their life. According to the National Institute of Neurological Disorders and Stroke (NINDS),” primary headaches occur independently and are not caused by another medical condition” and “secondary headaches are symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place” (NINDS, 2018).
Many healthcare providers use The International Classification of Headache Disorders which contains more than 150 types of primary and secondary headaches in conjunction with the International Classification of Diseases (ICD-11) for additional information related to pain (Treede et al., 2015). Fortunately, most headaches can be well controlled with medication and/or complementary therapies. Many headaches do not require medical attention. But sometimes headaches can warn you that there may be a more serious condition.
As stated above primary headaches do not have an additional factor that causes them. Those listed below are the most common forms of this type of headache. Nearly 98% of all headaches fall in this category can be very difficult to treat (Ahmed, 2012).
Many of the headaches that people will experience that belong to this category are ones that require little or no medical attention. However, from the list below, you can see that they stem from another condition that can be severe or even life-threatening. Therefore, they should not be overlooked if they start suddenly with no relief from standard medications or are associated with an illness. Only a few of the causes of secondary headaches are listed below.
- Caffeine or stimulants
- Sinus, fever, illness
- Head injury
Migraines are an extremely debilitating form of headaches that affect at least one person in every four households in the U.S. According to the Migraine Research Foundation (MRF, 2018):
- 90% of the people that experience migraines have a family member that also has the same condition
- Every 10 seconds (in the U.S.), a patient is seen in an emergency room for migraines
- Migraines are more prevalent in women (about 28 million in the US)
- During a migraine, 90% of all people are unable to work or function normally
The neurological symptoms of a migraine can be experienced just before a headache and are referred to as an aura. However, there can be symptoms present as early as one to two days before experiencing pain. Not everyone experiences auras, but they can include visual disturbances, ringing in the ears, unusual smells, difficulty finding words and tingling or numbness. Many times, an aura starts up to 60minutes before a headache begins and it a “warning sign” that a migraine is about to start. With or without an aura, migraines can be accompanied by nausea, vomiting, dizziness, confusion, and sensitivity of light, smells and sounds.
It is believed that this neurological condition is caused by chemical changes in the brain. The exact cause has not been determined, but researchers believe that it is related to neuropeptides and neurotransmitters such as glutamine, serotonin (Deen et al., 2018), and dopamine (Noseda et al., 2017). People that experience migraines have certain known things that can trigger an episode. These triggers can include smoke, perfume/cologne, tension or stress, foods and additives, sleep deprivation, menstrual cycle/estrogen, and even the weather to name just a few (Borkum, 2015).
There are different treatments available for acute migraines, but few are effective across the board. Many times, it is a matter of trial and error to find the right one or combination of them. Oral medications include NSAIDs, triptans (rizatriptan, sumatriptan, zolmitriptan), NSAID–triptan combinations and opioid-containing combination analgesics (Becker, 2015). More recently, injections have become available. Physician-administered onabotulinum toxin A (Botox) has been used to treat chronic migraines since 2010 and it has been used to treat more than 500,000 patients. The injections are administered every 10-12 weeks.
A self-injectable (sumatriptan) is designed for acute migraines when oral medications are not effective. The most recent drugs to be approved by the FDA are self-injections that are administered every 4 weeks. These medications target calcitonin gene-related peptide (CGRP), a molecule that’s produced in nerve cells of the brain and spinal cord. They are intended for chronic migraine sufferers to help reduce the number of headaches and the need for oral medications.
Cervicogenic headaches are considered secondary headaches. This means that they are caused by a different illness or physical condition. Many times, patients that are experiencing this type of pain will complain of headaches, but the actual source of the pain is in their neck. The source of this pain can be from any part of the cervical spine including the vertebrae, discs and/or soft tissue. Pain is located most often at the (C2/3) facet joints, followed by C5/6 facet joints (Garcia et al., 2016).
People that experience cervicogenic headaches typically have limited range of motion of their neck, increased pain with certain movements of the head and/or neck, and trigger points (Olivier et al., 2018). When pressure is applied to these trigger points the pain worsens. This type of headache typically is on just one side of the head and pain radiates from the neck up across the top of the head and is located behind the eye on that same side of the head. This may or may not be associated with neck pain.
It should be noted that this type of headache affects four times as many women than men and in more than 50% of the cases, there has been a history of whiplash, traumatic brain injury or other cervical injury (Drottning, 2003).
Nerve blocks have been shown to be a good choice for relief as well as diagnosing this condition. Any type of treatment needs to be focused on the cause of the pain. Other types of treatment may include medication, exercise, physical therapy, spinal manipulation, dry needling and more.
If you have chronic neck or back pain and want to consider stress as a possible cause you may want to read “Healing Back Pain” by John Sarno, M.D or you can contact Michael Sinel, M.D.
directly at michaelsinel.net.
Michael Sinel, M.D.
Dr. Sinel is an expert in spinal disorders, stress-related back pain, and mind/body medicine. He also has obtained certifications as a yoga therapist and mindfulness-based stress reduction instructor. Dr. Sinel is a proponent of using alternative methods to help patients overcome the pain and loss of mobility from spinal disorders and chronic pain syndromes.
Dr. Sinel has authored two widely read books: “Back Pain Remedies for Dummies” and “Win
the Battle Against Back Pain.”
Contact or Follow Dr. Sinel via:
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Becker, W. J. (2015). Acute migraine treatment in adults. Headache: The Journal of Head and Face Pain, 55(6), 778-793. https://doi.org/10.1111/head.12550
Borkum, J. M. (2016). Migraine triggers and oxidative stress: a narrative review and synthesis. Headache: The Journal of Head and Face Pain, 56(1), 12-35. https://doi.org/10.1111/head.12725
Deen, M., Hansen, H. D., Hougaard, A., Nørgaard, M., Eiberg, H., Lehel, S., … & Knudsen, G. M. (2018). High brain serotonin levels in migraine between attacks: A 5-HT 4 receptor binding PET study. NeuroImage: Clinical, 18, 97-102. https://doi.org/10.1016/j.nicl.2018.01.016
Drottning, M. (2003). Cervicogenic headache after whiplash injury. Current Pain and Headache Reports, 7(5), 384-386. https://doi.org/10.1007/s11916-003-0038-9
Garcia, J. D., Arnold, S., Tetley, K., Voight, K., & Frank, R. A. (2016). Mobilization and manipulation of the cervical spine in patients with cervicogenic headache: any scientific evidence? Frontiers in Neurology, 7, 40. https://doi.org/10.3389/fneur.2016.00040
Migraine Research Foundation. (2018). About migraines. Retrieved from https://migraineresearchfoundation.org/about-migraine/migraine-facts/.
National Institute of Neurological Disorders and Stroke (NINDS). (2018). Headache information page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Headache-Information-Page.
Noseda, R., Borsook, D., & Burstein, R. (2017). Neuropeptides and Neurotransmitters That Modulate Thalamo‐Cortical Pathways Relevant to Migraine Headache. Headache: The Journal of Head and Face Pain, 57, 97-111. https://doi.org/10.1111/head.13083
Olivier, B., Pramod, A., & Maleka, D. (2018). Trigger Point Sensitivity Is a Differentiating Factor between Cervicogenic and Non-Cervicogenic Headaches: A Cross-Sectional, Descriptive Study. Physiotherapy Canada, 1-7. https://doi.org/10.3138/ptc.2017-38
Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … & Giamberardino, M. A. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003. doi:10.1097/j.pain.0000000000000160]