In terms of managing headaches, there are two general approaches:
- You can treat the symptoms by taking pain killers, anti-inflammatories, or getting injections into the neck
- You can address the underlying cause!
If you have tried the first approach but are ready to do something different - to find the underlying cause of your headaches - one of the most important areas you can look at is the joints in the upper neck, known as the upper cervical spine.
A new study has confirmed what neck and headache specialists have long believed about “cervicogenic headaches” i.e., headaches that are coming from mechanical problems in the neck.
It is that the source of the problem frequently involves the joints themselves. Not the discs between the vertebrae. Not the muscles, either too tight or too weak. Not even the nerves directly.
The source of the problem 67-75% of the time involves the joints between the vertebrae that guide and define their normal movements.
Although the researchers focused their treatment methods on local injections to block pain, they found that 42-62% of the time the issue was between the C2-C3 vertebrae. The other cervical joints including C1-C2 and C3-C4 were also found to be involved but to a lesser extent.
62% of Cervicogenic Headaches may come from the C2-C3 Joints
This study highlights the importance of addressing the joints in the neck for people suffering headaches, possibly even migraines when they are believed to be cervicogenic in nature.
Now, the method that was used in this study focused solely on pain relief without necessarily addressing the underlying question, “What is WRONG with the joints in the neck that they are causing headaches in the first place?”
One of the leading hypotheses is that of “joint entrapment.”
The joints in the neck are designed to move. They are protected by an outer ligament (capsule) and contain fluid and cartilaginous surfaces that allow the surfaces to move without rubbing directly against each other.
However, if these joints ever experience a physical injury that damages the cartilage or the ligament, the joint can fixate or “get stuck” in the wrong position.
Although the body will attempt to use its muscles to recapture the misalignment, if it is unable to resolve the issue, the misaligned or “entrapped” joint may in turn cause mechanical irritation to the surrounding soft tissues. And if this irritation is perceived by the nerve receptors in that area as physical damage, it can manifest as neck pain, headaches, or even migraines.
Here is where natural therapies such as massage therapy, physiotherapy, chiropractic, and osteopathy are often able to help people with cervicogenic headaches.
Although many times people are diagnosed with having “stress” or “tight muscles,” these therapies are usually effective in providing relief for people who suffer headaches.
What if I’m not getting any headache relief with my natural therapies?
As the study showed, there were still 25% of people diagnosed with cervicogenic headaches, who did not experience any relief at all.
Indeed, there are many people who have been to the chiropractor, physiotherapist, and massage therapist to help their headaches and have not experienced relief and they’d hoped to expect.
Why might that be?
We have three possible explanations:
- The way that the therapist was working wasn’t quite right. If there is a problem with the alignment of the joints in the neck, it is important to make sure that the therapy focuses on correcting the misalignment, and does not push it further into the abnormal position. That only causes the muscles to tighten back up, like pushing on a bruise.
And when it comes to C2-C3 specifically, in our own practice we find that approximately two-thirds of all misalignments that occur between the joints cause the vertebra to move forwards. This is often the exact opposite direction from how many manual therapies work on the neck by pushing things from back-to-front.
- The headache is coming from somewhere else. The joints of the jaw and skull itself can mimic the pain distributions of the upper neck, so it may be possible that the headache that doctors believe is cervicogenic is actually coming from somewhere else, the most likely area being the TMJ! If so, this may be where your neck specialist may need to refer you to a specialist dentist to help!
- The lower neck is compensating for something else. As we have said before, the joints in your neck are designed to move. Misalignment and irritation may be occurring because the C2-C3 joints are actually compensating for something else. Therefore, any injection is actually targeting the wrong spot, because as long as the underlying cause is still there, all the medication in the world will not be able to fix it.
While there may be many potential areas, in our experience, the most common location of misalignment in the neck that causes C2-C3 compensation specifically is between the base of your skull and the C1 or atlas vertebra in your neck.
And you may see that the researchers did NOT do injections at this site!
Part of the reason is that from an injection perspective, it is frequently considered a “no go” zone because of all the delicate blood vessels and nerves in that area.
Instead, this area falls in the area of expertise of what is known as an upper cervical specific chiropractor
What is different with an upper cervical chiropractor to help my headaches?
A Blair upper cervical chiropractor is a practitioner who has completed an additional post-doctoral study in the role of the upper neck and its impact on the health of your nerve system.
Unlike general forms of spinal manipulation, a Blair chiropractic doctor does not use any twisting or cracking the neck. Instead, they first perform a detailed physical and neurological assessment to identify first if your headaches are related to a mechanical problem in your neck. If so, they will refer you for specialised x-rays, which help to demonstrate the exact location, direction, and degree of misalignment in your neck.
These types of images are often what differentiate Blair upper cervical chiropractic doctors because they are customised based on your own bone structure. That is how we are able to identify different types of misalignment, which may explain why you have not been able to experience relief with other methods.
Based on your results, your chiropractic doctor will then discuss with you a plan and approach to help improve the alignment and movement in your neck with the expectation that this will help offer relief with your headaches.
Our practice, Atlas Health, located in North Lakes (north Brisbane) is dedicated to helping people with chronic health conditions, frequently including people who suffer headaches and have been to a whole army of medical and another healthcare practitioner with limited results. Our aim is to help people find long-term solutions so that they can enjoy the quality of life that they desire most.
Dr. Jeffrey Hannah is an advanced certified Blair upper cervical chiropractor with over 14 years of clinical experience. He is an international lecturer, published author, and recognised leader in the field of upper cervical specific chiropractic care.
We hope that this article has been informative and valuable. If you would like to find out if Blair upper cervical care may be right for you, we are pleased to offer a complementary 15-minute phone consultation with Dr. Hannah so that you can discuss your individual needs.
To reach our practice, click the Contact Us link on this page, or call us direct at 07 3188 9329.
Atlas Health Australia - “Hope, healing, and wellbeing from above-down, inside-out.”
Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-C2) joint. Cephalgia. 2002;22(1):15-22.
Braaf MM, Rosner S. Trauma of the cervical spine as a cause of chronic headache. J Trauma Acute Care Surg. May 1975;15(5):441-446).
Bragatto MM, Bevilaqua-Grossi D, Benatto MT, et al. Is the presence of neck pain associated with more severe clinical presentation in patients with migraine? A cross-sectional study. Cephalalgia. 2019 May 27:333102419854061. doi: 10.1177/0333102419854061. [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pubmed/31132869
Gaul C, Meßlinger K, Holle-Lee D, Neeb L. [Pathophysiology of Headaches]. [Article in German]. Dtsch Med Wochenschr. 2017 Mar;142(6):402-408. doi: 10.1055/s-0042-111694. Epub 2017 Mar 22. https://www.ncbi.nlm.nih.gov/pubmed/28329901
González-Rueda V, Hidalgo-García C, Rodríguez-Sanz J, Bueno-Gracia E, Pérez-Bellmunt A, Rodríguez-Rubio PR, López-de-Celis C. Does Upper Cervical Manual Therapy Provide Additional Benefit in Disability and Mobility over a Physiotherapy Primary Care Program for Chronic Cervicalgia? A Randomized Controlled Trial. Int J Environ Res Public Health. 2020 Nov 11;17(22):8334. doi: 10.3390/ijerph17228334. PMID: 33187167; PMCID: PMC7697824. https://pubmed.ncbi.nlm.nih.gov/33187167/
Govind J, Bogduk N. Sources of Cervicogenic Headache Among the Upper Cervical Synovial Joints. Pain Med. 2021 Jan 23:pnaa469. doi: 10.1093/pm/pnaa469. Epub ahead of print. PMID: 33484154. https://pubmed.ncbi.nlm.nih.gov/33484154/
Mingels S, Dankaerts W, Granitzer M. Is There Support for the Paradigm 'Spinal Posture as a Trigger for Episodic Headache'? A Comprehensive Review. Curr Pain Headache Rep. 2019 Mar 4;23(3):17. doi: 10.1007/s11916-019-0756-2. https://www.ncbi.nlm.nih.gov/pubmed/30830498
Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357:j1805. doi: 10.1136/bmj.j1805. https://www.ncbi.nlm.nih.gov/pubmed/28512119
Whittingham W, Ellis WB, Molyneux TP. The effect of manipulation (toggle recoil technique) for headaches with upper cervical joint dysfunction: a pilot study. J Manipulative Physiol Ther. 1994;17(6):369-75.
Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016 Dec;16(12):1598-1630. doi: 10.1016/j.spinee.2015.08.024. Epub 2015 Dec 17. https://www.ncbi.nlm.nih.gov/pubmed/26707074