Updated: May 5, 2022
Cervicogenic Headache Causes
Take a look at this image courtesy of ccsbismarck.com which shows the pain map for cervicogenic headaches. If you suffer from headaches in these areas, then you are in the right place. I am going to discuss the causes and symptoms of these headaches and give you some ideas on how to get rid of your pain. Headaches can be frustrating and confusing, so let’s get right to the information!
One of the most important regions to understand with cervicogenic headaches is the suboccipital area. I have discussed this area before in my blog post about upper neck stiffness. A quick review is beneficial. There are four muscles on either side of your neck, making eight total suboccipital muscles. These run from the base of your skull to the first and second vertebrae along the back of your neck. If you place your fingers right along the base of your skull and provide some pressure, you are probably making contact with the muscles.
Another important structure to understand are the occipital nerves. They are pictured below courtesy of migraineurmagazine.com
These occipital nerves emerge from your suboccipital area and go over your head to your eyes. This is why the first image shows pain from cervicogenic headaches following this pathway and ending at the eyes. Tightness of the suboccipital muscles can compress the occipital nerves, causing pain anywhere along their pathway.
Another important anatomical consideration in this region are the first and second cervical vertebrae. They have a unique shape that optimizes for motion. In fact, these two vertebrae are responsible for approximately 50% of your rotation when turning your head. If you fused all of your cervical vertebrae except the top two, you would be able to turn your head about 45 degrees. Because these vertebrae are designed to be mobile, any restrictions can cause significant issues in the region. Joint restrictions can lead to compression of the occipital nerves as well. Pictured below courtesy of spineuniverse.com are the first and second cervical vertebrae, notice how little bony support they provide to allow for increased mobility.
The cause of tightness or restrictions in the suboccipital region can vary significantly. Sleeping in an unfamiliar position or turning your head too quickly can cause muscular spasms. Posture can also play some role, as a forward head position can create tightness and compression in the upper cervical region. Other factors such as stress play a role in these conditions as well.
Cervicogenic Headache Symptoms
The exact cause of a headache can be difficult to determine as many can be caused by hormones or other non musculoskeletal factors. However, there are several typical signs that point to a cervicogenic headache. These headaches are normally only on one side of your head. If there is muscular tightness, it can be on both sides, but more often it is only on one side. As mentioned before, the pain typically follows a “ram’s horn” pattern going around the top of your head. Symptoms are typically worst at the base of the skull or at the eyes.
Because there is musculoskeletal involvement, movement should impact the pain. If your pain is typically worse with sitting, it could be from postural stress on the back of your neck. Also, if you feel more pain when turning to one side, it could be due to joint or muscular restrictions. Finally, you should feel pain when pressing at the base of your skull. If pressing in that region makes your pain significantly better or worse, then your pain is probably based in that region.
Cervicogenic Headache Diagnosis
Diagnosing a cervicogenic headache can be difficult as exact causes of headaches are difficult to determine. However, there are a few practical tests that can determine if the suboccipital region is the cause. The first is palpating or pressing on the base of your skull. A medical provider should be able to identify the suboccipital muscles and provide greater clarity if they are the cause of your symptoms.
The flexion rotation test is a simple measure to look at range of motion and pain while comparing one side of the neck to the other. It is pictured below courtesy of sciencedirect.com
The patient should fully relax and let the examiner control their head. The examiner will flex the head as far forward as it can go and then turn it to one side and the other. You are looking for significant differences in range of motion as well as provocation of pain. The reason that this test is beneficial is that the flexion of the neck locks the lower cervical spine and prevents it from rotating. Any rotation is from the upper cervical spine, so about 45 degrees is expected. This should isolate the area that we are trying to test and provide accurate results about potential causes of a cervicogenic headache.
Another simple test is the chin tuck and lift test. This is performed as pictured below courtesy of summitortho.com
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