Chronic headaches can be one of the most debilitating medical conditions, and severely impact the quality of life.
The causes of headaches are numerous, and can come from eye problems, sinus disease, temporomandibular joint disorder or jaw problems, ear problems, trauma to the head, concussions, migraines, diseases of the spine and chronic muscle tension in the neck and head.
Sometimes, after thorough evaluation by one or more specialists, treatment with numerous medications, physical therapy, massage and acupuncture a small percentage of patients just don’t seem to get better. In these cases the cervical spine should be more closely examined.
A headache caused by problems of the cervical spine is called a cervicogenic headache (CHA). CHAs are seen in about three percent of the general population, but make up 20% of the headaches seen in an interventional pain clinic. CHAs are also 4 times more common in women. CHAs can be caused by trauma to the head and neck, osteoarthritis of the cervical spine joints, and motor vehicle accidents.
The symptoms of a CHA can mimic those of a migraine, making the diagnosis difficult. However, there are some subtle differences.
The pain of CHAs is usually on one side of the head and doesn’t change sides, is triggered by neck movement, or sustained or awkward neck positions (particularly looking up and behind).
On physical examination, pressure on the base of the head and upper cervical spine joints causes considerable pain and may trigger headaches. Loading the neck joints by pushing down on the head while it is extended and twisted, will reproduce neck pain and may also reproduce headaches.
There is also associated stiffness in the neck and decreased range of motion.CHAs are also associated with shoulder pain and occasionally arm pain on the side of the headache.
X-rays will often show degeneration or collapse of the disc and arthritic joints of the cervical spine called facet joints.
The arthritic facet joint is the primary cause of CHAs, and the most amenable to treatment. Pain from each inflamed cervical joint is referred (felt at a site distant from the source of pain) to a specific place on the head, neck or shoulders.
If the exam, history and x-ray films suggest facet joint pain, then diagnostic testing can be performed to determine the precise location of pain.
Facet joint or medial branch injection can be performed to numb the joint(s) in question. A small amount of local anesthetic is placed on the nerve (called the medial branch), which transmits pain signals from the facet joint. If the pain is relieved and the range of motion is improved after an injection, then that specific joint(s) is most likely the cause of the pain.
The duration of relief can be either short or long term. A good response to diagnostic blocks of the facet joints predict a good response to radiofrequency ablation of the facet joint nerves
Radiofrequency ablation utilizes a special needle, which heats the tissue around the needle tip. This creates a small “burn” over the nerve to the painful facet joint.
The painful joint is semi-permanently anesthetized or numbed, and symptoms may not return until 9 to 18 months when the nerve grows back. Aside from reduction in pain intensity, the nerve blocks allow for greater participation in physical therapy and rehabilitation.
Sustained long-term improvements in pain reduction, and improved function require consistent attention to body mechanics, posture, and muscle reeducation.
If you feel you have symptoms, which may be a cervical related headache, make an appointment with a pain specialist for evaluation and treatment.
ABOUT THE AUTHOR
Dr. Richard Gayles is a graduate of the University of Michigan Medical School. After obtaining his medical degree, Dr Gayles completed a residency in anesthesiology at The Johns Hopkins Hospital in Baltimore, Maryland. Subsequently, he held the post of visiting registrar at St. Bartholomew’s Hospital in London. Upon his return to the United States, Dr. Gayles completed a fellowship in chronic pain management at the Cleveland Clinic in Cleveland Ohio. Dr. Gayles is an Aviation Medical Examiner (AME) and a multi-engine instrument rated pilot. His interest in aviation led him to recently join Angel Flight, a volunteer organization which transfers chronically ill patients across country via private aircraft. Dr. Gayles is the co-director of Space Coast Pain Institute with Dr. Stanley Golovac. You may reach Space Coast Pain Institute by calling 321-784-8211.