LOL - Damien, I am not stalking you or trying to interfere with any thread you post on... Since this is my third post, and you've been active on all of them, it just seems like we might have interest in the same cases...

Philip, I just wanted to add a few things. Cervicogenic headaches are a distinct entity, accepted and described with diagnostic criteria in the three major headache societies. The problem is that the three societies does not have the same criteria... They have some common criteria, the MAIN criteria is that it's a headache predominantly on one side only, and does not change sides. They also describe one more common criteria, and that is that cervicogenic headaches are of a PuLsATiNg character. Another criteria (although described a bit different within the societies), is that the headache is USUALLY precipitated by a neck movement/position. From the description of your headache, I would not even consider that you present with a cervicogenic headache. The sterno and splenius capitis are not a part of the diagnostic criteria, and would likely tense up in anyone suffering from chronic headache compared to non-headache persons.

A correct diagnosis occurs in about 50% of cases representing in headaches, and the remaining cases and the reason for the variety in diagnostic criteria between the societies, is that there is often a considerable overlap of symptoms, and many cases can also have elements of different types of headaches. E.g. a person suffering with migraine can also have tension headache. And most headaches will at some point or another, have an element of cervical (neck) involvement. See the problem?

As far as I can say, on a VERY general basis, my initial thoughts are that from the location of your headache, that it could resemble the typical location of a tension type headache. If you think the criteria for cervicogenic headache are vague, tension type headache is probably the most controversial in terms of pathogenesis, whilst there is quite good consensus on cervicogenic headache pathogenesis. The fact that it seems like sleeping is your main aggravating factor makes this less likely.

A thing that DO change when you go to sleep, is that your blood pressure drops. This fact combined with your vision sometimes pulsating with your heartbeats, that you sometimes hear the blood rushing when lowering your head, and after exercise (association to falling blood pressure) makes me think of a vascular element.

The pain/tenderness in your sterno COULD, if we play around with the thoughts a bit, be contributing to your problem, as the sterno would be stretched if you lie on your front with head rotated, potentially causing - i don't know what to call it - lets say a potential "situation" with your vascular structures (e.g. carotid or occipital artery). And the current pathogenesis of migraines is thought to be caused by sensitized neurovascular structures, i.e. the nerves in the blood vessels are somehow sensitized (we don't know why), soooo....... Well.

This is just me thinking out loud, the drop of blood pressure and relating this to sensitized vessels and so on are MY hypothesis alone, and as far as I know, not supported by any literature, so take it with a pinch of salt. But I'd say there's a strong vascular component to your headache from what I can extract from the information given so far.

The true experts on headaches are neurologists, and of the neurologists, you should probably see a neurologist with a special interest/additional expertise on headaches and maybe mention some of the thoughts we've discussed here. I also strongly support Damien's advice, to look into those deep neck flexor exercises, as there is some evidence to suggest that the deep neck flexors are dysfunctional in many people suffering with chronic headaches. The improvement seem to be unrelated to what kind of headache they suffer from, so I'd say it's definitively worth a try. Good luck!

Kind regards,
Sigurd Mikkelsen