Many patients seem surprised when I tell them that the source of their headache, or even migraine, may be caused by referred pain from a problem in the neck. Typically, patients seeking mainstream medical care for headaches are left to an anti-inflammatory such as Tylenol or Ibuprofen to take the edge off or possible invasive surgery to ablate or cut and destroy nerves carrying the pain signal. These treatments address the symptoms of the headache, many times with poor results. But without addressing the source of the head pain, the patient will be chasing the tail of symptoms in circles.
So, where is the pain of a headache coming from? There are 4 key players when it comes to this story: the brainstem, the thalamus, the sensory nerves of the face and head and the nerves coming from in between the first 3 bones in the neck. Let’s take a closer look at how these structures relay pain.
The brainstem is the largest bundle of nerves in the body and is the center for many autonomic processes such as breathing, heart rate and even posture. There is a part of the brainstem called the trigeminocervical nucleus, TCN for short, and its job is to relay any pain signal from the upper neck, head and throat up to the thalamus.
The nerves in the face, head and throat branch from a large cranial nerve called the trigeminal. Almost all pain sensation in this region of the body passes through the trigeminal nerve and then into the TCN.
The nerves coming from the back of the neck are responsible for detecting any pain stimulus. Once these nerves are triggered, they send the pain signal to the TCN. The first three nerves in the neck, called dorsal rami, are responsible for the majority of the pain signals sent to the TCN.
When a patient sustains a trauma to the delicate joints, ligaments or soft tissue of the upper neck, pain from inflammation or joint dysfunction is sent to the TCN. The TCN sends the signal to the thalamus for processing. Because the wiring for pain in the neck and head are so intimately connected, the thalamus can become excited in the same region by either true head pain or neck pain.
In other words, your brain becomes confused as to where the pain signal is coming from and it can mistake neck pain for head pain. This is called a Cervicogenic Headache and was proposed by Dr. Nikolai Bogduk in 1992. Bogduk has said after studying the head and neck relationship “… that a large portion of patients otherwise diagnosed as suffering from tension headache may, in fact, be suffering from cervicogenic headache” (1).
If your doctor has told you that you have tension headaches, there is a possibility they are actually Cervicogenic Headaches stemming from a problem in the neck.
What can be done about it? A specific NUCCA adjustment to the neck has the ability to align the joints in the neck and reduce pain signals sent to the brain. This is done without drugs or surgery. We see clinically that many headache patients are actually neck ache patients that quickly resolve when we align the neck back to normal.