Misdiagnosed? You may have cervicogenic (neck based) headache

The faster you diagnose, correctly, your headaches or migraines, the faster you can find relief. It has taken me more than a year -- so I wanted to post about cervicogenic (neck based) headaches, so you can avoid misdiagnosis.

I do also get more traditional menstrual migraines and tension headaches, but after 5 years of migraine prophylactic treatment, numerous visits to the GP and National Migraine Clinic and hours and hours researching on the web, I am now convinced that the real culprit is in fact my neck. While doctors have generally been extremely dismissive, my physiotherapist and osteopath have been certain from day one that most of my headaches were neck-related.

There is much more detail in the article (best I've found) at the link below, but here are the high-level top messages:

1. What is it? Cervicogenic headache is a syndrome characterized by (often one-sided) chronic pain that is referred to the head from either bony structures or soft tissues of the neck.

2. How do I know if I've got it? It can be difficult to distinguish from primary headache disorders such as migraine, tension-type headache, but main features include: one-sided head pain, head pain triggered by neck movement, awkward neck posture or pressure points in the neck; stiff or restricted motion in neck. Symptoms can include ones similar to migraine e.g., nausea, vomiting, dizziness, blurred vision, etc.

3. Isn't the migraine causing the neck pain, not the other way round? It can work both ways or the two can build on each other. But if you've got neck pain, don't just assume it is because of migraines.

4. What treatments work? Like with most headaches, my personal summary is that "no-one really knows" or "it's a lot of trial and error". The link below provides a long list of possibilities, but it seems that a combination of medications and physical manipulation are often most effective.

5. What has worked for me? I'm still working through the options, and while I haven't found a "solution" (i.e., something that would permanently remove the root cause), the things that have really helped with the symptoms include:

- physiotherapy

- osteopathy

- Alexander technique

- meditation

- prophylactic (preventative) medications (I've tried amitriptyline and propranolol, currently on 900 mg gabapentin a day)

Very gradually, I'm learning to hold my posture more consistently in a way that puts less pressure on my neck and doesn't tighten up my neck muscles, so I'm hopeful the symptoms will get better over time.

jaoa.org/content/105/4_supp...

12 Replies

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  • Not sure it's the same thing, but I just had a few weeks of bad headaches. Went to my Chiropractor who said the muscles in my neck/shoulders were in spasm. He gave me really deep massage to the muscles around my neck and shoulders and he really went for it. I walked out 100% cured. He can't due that usually, because it's so tough on his hands.

  • hi Emma

    I agree with you about the neck having an impact on headaches. I've had chronic pain in my face, head and mouth for years, and it's improved after having physio on my shoulder and part of my neck, (and some botox in these areas). I've also noticed an improvement in posture having taken up some dance-type exercise and I think this helps. I'm trying to be more careful about carrying heavy things and when typing.

    I get migraines too but can now distinguish between migraine pain and "other head pain". I am certain that one of my migraine triggers is pain in my neck & shoulder or face. The migraines are usually less if the other pain is well managed.

    The only note of caution I would add for anyone with a neck problem is to be very careful of any exercise or treatment that involves forceful manipulation or movement of the neck - there's a major artery that goes to the brain that can be damaged easily and this can result in strokes.

  • Hi Emma

    I've been suffering with supposedly "Daily Severe Chronic Migraine" for nearly 16 years. I've always had neck pain (left side) thinking it was to do with my Migraine. Obviously over time I have noticed certain things. Strain of the neck brings a bad migraine.

    I believe I may actually have cariogenic headache, I will look into this.

    I'll get back here with any outcomes. Cheers David

  • I hope looking at your headaches/migraines from a different angle will help. For me, all of them are interconnected, but certainly the "remedies" proposed for cervicogenic headache have been helpful and had not been suggested by GPs or headache specialists. [One clue I had was that the triptans never helped much, so I suspected something else might be going on. But apparently even the definition of what is a "migraine" is not really that scientific, so it's worth talking about ALL your symptoms with whichever doctor or other advisor you are seeing.]

  • Hi Emma

    I find it's all connected too. Everything I've tried so far hasn't helped. But I'm on paroxetine (seroxat) 40mg a day and that helps. It's an Anti-depressant but also prescribed for Chronic Migraine. I do know that very little is known about the brain. Also very little known about Migraines and the literally hundreds of different causes. I did once suffer a very bad head injury (broken cheek-bone) in 5 places clashing heads playing football. Maybe that gave me a bad neck injury. Thanks for your posts.

  • Hi Emma. I just wanted to say what a helpful post this is - it's just the thing I was looking for. I've been diagnosed with polymyalgia which affects my shoulders and upper arms but there is something going on with my neck which is often stiff and triggers intense headaches. Yesterday I had a strange event while driving - I lost part of my vision in the centre area while driving and had to pull over for 15 minutes or so. It looked as if there was an oily puddle in the middle of the windscreen. When I closed my eyes I saw a bright green and yellow ring with jagged edges. When this disappeared I had a stabbing headache and I took to my bed for a couple of hours. Saw my consultant today and now have amitriptyline 10mgs to add to my steroids. He thinks this will help with the headaches and also help me sleep (which I haven't been doing for quite a while). I will try to improve my posture in the meantime and not slouch, and hopefully things will improve eventually. Thanks again for your post. Angela.

  • maybe you need some rememdies to help you sleep too as insomia can trigger headaches for me.

  • Have you tried a tens machine. I too attended physio with neck pain and discomfort which would trigger tension and migraine. Physio helped with exercises at home, unfortunately had flu for 3 weeks and could not complete any exercise now dreaded neck pain and migraines back. I had a tens machine and might give it a go. Just wondered has anyone else tried this?

  • I don't know if anyone checks this or not. I really think I have cervicognenic headaches. I've spent years thinking I have bad sinus headaches, which wasn't even close, then I was diagnosed with migraines, which was much closer, and then with a slipped or bulging disc. I had some physiotherapy last year, which was time consuming and costly. I went for a few months headache free, but the headaches and neck pain are back. I want to get to the point where I don't have to constantly go through this. I'm looking into the Mulligan Concept and the Alexander technique. Has anyone had good results?

  • Hello. I'm glad it's not just me who has suffered like this.

    I have been under a neurologist for 3 years now and feel like I am a just testing every drug on the market that also make me so poorly.

    I have had one sided head pain coming in episodes start of gradual then become acute over a few weeks. I had numbness in my face and my vision was affected.

    I have made a decision to not take anymore drugs as I ended up taking a epilepsy drug and it made me so poorly.

    I have now decided it may be related to my neck. I have a curving in my spine near my neck and it's constantly clicking and I have pain.

    I have tried massage and yoga stretching etc. I can now managed the pain upto now by hot bath and massaging my own head and neck.

    I hope I can get some permanent results xx

  • poor you. I have similiar problems but my docs always just focus on my bipolar and don t understand that sometimes I'm irritable because I'm in so much pain w the head/neck/shoulder pain. They just want to fill me full of anti psychotics. Try a BACKNOBBER ( an acupressure gadget to self manipulate sore muscles) Good luck x

  • found this v interesting as I have chronic headaches with localised pain, light sensitive and nauseus and always have neck pain too. I also use a BACKNOBBER (an acupressure device) to self massage my pressure points below my neck which always gives me instant relief. They re expensive (£24) but far cheaper than repeated visits to the osteopath. 

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