Migraines, Neck Pain, and Cervicogenic Headaches
This article reviews headaches and migraines that are associated with neck pain. It discusses why doctors and patients are confused and offers solutions.
Migraines Trigger Neck Pain
In a study published in 2010, neck pain was a symptom in 75 percent of 113 migraine sufferers (study).
Neck pain was more common than nausea, the telltale sign of migraines.
Neck pain also correlated with more severe migraine attacks.
Neck Pain Trigger Migraines
Based on data from 61,000 patients, the odds of experiencing migraines are 4.82 times higher in people with spinal cord injuries (study).
Does neck pain cause my migraines or do migraines cause my neck pain?
It’s a vicious cycle.
Neck pain can increase inflammation and trigger migraines. This often happens after car accidents with whiplash (study).
Migraines can, and often do, increase inflammation and neck pain (study).
This inflammatory cycle creates confusion among doctors and patients when trying to find the underlying causes of one’s migraines.
Two Types of Headaches
There are two types of headache classifications: primary and secondary.
Primary headaches, such as migraines, cluster headaches, or tension-type headaches, are diagnosed when the cause of the pain is unknown.
Secondary headaches are from known sources, such as MSG, inflammation, or neck injuries.
Therefore, migraine-like symptoms triggered by neck injuries are identified as secondary headaches (study).
Migraines triggered by neck inflammation cannot be classified as migraines because they have a known cause. Read on.
In 1983, a Norwegian physician coined the term “cervicogenic headaches” for headaches that are aggravated by the cervical spine (study).
Migraine symptoms that are suspected of being caused by the neck are often diagnosed as cervicogenic headaches.
Diagnoses and Misdiagnoses
Doctors are just as confused as you are as to whether your migraine-like symptoms are coming from the neck, hundreds of other triggers, or all of the above.
Studies have shown that cervicogenic headaches are misdiagnosed more than 50 percent of the time (study).
Part of the problem is a lack of headache education among doctors (full article), but the criteria for differentiating migraines and cervicogenic headaches is where the dilemma starts.
The diagnostic criteria include the following (study):
♦ Headache associated with neck pain and stiffness. However, studies have shown that up to 84 percent of migraine patients have neck pain (study).
♦ Pain on one side of the head that radiates from the neck to the face. This is a strong indicator of cervicogenic headaches, but it is not a requirement (study).
♦ Triggered by neck palpations, but this is not a requirement.
♦ Aggravated by holding the neck in one position, but this is also not a requirement.
Table 2 (below) shows factors that can help separate migraines from cervicogenic headaches.
Cervicogenic headaches are suspected if the patient has problems with vision, dizziness, photophobia, phonophobia, nausea, stiff neck, rash, or headache onset after a head or neck injury (study). Yes, some of the research is conflicting.
New research also suggests that shoulder pain, arm pain, nerve blocks, and the Cervical Flexioin Rotation Test (CFR) can help diagnose cervicogenic headaches (study).
The CFR test measures how far you can rotate your neck left or right. The CFR test is up to 91 percent effective at differentiating cervicogenic headaches from migraine. Unfortunately, range of motion is also lower in migraine sufferers and the test requires a highly trained manual therapist (study).
Isolating cervicogenic headaches from migraine or tension headaches is difficult because a significant number of headache sufferers have a mix of all three conditions and do not fall into a single category (study).
Ninety-four percent of people with cervicogenic headaches are also diagnosed with another form of headache (study). For example, you can have a diagnosis of cervicogenic headache, migraine, and tension headache. This makes diagnosis even more difficult.
According to a recent study, “the present International Headache Society criteria is still probably not a safe basis for diagnosing cervicogenic headache.”
Temporomandibular Joint Dysfunction (TMD)
Up to 44 percent of cervicogenic headache patients have TMD or jaw pain (study). It’s suspected that cervicogenic patients will have more facial triggers than migraine patients.
However, migraine is also very common in TMD patients (full article, #31).
Neck, Nerves, and Blood Pressure
A recent study found the nervous signals in the neck could play a key role in maintaining blood supply to the brain, blood pressure, heart rate, and breathing (study).
When blood supply to the brain is insufficient, it can cause migraines, headaches, neck pain, dizziness, vertigo, difficulty swallowing or speaking, and auditory and visual disturbances (study).
Inflamed nerves in the neck could make it difficult to maintain blood pressure when we quickly stand up. This may explain why migraine sufferers are more likely to faint and have problems maintaining blood pressure or have abnormally low blood pressure (study 1, 2).
The blood supply to the brain is also decreased during a migraine attack and may contribute to the brain lesions that are common in migraine sufferers (study).
Neck Pain and Breathing
Neck pain or injuries are associated with changes in breathing patterns and poor respiration (study).
Breathing exercises, such as those done during biofeedback, have been proven to reduce migraine pain and frequency just as well as medication (article).
Botox is a migraine treatment that paralyzes muscles in the face and neck (study). Botox may reduce inflammation in the neck by consistently keeping the neck muscles relaxed.
Up to 60 percent of migraine sufferers feel neck pain directly before a migraine takes hold (study).
Botox may stop the inflammatory cycle between the neck and the vascular system that triggers a migraine. This would explain why some people benefit from Botox injections in the neck, even if they don’t have neck pain.
A nerve block is an anesthetic or anti-inflammatory injection that turns off pain signals.
Nerve blocks are typically injected in the neck to immediately stop migraines and can continue to prevent migraines for up to a year, but typically only last from a few days to a few months.
Similar to Botox, it’s suspected that limiting the initial pain from the neck will reduce the sensitivity of the trigeminal nerve that spirals a headache into a full-blown migraine (study). Nerve blocks stop the inflammatory cycle.
Pulsed radiofrequency (PRF) is a similar procedure that may provide as much pain relief as nerve blocks, but a recent study found that it did not reduce migraine frequency (study).
Nerve blocks need more research and have temporary effects. Long-term side effects are unknown and the cost for the procedure can be well over $3,000.
If nerve blocks or Botox injections are successful, it’s more likely you have cervicogenic headaches and will be recommended for surgery.
A stimulator implant that delivers electrical impulses to ease the nerves in the neck or face is part of the most popular surgery.
Stimulator surgery can cost over $75,000, battery replacements are not included, and up to 71 percent of patients have side effects that include migration of the stimulator, ineffective stimulation, and serious infections (study).
There is also a new surgery that decompresses inflamed nerves in the neck by removing surrounding fat and muscle tissue. The surgery was 59 percent successful at significantly decreasing migraine frequency in a study published in 2011 (study).
Migraine surgery comes with large risks and is an absolute last resort. Note that injections and surgery come with an ultra-high placebo effect, making the initial research for surgery questionable (full article).
There is not enough valid research, in my opinion, to take a risk on surgery that does not address the underlying source of inflammation.
Relaxation exercises, such as those done in biofeedback, the Wim Hof Method, or meditation, relax the muscles in the neck and face.
These muscles may be responsible for triggering migraines by compressing the trigeminal and occipital nerves.
Before paralyzing these muscles with Botox or risky surgery, try natural relaxation techniques.
Relaxation exercises are proven to work just as well at reducing migraine pain and frequency as prescription medications (article).
A large study found that 72 percent of migraine patients improved after chiropractic care and 22 percent reduced migraine frequency by more than 90 percent (study).
Chiropractors are masters of the spine, nervous system, and inflammation (study). If you believe your headaches may be caused by the neck, why not see an expert?
You could also visit an orthopedic doctor that specializes in neck injuries.
Massage those kinks out. Relaxing the muscles around the neck and shoulders could prevent cervicogenic headaches.
A review published in 2011 found that massage therapy might be equally as effective as migraine prevention medications, but previous studies on massage had shortcomings and more reliable research is needed (study).
A German study published in 2016 of 64 migraine patients found massages significantly reduced migraine frequency (study).
Electric massagers are also a great option for relieving shoulder, neck, and facial inflammation. Pure-Wave hand massagers are my personal favorite.
Cryotherapy (Cold Therapy)
An ice pack on the neck is one of the most common remedies for neck pain or migraine pain.
Research shows that when cryotherapy is used to cool the entire body, it can reduce inflammation in the neck and improve long-term rehabilitation for neck injuries (study).
In 2013, researchers in Hawaii found that wrapping an ice pack around the entire neck could reduce migraine pain by 63 percent (study).
FlexiKold Neck Cold Packs are the most popular for neck relief, but remember that cold therapy is also good to use on a regular basis for migraine prevention.
Learn more about how cold therapy can prevent and relieve migraines (full article).
Neck Pain and Diet
Omega-3 supplementation is comparable to the anti-inflammatory pain relief of ibuprofen in patients with neck pain (study).
One of the best ways to manage inflammation and migraines is through diet (full migraine diet).
Posture, Exercise, Sedentary Lifestyle
Learn more about how to relieve neck pain and migraines in part two of this article: How Posture Affects Migraines.