Neck pain & cervicogenic headache
A large share of the headaches treated as migraine in Karachi are referred from the upper cervical spine. They do not respond to analgesia because the analgesia is not aimed at the structure producing them.
Why the neck refers pain to the head
The sensory nerves from the upper three cervical segments converge in the brainstem with the trigeminal nerve, which supplies the face and head. The nervous system cannot always distinguish which of those inputs a signal came from, so a problem at C1-C3 is genuinely felt behind the eye or over the temple.
Cervicogenic headache is typically one-sided, always the same side, starts at the base of the skull and spreads forward, and is reproduced by pressing or moving the upper neck. Unlike migraine, it rarely comes with true aura or vomiting, and it responds to treating the neck.
Conditions in this group
Cervical spondylosis
Age-related degeneration of the cervical discs and facet joints, producing stiffness, a grating sensation on turning, and a dull ache that worsens through the working day. Very common from the forties onward and often visible on X-ray in people with no symptoms.
Cervical disc prolapse
Neck pain with radiation into the shoulder blade and down the arm, often with numbness in specific fingers and weakness of grip. C6-C7 is the most commonly affected level. Examination establishes whether a root is genuinely compressed.
Whiplash
Acceleration-deceleration injury, familiar to anyone rear-ended on Shahrah-e-Faisal. The problem is rarely the soft tissue alone: segmental joint restriction and disturbed proprioception in the deep neck muscles are what sustain the pain and dizziness for months after the collision.
Assessment
We assess segmental mobility level by level, test deep neck flexor endurance, almost universally poor in chronic neck pain, and screen for neurological involvement with reflexes, power, sensation and Spurling's test. 3D imaging quantifies loss of cervical lordosis, which is the single most common structural finding in desk-based patients.
Where headache is the main complaint, we take a careful headache history to separate cervicogenic from migraine, tension-type and medication-overuse headache, the last being common and self-perpetuating in patients who have been taking daily analgesia for years.
Treatment
Acoustic wave realignment addresses the loss of cervical curve and the deep muscular guarding that maintains it. Because the neck is a mobile, sensitive region, treatment intensity is titrated carefully, this is not manipulation, and there is no thrust or cracking involved.
Where facet joints are confirmed as the pain generator, medial branch blocks and, if those confirm the target, radiofrequency ablation can give durable relief for axial neck pain and associated headache.
The retraining component targets the deep cervical flexors and lower scapular stabilisers, proprioceptive re-education, and, the unglamorous but decisive part, the workstation and phone habits producing the load in the first place. A neck treated for eight weeks and returned to fourteen hours a day of the same posture will relapse.
Headaches that painkillers only dull for a few hours?
It is worth having the neck assessed properly before another year of analgesia.