Neck Pain and Headaches

We can all probably relate to experiencing a nagging headache. While there are two traditional types of headaches: tension headaches and migraines, it’s now believed that certain headaches are due to damaged areas in the cervical spine and neck. A large number of headaches are found to have their beginnings in the neck and are known as cervicogenic headaches.

What causes neck pain and headaches?

It is common to feel cervicogenic headaches in the neck before they radiate toward the head. Sometimes, the pain reaches the temples, the front of the head, and behind the eyes. Such debilitating headaches stem from issues or injuries in the upper neck (cervical spine).

But how can neck pain cause headaches? Experts believe that it is because nerve fibers in the upper neck meet with nerve fibers branching from the trigeminal nerve (the largest nerve in the brain), meaning that the brain can’t accurately interpret the location of the pain. Let’s explore this. 

The spine (of which the neck is a part), consists of many individual bones stacked on top of each other. This creates a vertical, hollow canal through which the spinal cord runs. The all-important spinal cord is an extension of the brain and has many nerve roots branching from it.

The neck is an incredible anatomical structure consisting of bones, nerves, muscles, ligaments, and tendons, including seven vertebrae (C1, C2, C3, C4, C5, C6, C7). These vertebrae begin at the base of the skull and extend down to the upper back. Located at C1, C2, and C3 are three nerve roots of the cervical spine, sharing a common pain nucleus with the trigeminal nerve. The pain nucleus directs pain signals to the brain.

As we know, the trigeminal nerve is the largest cranial nerve, and the main sensory nerve running through the brain. The trigeminal nerve transmits sensations from the face to the brain, as it has three divisions that branch off to the ophthalmic nerve (forehead and eye), maxillary nerve (cheek), and the mandibular nerve (jaw and lower face). What’s more, the trigeminal nerve activates the muscles we use to bite and chew.

Certain nerve fibres of the trigeminal nerve interact with sensory fibers branching from the upper nerve roots of the cervical spine. This meeting of the upper neck and trigeminal sensory pathways confuses the brain so that it can’t find the source of the pain. “The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathways allows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.” [1].

Referred Pain: Perceived in the head but with source in the neck

It is because of this confusion that a cervicogenic headache is also known as “referred pain”, a kind of pain that stems from a part of the body other than its true source. In this case, the pain is referred to the head from bones or soft tissue in the neck. 

Damage to the bones in the neck can lead to pinched trigeminal nerves in that area. Because the cervical nerve tracts and the trigeminal nerve are shared, the brain mistakes the pain signals and perceives the pain as being located in the head. The trigeminal nerve sends a “pain message” to the brain, but the brain cannot locate the pain source, ultimately perceiving the pain to be located in the head.

Cervicogenic headaches can be caused by damage to the structures in the neck such as the muscles, joints, ligaments, and top 3 bones. Some of the most common causes of neck and cervical spine damage include whiplash injuries, sports injuries, arthritis, herniated cervical disks, and falls. What’s more, neck damage can be triggered by simple things such as repeated poor sitting posture, certain neck movements, or twisting. The cause of neck damage can even be traced back to an old injury sustained in childhood, such as a fall in the playground. Simply put, any inflammation or irritation to the trigeminal nerve, no matter the cause, can lead to cervicogenic headaches. Such headaches are commonly misdiagnosed as migraines or tension headaches because the sufferer experiences the pain as located in the head instead of the neck.

Every year, many patients are misdiagnosed and, therefore, do not receive the correct treatment. An accurate diagnosis and correct treatment [2] can be life-changing in relieving chronic headaches and neck pain, greatly improving the patient’s quality of life.

  1. David M. Biondi Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies. The Journal of the American Osteopathic Association, April 2005, Vol. 105, 16S-22S. 
  2. Phil Page. Cervicogenic Headaches: An Evidence-Led Approach to Clinical Management. International Journal of Sports Physical Therapy. 2011.