Headaches in a certain percentage of cases are caused by problems in the neck and are called cervicocranialgia . Such pain is usually associated with changes in the structures of the neck or head or may be referred (for example, from the upper back, jaw or shoulders).
Sudden onset of neck and head pain is often associated with injuries from contact sports, motor vehicle accidents, weightlifting, bending forward or sideways, twisting the neck, or a combination of these movements. In addition, if there is damage to the ligamentous apparatus, pain in the neck and head can occur even after sneezing due to strong adaptive muscle spasm. Also, one of the most common causes of acute neck pain radiating to the head, shoulder, arm, and forearm is a herniated disc or subluxation of the facet joints. The gradual onset of neck and head pain often occurs in patients sitting at a computer for long periods of time, repeated bending of the neck, poor posture, or a combination of these factors. Another common cause of pain may be a herniated disc. In older patients with gradual onset of neck pain, one of the most likely causes of symptoms is degenerative changes in the spine.
What is cervicocranialgia
Cervicocranialgia, or cervicogenic headache, is pain emanating from the cervico-occipital region.
Cervicocranialgia accounts for 15-20% of patients experiencing chronic headaches. Currently, there is more consensus that in most cases cervicocranialgia is a functional pain rather than pain associated with structural changes in the cervical spine. Cervicocranialgia manifests itself if those structures of the neck that are capable of producing a pain impulse are involved in the pathological process. These include:
- neck muscles and places of their attachment;
- own ligaments of the cervical spine;
- outer layer of the fibrous ring of the intervertebral disc;
- spinal nerve roots;
- vertebral arteries;
- vertebral joints and atlantooccipital joint.
The spread of pain from the suboccipital region to the area of innervation of the trigeminal nerve (temporal region, forehead, orbit) is apparently associated with a feature of the neuroanatomy of the upper cervical region, namely: the presence of neural connections with the spinal nucleus of the trigeminal nerve, which lies deep in the medulla oblongata, and its lower part reaches the upper cervical segments C2-C3.
Prevention
General restorative therapy helps prevent the development of cranialgia and relieve the patient from exacerbations.
- Taking vitamins...
- Daily morning exercises.
- Massage.
- Proper nutrition.
- Spa treatment.
It is necessary to avoid hypothermia and excessive stress on the spine. When sitting for a long time, it is recommended to take a break, move, and do exercises.
Pain in the head requires examination to rule out the development of pathological processes. Self-medication without an accurate diagnosis will not give positive results and may worsen your health. The sooner the patient consults a doctor, the faster the recovery will occur.
Vertebrogenic cervicocranialgia
Cervicocranialgia due to prolonged work at the computer, repeated bending of the neck, poor posture, or a combination of these factors is quite common. In some patients with gradual onset of neck pain, the cause of symptoms is degenerative changes in the spine.
Sudden onset of neck and head pain is often associated with acute trauma from contact sports, motor vehicle accidents, weightlifting, bending forward or sideways, twisting the neck, or a combination of these movements. In addition, if there is damage to the ligamentous apparatus, pain in the neck and head can occur even after sneezing due to strong adaptive muscle spasm. Also, one of the most common causes of acute neck pain radiating to the head, shoulder, arm, and forearm is a herniated disc or subluxation of the facet joints.
In 26% of cases, the cause of cervicogenic headaches is congenital anomalies of the craniovertebral region, one of the most common is the Arnold-Chiari anomaly, characterized by the descent of the cerebellar tonsils into the foramen magnum.
Causes
Headaches have many causes and are often associated with specific neck pain. Such headaches are known as cervicogenic headaches and are often caused by myofascial pain and muscle-tonic syndromes of various etiologies and types. But it must be taken into account that pain in the neck and at the same time in the head can be a sign of serious diseases such as meningitis or a brain tumor, and can also be caused by a neck injury and this must be taken into account when diagnosing cervicocranialgia .
Muscular causes of cervicocranialgia
Problems in the muscles can lead to such pain, especially if there are problems in the muscles that run from the lower jaw towards the head. These muscles are connected to the base of the skull and can become tight due to poor posture, overuse, or stress. Typically, headaches associated with muscle problems also feel like pain when moving the shoulder. When you apply pressure to the area of pain (neck or shoulder), the headache usually changes. The pain can be mild to moderate or intense, lasting from several hours to several weeks.
There are three main nerves, C1, C2, C3, that run directly into the head from the cervical spine.
These nerves innervate the muscles around the skull at the top of the neck and can go into spasm as a result of inflammation or prolonged strain. Muscles such as Semispinalis capitus, Capitus long, and Longus Capitus, Capitus lateralis are responsible for moving the head back, forward and sideways, respectively. The trigeminal nerve innervates the facial muscles, and the second cranial nerve provides sensation to the back of the head. These two nerves are located in the upper part of the neck, so any damage or injury to this area can result in pain that can originate from the lower back of the head and radiate to the top of the head, eyes and face. Pain in the neck and head can also be caused by myofascial syndromes associated with muscles such as Upper Trapezius, Sternocleidomastoid, Splenius Capitis, Splenius Cervicis, Semispinalis Capitis, Semispinalis Cervicis, Longus Capitis, Longus Colli, Multifidi and Rotatores Omohyoid.
Degenerative changes in the spine
Structural involutional degenerative changes in the intervertebral discs and vertebrae can cause referred pain to the head, usually in the back of the head.
A herniated disc in the cervical spine is one of the most common causes of neck pain, with possible radiation to the arm, shoulder and often to the head, but more often the headache is caused by secondary muscle spasm. The pain may increase with palpation pressure in the neck area and the pain is often accompanied by limited mobility in the neck. Sometimes there may be no pain in the neck, but there may be only pain in the arm or only a headache. As a rule, pain in the hand is accompanied by numbness and a tingling sensation in the hand. Pain caused by a disc herniation often intensifies with prolonged static loads (for example, when sitting) or when turning the head.
Neck injuries
Injuries to the muscles, ligaments, tendons, joints, discs and nerves in the upper neck can lead to chronic neck and head pain. The most common injuries are whiplash, which occurs during falls or motor vehicle accidents, or sports injuries such as facet joint subluxations, which respond well to manual manipulation. Poor posture, repetitive motion, and stress can also cause facet joint subluxation, which can lead to localized neck pain and chronic headaches.
Sprain
Tears (tears) of the connective tissue surrounding the articular joints are usually the result of excessive stretching of the tissue during twisting, bending, and extension, especially against the background of postural disorders. A sprain usually presents with neck pain on one side, which may radiate to the lower part of the head. As a rule, such conditions are accompanied by muscle spasms.
Facet joint injuries often occur as a result of sudden neck movements or collisions during contact sports. Usually in such cases there is a constant, dull pain that can be localized in the back of the head, the top of the forehead, behind the eye, in the temple area and, less commonly, around the jaw or ear. Typically, headache is associated with neck pain, neck stiffness, and difficulty turning the neck. The pain may increase with palpation in the cervical spine, usually on one side of the neck, just below the base of the skull. Sometimes there may also be symptoms such as a tingling sensation, numbness, nausea or slight dizziness.
Arthritis of the cervical spine
The most common cause of chronic neck pain leading to headaches is osteoarthritis, which is caused by degenerative changes in the joints of the vertebrae. Typically, only changes in the joints of the upper three vertebrae of the neck are the cause of cervicogenic headaches. Osteoarthritis of the neck (spondylosis) is degenerative changes in the facet joints that lead to the formation of osteophytes and bulging discs. These degenerative processes can generate chronic, dull or sharp pain in the neck and pain in the back of the head.
In addition to involutional degenerative changes in the cervical spine, changes in the joints can also be caused by systemic diseases, such as rheumatoid arthritis or psoriatic arthritis, in which inflammation in the joints can cause neck pain and cause chronic cervicogenic headaches. Such causes of cervicogenic headaches are much less common than osteoarthritis (spondylosis), but pain caused by inflammatory diseases of the neck joints is more intense and prolonged.
Serious illnesses
Many serious diseases or conditions can lead to chronic headaches and are often accompanied by neck pain. These are diseases such as brain tumors, brain abscesses localized in the occipital region, tumors of the cervical spine, Paget's disease. Acute pain in the head and neck can be caused by infectious diseases such as meningitis. In addition, acute pain in the neck and head can be caused by spinal fractures due to injuries, sports, or road accidents. As a rule, the pain syndrome is acute and is preceded by an episode of trauma. A fracture may cause pain in the neck and head, as well as symptoms such as impaired movement in the limbs and sensory disturbances. Therefore, when diagnosing pain in the neck and head, it is necessary to take into account the possible genesis of the pain syndrome in the neck and head, which requires emergency medical care.
Symptoms
Cervicocranialgia, as a rule, has a certain connection with damage to structures of the upper cervical level.
The following characteristic symptoms of cervicocranialgia can be distinguished:
- the pain is strictly one-sided;
- pain begins from the suboccipital region, from where it spreads to the temple, forehead and eye on the same side;
- pain may be accompanied by nausea, vomiting, sensitivity to light and sound;
- sometimes there is lacrimation on the affected side, redness of the sclera and conjunctiva;
- the pain is monotonous, aching, very rarely there is a pulsating nature of the pain;
- pain intensity ranges from moderate to severe;
- pain intensifies with neck movement or prolonged unphysiological position;
- there may be referred pain in the arm on the affected side, not associated with damage to the spinal nerve root;
- limited mobility of the cervical spine;
- the pain can last from several hours to several days or even weeks.
- Depending on the structures of the central nervous system involved, symptoms such as dizziness, staggering when walking, difficulty swallowing, weakness in the limbs, blurred vision, and spots before the eyes may occur.
The main manifestation of cervicocranialgia, which distinguishes it from other forms of headache, is limited mobility in the cervical spine, a feeling of stiffness that can extend to the thoracic spine. This symptom often appears after a prolonged position in an uncomfortable position, sudden movements in the neck and is accompanied by characteristic pain.
Treatment process
Treatment of cranialgia is complex, aimed at eliminating the causative factor and the main clinical manifestations. It is usually carried out at home: patients themselves take medications prescribed by a doctor. When attacks of cranialgia occur frequently, become prolonged and intense, patients are hospitalized in the neurological department of the hospital.
Medicines
Medicinal effects involve the use of pharmacological drugs of various groups. The choice of treatment regimen is determined by the cause of the pathology. Cranialgia of unknown origin is treated according to a standard regimen, including the following medications:
- Painkillers - analgesics "Pentalgin", "Ketorol", "Nimesulide";
- Drugs that relieve muscle tension and spasms - muscle relaxants “Sirdalud”, “Mydocalm”;
- Vascular agents that improve cerebral circulation - Vinpocetine, Cinnarizine;
- Neuroprotective and nootropic drugs - Actovegin, Mexidol, Piracetam;
- Multivitamin complexes containing B12, B1 and B6 - “Neuromultivit”, “Kombilipen”;
- Psychotropic drugs - Diazepam, Duloxetine, Venlafaxine;
- Chondroprotectors – “Alflutop”, “Chondroitin”;
- If necessary, broad-spectrum antibiotics - Ampiox, Ceftriaxone;
- NSAIDs - Indomethacin, Ibuprofen, Diclofenac.
For intense shooting pain in the neck and shoulders, use local anesthetic and anti-inflammatory ointments, creams, gels - “Dolgit”, “Nurofen”, “Capsicam”.
When it is not possible to achieve a lasting therapeutic effect and pain relief with the help of tablets and intramuscular injections, they move on to paravertebral blockades. The medicine is injected directly into the lesion. This prevents the further occurrence of pain.
Non-drug treatment
Physiotherapy is of great importance in the treatment of cranialgia. Specialists individually select a set of physiotherapeutic procedures for each patient, which are carried out between attacks. They are usually prescribed after pain and other signs of acute inflammation are relieved for a speedy recovery and restoration of the body.
The choice of physiotherapy method depends on the cause of cranialgia. The most effective are:
- Paraffin applications,
- Mud wraps,
- Warming compresses,
- Electrophoresis and iontophoresis,
- Laser therapy,
- Ultrasound,
- UHF therapy,
- Magnetotherapy,
- Galvanic currents,
- Acupressure,
- Acupuncture,
- Inhalations with aromatic oils,
- Exercise therapy.
There are quite effective folk remedies that reduce or completely eliminate head pain. They can only be used with the permission of the attending physician. The most popular among them:
- Inhalation of clove and eucalyptus essential oils;
- Warming pepper lotions;
- Rubbing.
The patient should be in a comfortable home environment - in a calm environment and a clean, ventilated room. It is necessary to exclude external irritating factors - light and sound, do a light self-massage of the back of the head and temples, and inhale aromatic oils that help to completely relax.
Special gymnastics according to Bubnovsky has a good therapeutic effect. This doctor has developed a number of exercises with which you can cure osteochondrosis and other diseases of the spine, bypassing medications and surgeries. A sports machine allows you to normalize blood flow in the spasming muscles of the spine, strengthen the muscle corset and increase muscle tone. Relaxing poses and movements are safe for the spine. They do not create stress on the cervical spine. These exercises can only be performed with the consent of the attending physician.
Manual therapy is also used in the treatment of vertebrogenic cranialgia; it gives good results, but requires special caution. This technique is contraindicated for people with arterial hypertension. To relieve pain, an orthopedic collar is also used - a cervical support that supports it in the correct position. Spa treatment has a positive effect.
The acute form of the pathology, and especially its early stages, responds well to treatment. When the process becomes chronic, long-term therapeutic effects are required. That is why it is necessary to consult a neurologist when the first symptoms of pathology appear. If the disease is ignored, cranialgia can result in the patient's disability.
Diagnostics
Headaches associated with the neck must have at least one of the following characteristics:
- The source of pain in the neck has been clinically confirmed, from where the pain spreads to the temple, forehead and orbit strictly on one side;
- Headache should be preceded by movement in the neck, prolonged uncomfortable position of the head, pressure on the upper half of the neck or base of the skull on the side of the headache;
- Limited range of motion in the neck;
- Pain in the neck, shoulder or arm is not radicular;
- The headache should completely disappear no more than 3 months from the start of treatment;
- Often there is a history of neck trauma (whiplash, cervical spine contusion, sprain, facet joint subluxation).
Diagnosis of cervicocranialgia, like any other headache, involves, first of all, excluding serious causes of headache, such as brain tumors, meningitis or spinal injuries. In most cases, the doctor, based on the medical history, examination of symptoms and physical examination, can make a diagnosis or determine the necessary additional scope of examination.
Due to the presence of autonomic symptoms: swelling around the eyes, redness of the sclera and conjunctiva, severe lacrimation, sensitivity to light and sound on the pain side, differential diagnosis with migraine is most often necessary.
Exercise therapy recommendations
As a preventative measure, you should engage in physical therapy aimed at strengthening the muscular corset of the cervical spine. The massage technique for vertebrogenic cervicocranialgia should include a long preparatory process (stroking and rubbing), while kneading is almost not carried out. It is better and more effective to use acupressure and other manual techniques on the scalp area - after all, relaxation of the tendon helmet can provide quick and pronounced relief.
Important! The persistence of headaches after complex treatment of vertebrogenic cervicocranialgia and relief of muscle tension in the collar zone and pain in the cervical spine should be a reason to begin a diagnostic search for another cause of the cephalgic syndrome.
Treatment of cervicocranialgia
In recommendations for the treatment of cervicogenic headaches, the first line is manual therapy in combination with other non-drug treatment methods: acupuncture, exercise therapy, and physiotherapy. Good treatment results using gentle manual therapy methods can be achieved in cases of cervicocranialgia against the background of cervical osteochondrosis.
The Shants orthopedic collar will help get rid of pain and relieve tension in the neck; wearing it is recommended when working at a computer for a long time, driving a car, etc. By maintaining the neck in the correct position, the neck muscles are unloaded and relaxed, which leads to a gradual fading of the pain syndrome.
It is possible to take a short course of drugs from the group of non-steroidal anti-inflammatory drugs, muscle relaxants and B vitamins.
In extreme cases, in the absence of positive dynamics from conservative therapy, surgical intervention may be required.
Depending on the stage of the disease, we choose one or more treatment methods:
Therapeutic massage, osteopathy, manual therapy
Helps bones and joints take the correct physiological position, relieves pain and spasms, relaxes muscles.
Acupuncture
Work on biologically active points. It affects the affected area and the body as a whole. Eliminates the cause of the disease and removes the symptoms.
In addition, according to indications, the following are used: taping, pharmacopuncture, FormTotix insoles, exercise therapy with an instructor and other methods. The choice of procedures depends on the current condition; taken together, they act faster and give a more lasting result.
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