Neck Pain & Headaches

Neck pain and headaches are uniquely debilitating because the pain occurs where you think and effects your mind.  It limits everyday tasks and causes frustration as you try to carry out a normal life.  Often, patients are exhausted and irritable at work and at home especially towards the end of the day.   Many resort to pain medication, but it  has harmful side effects and the effectiveness decreases with time.  And some receive injection to the neck which is very short lasting.  Instead of simply treating the pain, finding the underlying impairments will allow the body to repair and ultimately resolve neck pain and headaches.  This wholistic approach is not conventional due to the complexity of the interworking of the body.  We have been successfully treating people with these problems without medications or surgery.  Chronic neck pain and headaches are not normal part of life.  Take the first step to enjoying your life again by filling out the form below. 

Neck Pain and Headaches

Neck pain and headaches are becoming the most prevalent musculoskeletal pain in the world.  Studies show up to 80% of the population will experience neck pain, with higher prevalence for women and those who work in front of a computer.  Certain problems are minor and short-lived, others more disabling, persistent, and serious.  Almost everyone suffers from some form of neck discomfort on occasion.

The cervical spine (neck), consists of the seven vertebrae surrounding the spinal cord.  The skull sits on the top  vertebra (C-1 or atlas) and the lowest cervical vertebrae (C-7) is located at the base of the neck, just above the shoulder bales.  Between each vertebrae, lies a disc which separate them in the front.  On the back of the vertebrae, there are facet joints which allows for movement.  The disc also allows for spaces in between the vertebrae so that the cervical nerves can exit the spine at each level.  The cervical nerves supply sensation to the head and face, as well as sensation and muscular control to the arms. The entire series of bones is supported by numerous muscles and ligaments that connect from the neck to the shoulder, skull, and jaw. 

Due to the anatomy of the cervical spine, the neck moves in many directions and is flexible.  However, it is also susceptible to traumatic injuries such as whiplash during a car accident or a fall.  Daily activities such as unusual positions while sitting, driving and using the phone or computer cause repetitive micro-traumas as well.   Furthermore, increase in mobility also encourages earlier onset of arthritis due to overuse.

Causes and Symptoms of Neck Pain and Headaches

Muscular and Ligamentous Injury

Neck pain caused by soft tissues tends to produce symptoms localized to the muscles running up and down both sides of the neck and spread out towards the shoulders, but rarely shoots down to the arms.  Pain is usually worse when the head and neck is still and better with movement.  Pain tends to be persistent, often precipitated by injury or overuse.  The cause can be injuries to the muscles and ligaments or to the underlying bones and discs.  Once injury occurs, there tends to be a tightening of the muscles, perhaps as a reflex designed to hold the head and neck stable, creating a vicious cycle of increased muscle tone and discomfort from the chronic muscle spasm.

Headaches & Upper Cervical Spine

Headaches called Cervicogenic Headaches commonly accompany this form of cervical spine disorder.  The tight neck muscles pull at the skull and compress the upper cervical joints disc, ligaments, and other smaller muscles.  And any of these structures could be the source for a cervicogenic headache.  The chronic state of muscular tightness is often not recognized until it is sufficient enough to cause head pain.  The headaches can be more prominent and disabling compared to the neck pain which may be the root of the problem.  These headaches often begin at the skull base, radiate up over the scalp and produce a pressure-like sensation over the entire head and/or face.  The headaches can be quite frequent, even daily, and can range from mild to severe.  Sometimes these headaches mimic migraine headache symptoms. Initially, pain may begin intermittently, spread to one side of the head, and become almost continuous.  Pain may also radiate to one side of the shoulder.  Furthermore, pain can be exacerbated by neck movement or a particular neck position such as using a laptop.  

The upper Cervical Spine consists of the first two vertebrae which have a unique shape and function.  The upper vertebrae (C1/atlas) supports the skull.  This joint is responsible for 33% of bending the neck up and down.  Below the atlas is the Axis (C2) that allows turning of the head.  C1 and C2 joint are responsible for 60% of all cervical rotation.  Part of the nerves from C1-C3 connect to another part of the brain called the trigeminocervical nucleus, that sends messages to the face and head.  Because of this connection, neck trauma, whiplash, chronic muscle spasms can cause headaches and symptoms in the face and head.   

Tension Headaches and Temporomandibular Joint (TMJ)

Surprisingly to most, the jaw can cause neck pain, tension headaches and migraines.  Tension headaches are often associated with TMJ disorders, as it can be caused by over-active aggravated muscles from jaw clenching and teeth grinding.  Due to the swelling and inflammation in the TMJ, the pain travels to other muscle and ligament tissues in the jaw area.  As it spreads, muscles become tight and inflamed causing spasms in the neck, face and head.  Pain may radiate to the back or side of the head or down into the neck and vary in intensity.  Chewing, talking or any use of the jaw may increase neck pain and headaches.  Clicking, popping or grinding sounds may occur in the jaw.  And vertigo, dizziness, and ringing in the ears can also be evident in TMJ disorder.

Degenerative Disc Disease

Degeneration of the discs and arthritis of the spine occur with normal aging.  These conditions may be accelerated or precipitated by trauma or repetitive use.  Despite being diagnosed with degenerative disc disease and/or arthritis, many people are pain free.  Initially, pain is usually localized to the spine.  It gradually spreads to the muscles and can lead to headaches.  Since the underlying structures are the joints itself, it is important to treat the root of the problem, not just the muscular symptoms of neck pain and headaches.  

Most degenerative changes occur between the fourth cervical vertebrae and the seventh vertebrae.  Any structural change that narrows the hole where the nerves exit the spinal canal will produce nerve symptoms into the arms.  Often, individuals will notice arm pain spontaneously upon awakening one morning.  Symptoms are generally worse in the mornings and improve with motion.  With nerve irritation, head movement will cause pain, numbness, tingling, and/or weakness of arm, shoulder or shoulder blade.  The numbness and tingling usually radiates down the arm to the hand and fingers, and the weakness is quite subtle.  And the pain may be severe and sharp or dull and achy.

Examination and Tests of Neck Pain and Headaches

Subjective Examination

A comprehensive history is necessary to understand the characteristics of the symptoms, which will in turn help with determining the root of the problems.  Detailed questions will be asked.     

Neck Pain may be chronic or recent in onset.  It may be confined to the neck or radiate to the arms. It may be described as mild or severe and dull or sharp and better or worse with certain physical maneuvers. These characteristics will help localize the issue and point towards its origin. On occasion the distribution of pain will suffice to establish the correct diagnosis.

Headache frequently occurs with neck pain and may appear to be the bigger problem.  The headache is usually daily, in the back of the skull and radiates forwards over the temples.  It is generally mild and relieved with minor pain medications.  When chronic, it can be quite severe and mistaken for a migraine.

Numbness of the arm in a particular location provides clues as to which nerve is involved.

Weakness is usually less noticeable in function, unless it is tested in isolation and it is less noticeable in the arms compared to the legs.  Fatigue of certain motions may be more readily recognized.

Bowel, bladder, gait and balance difficulties are important clues to spinal cord injury.  

Physical Examination 

A thorough physical examination from head to toe is key to understand the cause of the neck pain and headaches.  These include:

• Motor function / strength of muscles in arms and legs are tested to determine the maximal power generated.  
• Sensory Function is tested to look for areas of numbness, tingling or burning.
• Reflex of the arms and legs is tested to provide insight to the connection of nerve, spinal cord and muscle.
• Gait Assessment is reviewed for balance and pattern of muscle activity. 
• Coordination of both arms and legs is reviewed for both dexterity and balance.
• Range of Motion of the spine, extremities, and nerves are tested to determine if nerve, spinal cord or pain emerges. 
• Intervertebral joint mobilization is performed while assessing the joint capsule mobility and identifying whether any nerve or somatic referred pain emerge.
• Pelvis, Lumbar and Thoracic spine examination is warranted as they influence the position of the cervical spine.

Treatment of Neck Pain and Headaches

Self Treatments

First steps to treat neck pain and headaches consist of rest, stretch, massage, correct movement, and ice or heat.  If symptoms continue to improve, medical intervention may not be necessary.  Sometimes, several weeks are necessary for resolution of neck pain.  

Helpful modifications include:

• Avoid poor neck position including looking down and forward head posture.  Sit up straight and keep the head centered over the chest while sitting and standing. 
• Avoid working with arms up over the head. 
• Avoid frequent twisting or turning of the neck.
• Avoid carrying a heavy bag over one shoulder or cradling the phone to one ear.
• Avoid sleeping on your stomach and try to sleep with fewer pillows.
• Perform postural exercises on this link.
• Minimize stress, as tension can be focused on the neck region and cause muscles to tighten leading to neck pain and headaches.  Long hours in front of the computer, lack of exercise, poor sleep and diet all perpetuate neck pain and headaches.

Medications

Anti-inflammatory agents, analgesics and muscle relaxants may work for most spine discomfort for a short period of time.  Some are available over the counter (ibuprofen, naproxen, aspirin and Tylenol).  At best, this approach is a temporary fix until the root of the problem is identified and corrected.  Side effects and hazards from long-term use of these medications are common.  

Tension headaches can be treated without medications.  While medication can help reduce headaches for a short period of time, the headaches usually return as the medications become less effective or higher doses are required.  Overuse of pain medication can cause rebound headaches.  And over time, headaches or migraines can become a chronic condition due to the changes that occur in the brain’s perception of consistent pain.  It’s important to know that medications for headaches and migraines only treat the symptoms. They do not treat the cause of the problem.

Functional Manual Physical Therapy

A physical therapist that specializes in the neck and headaches will be able to determine the root of neck pain and headaches.  The first visit should consist of a comprehensive examination of the whole body, not just the neck, followed by education of the diagnosis, plan, manual treatment and postural education.  The manual treatments will restore joint, muscle, tendon, and nerve mobility.  Implementing a neuromuscular exercise program and proper posture tends to be the best prevention for recurrent neck pain and headaches.  Active therapeutic exercises are designed specifically based on the result of the examination.  Generally for the neck, exercises are not so much for enhancing power in the neck muscles, but instead for promoting better neuromuscular stability and motion work best.  To support the head, the postural muscles will need to be balanced from the front and back of the spine.  Professional instructions and directed progression is key to recovering quickly without setbacks.  In most visits, a minimum of half of visits should consist of manual treatment and visits should not be consisted of repetitive exercises that can be performed independently at home.  

Alternative Medicine

Complementary Medicine may play a role particularly when stress is a causative factor.  As long as goals are achieved without harmful side effects, alternative medicine may help to decrease stress which in turn decreases neck pain and headaches.  Also supplements may benefit some individuals.  It is important to communicate with all clinicians regarding all of the past and current treatment. 

Invasive Treatments

Trigger point injections and epidural injections are useful for temporally pain relief, but do not generally create enough change in the underlying pathology to create permanent relief.

Facet blocks may be used when there is suspicion that degeneration has occurred in the joints connecting the vertebral bodies and is the source of discomfort.  Generally, it is first performed as a diagnostic procedure with lidocaine.  If successful, radiofrequency blocks can be performed which is more long lasting.  This is not a permanent solution, but can be quite helpful to a select group of patients.  And finally, if all conservative treatments fail, surgical intervention may be inevitable in certain cases.