This week a new patient came to our office that has been suffering from headaches for years and has tried every drug available, and is still having headaches.
Researchers have known for a long time that the first 3 cervical vertebrae carry nerve signals via the trigeminal nerve, which is the nerve typically associated with migraine headaches. So, would it surprise you to know that patients with loss of cervical curve due to whiplash-type injuries are the most common patients who report chronic headaches and migraines?
Headaches originating from the cervical spine are also called cervicogenic headaches.
Early diagnosis of this condition is rare, unfortunately. This leads to a lot of unnecessary consumption of medications, some with a list of side effects a mile long that can cause worse issues than the migraine itself.
Today, I will examine the cause of chronic cervicogenic headaches in patients who develop them without trauma, but rather from posture issues.
The most common presentation is a patient with anterior head carriage and forwards rolled shoulders. Below are two pictures one is a normal cervical curve and the other is a loss of cervical cure due to posture.
We all have phasic and postural muscles.
Postural muscles are designed to sustain long periods of contraction and are considered slow twitch muscle fibers. Phasic are muscles that move us and perform quick movements, but they cannot sustain long periods of contraction.
In the cervical spine when a person develops anterior head carriage the weight of the head and neck become too much for the muscles to support them.
In the illustration above the head and neck, when in an anterior position, can weigh as much as 42 lbs. In these cases, phasic muscles get recruited to help support the head and neck and phasic muscles are designed for gross motor movement. Ultimately, they tighten and fatigue much more quickly and that puts more tension on the base of the skull and more pull on the upper cervical spine. This can cause minor shifts in the cervical vertebrae and compression on nerves in the neck that route to the trigeminal nerve. The result is a migraine.
How is this condition treated for the best outcome?
- First it must be diagnosed correctly. It’s important to choose a clinician who understands functional movement and correction. Integrated practices are setup for this sort of comprehensive treatment in that there are several providers working directly with the patient and each has a different expertise that lends to the outcome. In some cases, you can find a provider that has both functional movement and correction background and also can perform any of the noninvasive procedures that are required to correct this.
- Physical rehabilitation designed to correct anterior head carriage and thoracic kyphosis. Sometimes posture bracing is warranted. Chiropractic adjustments are also very beneficial in treating this because the cervical spine is often in misalignment and manipulation allows inflammation to reduce, it breaks up muscle adhesions and restores proper movement in the cervical spine.
- Trigger point injections are sometimes helpful in chronic cases. Patients who have been suffering with this condition for years start to develop bundled muscle fibers that refer pain when pressure is applied to them, and these are often referred to as trigger points. Trigger points are less elastic tissue and because of that elasticity they effect the movement of any bone they connect as well as the muscles that connect to that bone. When this tissue is broken up and allowed to move the way it was designed, it will restore function to the bones and joints and this will have a big impact on the patient. Scapular movement, specifically, is an area where this has the biggest impact on cervicogenic headaches.
- Posture bracing to restore cervical curve and thoracic kyphosis can be vital adjuncts in care because they can be used post care and for a longer period of time to continue to restore and reinforce the corrections made in therapy and the other noninvasive procedures.
- One of the treatments that can have a huge effect on a patient’s pain severity and frequency of chronic cervicogenic headaches is Botox. It can relax the muscles associated with chronic headaches as well as inhibit nerves that if activated can trigger the trigeminal nerve. It is great when used in conjunction with a passive therapy that can potentially restore function to the cervical and thoracic spine and eventually alleviate the need for a Botox injection. On average patients report 80% reduction in symptoms and frequency with just 3 treatments. In clinical practice I have experienced it with patients as early as 1 or 2 treatments. Another perk is that it is only done 4 times a year versus daily like many medications used to treat headaches, and the side effects, if administered correctly, are minimal.
If you are suffering from chronic migraines it is worth scheduling a consultation with a provider who specializes in physical medicine.
Chiropractors and Physical Therapist are a good start, but ideally you want a provider and practice that can look at you from several sides of the spectrum and provide a combination of medical and functional rehabilitation treatments.
