Where does the pain come from?
Sensory fibers from the first three cervical segments converge in the brain stem with fibers of the trigeminal nerve, which is responsible for sensitivity of the face and head. The brain cannot always accurately determine the source of the signal and “projects” pain from the neck to the head. These structures can be irritated by arthrosis of the intervertebral joints, prolonged muscle tension, the consequences of a whiplash injury, and sometimes by habitual uncomfortable posture. At the same time, degenerative changes in the photographs are often present in people without any pain, so the diagnosis is not made only by X-rays.
- Arthrosis of the joints of the upper cervical vertebrae
- Chronic tension in the neck and shoulder muscles
- Consequences of whiplash
- Long static pose at the computer and phone
- Unsuitable pillow and sleeping in an awkward position
- Irritation of the occipital nerves
How to distinguish between migraines and tension headaches
Cervicogenic pain is almost always one-sided and does not change side from attack to attack. It starts in the neck or back of the head and spreads to the forehead and eye, not the other way around. The attack is provoked by movement of the head or prolonged posture, and pressure on certain points of the neck reproduces the usual pain. Neck mobility is usually limited. With migraine, the pulsating nature, nausea and intolerance to light and sound come to the fore, and it is provoked by sleep, hormonal fluctuations and food, and not by posture.
- Unilateral pain, side does not change
- Spread from the back of the head to the forehead and eye
- Provocation by movement or posture
- Limiting head turns and tilts
- Pain in the muscles and joints of the neck upon palpation
- Nausea and photophobia are less pronounced than with migraine
Related complaints
In addition to headaches, many are bothered by heaviness and crunching in the neck, aching pain in the shoulder girdle and between the shoulder blades, and a feeling of “sand” when turning the head. Non-systemic dizziness, tinnitus, blurred vision on the side of pain and nausea are possible, but these symptoms are nonspecific. Often accompanied by sleep disturbances and irritability, which themselves increase muscle tension and complete the circle. Numbness and weakness in the hand require a separate assessment: they already indicate damage to the root.
- Stiffness and crunching in the neck
- Pain in the shoulder and between the shoulder blades
- Unsystematic dizziness
- Tinnitus, blurred vision
- Sleep disturbance, increased fatigue
- Numbness in the hand is a reason for additional examination
Survey
The basis of the diagnosis is an examination by a neurologist: assessment of neck mobility, tests for pain reproduction, muscle condition and neurological status. X-rays of the cervical spine, including functional tests, help to see instability and changes in the joints. MRI is not prescribed for everyone: it is needed if there is suspected damage to the root, spinal cord, injury, persistent pain or alarming signs. Sometimes the diagnosis is confirmed by a diagnostic block: if after precise administration of the drug the pain goes away, the source in the neck is confirmed.
- Neurological examination with manual testing of the neck
- X-ray of the cervical spine in two projections
- Functional tests to detect instability
- MRI of the cervical spine for warning signs
- Diagnostic blockade according to the doctor's decision
- Headache Diary
Treatment and prevention
The most effective method is regular exercises to strengthen the deep stabilizer muscles of the neck and gently restore mobility; the program is selected by a rehabilitation specialist, and you need to study for months, and not in ten-day courses. Manual therapy and massage help as an adjunct, but manipulation of the neck is performed only by a trained doctor after eliminating contraindications. Painkillers are used in short courses as prescribed by a doctor; long-term use alone can maintain a headache. For persistent pain, blockades are discussed. The organization of the workplace and sleep plays a huge role.
- Daily exercises for the muscles of the neck and upper back
- Breaks every 40–45 minutes when working sedentarily
- Screen at eye level, phone not at knee level
- Medium height orthopedic pillow
- Short courses of painkillers only as prescribed by a doctor
- Paravertebral blockades for persistent pain
- Dealing with stress and normalizing sleep