Sometimes headaches are due to pain in the neck and shoulders. We call this kind of headache a cervicogenic headache.   These kinds of headaches can present themselves as the only kind of headache problem that you have, or often are superimposed on another headache, like migraine.  Neck pain can worsen your migraines, and migraines can worsen your neck pain, and if untreated, this can become a vicious cycle that spirals out of control.  

Neck Pain

Neck pain itself is very common, and is typically separated into two categories: neck pain that comes from the spinal cord and nerve roots, and musculoskeletal pain.  A thorough examination by your doctor will look at your reflexes, sensation and strength which can help determine if there are any underlying spinal cord issues.  Even on a virtual exam, many of the maneuvers you get asked to perform can help your doctor determine if an in-person exam or imaging is necessary.  This will make sure that if there are any herniations of the discs in your neck they are only mild, and that there is no compromise of your spinal cord.  In rare, severe cases, you may need to see a neurosurgeon to relieve severe compression.  

Musculoskeletal pain is more associated with a decreased range of motion of the neck, and “trigger points” - areas of tenderness around the neck, shoulders and base of the skull.  If your doctor is concerned they may still recommend imaging to help look at the cervical spinal cord and its nerve roots.  

An Ounce of Prevention

Regardless of the nature of the neck pain, your doctor will likely recommend physical therapy as a non-medical, and low risk treatment.  Physical therapy can help stretch affected areas that have chronic muscle spasm, and strengthen compensatory areas.  It can also help posture, which can be a major contributing factor. 

Injections 

One therapy that may also be recommended for musculoskeletal pain is a trigger point injection.  This is a set of injections, typically done with a mixture of lidocaine solutions, into the individual trigger points of the neck and shoulders.  There is typically an immediate benefit and it can definitely help if you are in acute pain.  If a long-acting lidocaine solution is included in the mixture, such as bupivacaine, the benefit can last for weeks. 

 If you do have moderate disc herniations that are compressing some nerve roots, your doctor may refer you to a pain specialist who can perform a medial branch block.  This is an injection around the nerve root compression, to help decrease the pain, and inflammation.  Another injection that pain specialists perform is an epidural steroid injection - to relieve pain and inflammation in the spine. 

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Medications

If you have an underlying headache on top of the cervicogenic pain, your doctor might also recommend treating the underlying headache disorder.  This may include preventive  medications or even Botox for migraine or chronic migraine, or medications that can help tension type headache if you are not experiencing migraine symptoms. Antiinflammatories and muscle relaxants can help cervicogenic headaches acutely as well.