The Role of the Upper Neck in Chronic Pain and Fatigue

Posted in Nervous System Disorders Head Pain Disorders on Jul 26, 2018


Potential Causes of Chronic Pain

If you experience chronic pain, I am certain that you have already researched a number of potential reasons that your brain can get software into a pain-loop:

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  • The person who experiences chronic pain and does NOT feel depressed or anxious is the abnormal person! post-traumatic stress that effectively “fried” your circuits (… and now you need to learn how to bring them back online safely);

  • an unidentified inflammatory response within your body, which could be caused by a number of things (e.g., certain infectious agents or heavy metal toxicity);
  • an unknown imbalance in the function of your digestive system, which could be neurological, nutritional or “dysbiotic” in nature (which means there is an imbalance of the normal, healthy bacteria in your digestive tract); or
  • an imbalance of your autonomic nervous system: i.e., something is wrong with your hormones, immune cells, and/or you have a predilection towards sympathetic or parasympathetic dominance.

Any-and-all of these issues can cause serious systemic health problems that all of us in the healthcare world are still working to understand. What I am going to discuss is the part that the National Pain Survey did not mention: the role of the upper neck in chronic pain, and how upper cervical specific chiropractic care may be able to help.


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What is the connection between the upper neck and chronic pain?

 The C1 (Atlas, in blue) and C2 (Axis) support the weight of your head and are intimately involved with the normal function of your nervous system and pain. The upper two bones in your neck - the C1 (atlas) and C2 (axis) - are not constructed like any other vertebra in your spine.

They provide approximately 50% of the total movement between your head and your neck. The trade-off for this amount of flexibility is that injuries can dislodge their normal alignment. In itself, that is not the problem. The problem is that the C1 and C2 are physically tethered to your brainstem but extremely strong structures called myodural bridges and dentate ligaments.

These ligaments normally provide support so that when you move your head you don’t crush your spinal cord. They are also believed to be involved with the rhythmic circulation of cerebrospinal fluid (CSF), which bathes and protects your central nervous system.

However, if the C1 or C2 misalign, they may exert direct physical tension onto your brainstem, which can interfere with the normal transmission of neurological information. Moreover, the very misalignment of these joints can overload the nerve receptors in your neck, nociceptors included… and there are more of them in the upper part of your neck than anywhere else in your spine!

Like a tidal wave, if your neck transmits so much abnormal information that your reticular activating system (RAS) can’t cope with the volume, it may essential “short circuit” the filter. It doesn’t stop there. If a C1/C2 misalignment disrupts the normal flow of CSF, that fluid can congest within your skull and create a back-damming of pressure.

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Although your nervous system will adapt as best as it can, the accumulation of noxious substances within the CSF may cause inflammation of the brain itself and its supporting connective tissues (… hence one possibility why it's entirely possible to have normal blood inflammation levels).

 Swelling on the brain is pretty easy to see but isn't usually mentioned unless it is highly advanced as in the picture on the right side (note: do NOT try to compare your own MRIs to online pictures). In fact, chronic pain syndromes such as chronic fatigue syndrome and fibromyalgia have been renamed “Myalgic Encephalomyelitis (ME)” to describe this very process! (Note: “Myalgic” means “muscle pain” and “Encephalomyelitis” means “Upper Brain & Spinal Cord swelling/inflammation”) 

It's interesting that this inflammation is visible on a standard MRI. (1,2,3) Alas, it is not usually commented on until there is significant brain tissue destruction that is accompanied by serious neurological pathology such as dementia. Among the more common pain syndromes if this occurs are migraines (varying degrees) and nausea.

However, it is also remarkably common for people to say things such as, "It feels like there's a pressure behind my eyes," or, "It feels like my head is in a fog ... and its all grey and fuzzy," or, "I just can't focus, and my eyes get all blurry when I try to concentrate."

To minimise the damage, your brain innately works to shift the pressure from your central nervous system and into your skeletal system. The result is that your posture may start to skew, causing your muscles to work overtime. I've also written on this topic before that the common belief that you have a posture problem is usually not true: its that you have a nervous system problem.

Your brain will do whatever it takes to keep you alive, even if means shifting the structure of your entire body in order to keep itself level. But remember what I mentioned about the cerebellum and the buildup of lactic acid? If your muscles are working so much harder to maintain your head balance, that’s going to require a huge amount of energy.

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And if the balance is never properly restored, it only works to produce chronic fatigue and deep muscle pain that never fully goes away even after a massage. Characteristically, you will look in the mirror and see one shoulder elevated, or your neck leaning to one side.

These signs are common enough indications that something is wrong with the alignment of your atlas even if you are not experiencing any pain at all!

Now What?!

Now before you start to panic, I want to be sure to let you know that there is hope! I would not have strung you along with this far to say what you've unfortunately heard too often by now that "there isn't anything we can do." There may still be a LOT of things that you've never considered may be creating your pain symptoms

And what I will introduce and describe in the next article is the stranger interplay that exists between your upper neck and your jaw with significant research that shows promise for people suffering chronic pain.


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  1. Pomares FB, Funck T, Feier NA, et al. Histological Underpinnings of Grey Matter Changes in Fibromyalgia Investigated Using Multimodal Brain Imaging. J Neurosci. 2017 Feb 1;37(5):1090-1101. doi: 10.1523/JNEUROSCI.2619-16.2016. Epub 2016 Dec 16.
  2. Murga I, Guillen V, Lafuente JV. Cerebral magnetic resonance changes associated with fibromyalgia syndrome. Med Clin (Barc). 2017 Jun 7;148(11):511-516. doi: 10.1016/j.medcli.2017.01.034. Epub 2017 Apr 25.
  3. Diaz-Piedra C, Guzman MA, Buela-Casal G, Catena A. The impact of fibromyalgia symptoms on brain morphometry. Brain Imaging Behav. 2016 Dec;10(4):1184-1197.
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