Headaches and Cervical Spine Degeneration
Headaches affect almost everybody from time to time, the most common types being "tension" or "migraine" headaches. This is no different for patients with degenerative disease of the cervical spine. However, degenerative changes in the neck in rare cases, can cause a less common subtype of headache called a 'cervicogenic' headache.
The classification of the headache is important as it dictates the types of treatment which are likely to be effective.
Cervicogenic headaches are a pain in the head or face attributable to a source in the neck. The most common sources in the neck are tumours, infection, fractures, trauma and arthritis. As per the International Headache Society, the presence of cervical spondylosis alone is not thought to cause a 'cervicogenic headache.' (1) It is rather when the degenerative changes leads to nerve irritation; for example where degenerative changes lead to upper cervical nerve root contact (C1 or 2).
The headache severity can vary depending upon the cause. Pain often affects the back of the head (occiput), moving forward to affect the whole head or face. Movement of the head can feel restricted or painful. It is often bilateral (both sides of the head or face) but can on occasion be unilateral (one side). The pain is constant, disturbing sleep.
The best treatment for this pain is managing the underlying problem in the neck (for example, antibiotics for infection). In the interim, oral painkillers can be helpful. Longstanding problems, such as mild arthritis, may benefit from physiotherapy. Other options for troublesome pain include occipital nerve blockade or cervical epidural steriod injections.
Tension or Migraine Headaches
These are examples of "primary headache" disorders. They are not known to be caused by a disease in the neck, but sufferers report headache, neck pain and tenderness. These are very common.
In tension headaches the pain is typically dull, aching and persistent. In migraine the pain is associated with light sensitivity, vomiting and visual disturbance. The management of these headache types differ from cervicogenic headaches, with patients often benefiting from acupuncture or physiotherapy. Medications offered for tension headaches include simple painkillers (e.g. Paracetamol) and neuropathic painkillers such as Amitriptyline or Gabapentin. In chronic migraine Amitriptyline or betabockers are often used.
Dr. Tim Lavin MBBS MRCP (Neurology) is a a Specialist Registrar in Neurology at Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust. A graduate from Newcastle University Medical School in 2006, he completed his initial training in the North West of England and New Zealand before taking up his appointment as a Neurology Specialist Trainee in 2011.