Cervicogenic Headache in sleep

Hi, I have a question (a few...) about a problem I have been having with what appears to be cervicogenic headache.

About six or seven years ago I started suffering from headaches when I slept. I wake up with pain all over my head, but most noticeably above my eyes. I can at times hear the blood rushing, especially in some positions where my head is lowered. These headaches start to subside once I get up and start my day. After a few years I started to suffer from them the morning after I did exercise (running, swimming). I had unsuccessfully been treated for cluster headache and migraines but eventually I visited a physiotherapist who told me that this was most likely a headache that originates in my neck. My Sternocleidomastoids and Splenius Capitis are always tender and painful to touch, especially at the base of the skull, but do not feel tight or restrictive. I have received treatment from a physiotherapist and osteopath, and while both helped a little, neither have been able to really tackle the cause of the problem. I also tried pilates and found a few exercises that helped, one is called the diamond press. I have tried sleeping in different positions (I usually sleep on my front with my head turned to the side), but again this doesn’t seem to tackle the cause of the problem. I have mild scoliosis in my back which causes my chest cage to point slightly off-centre (to my right) this causes my left shoulder problems and I can often feel discomfort down the left side of my back next to my spine if I lean my head very far forward.

I would like to know - If these headaches are a result of stress in the Sternocleidomastoids and splenius capitis, what could be causing this stress? How can I stop these muscles from being painful? Why do the headaches only occur when I sleep? Might this problem be related to my scoliosis? What kind of exercise would help these problems? Who should I approach for further treatment?

Thanks for reading, I tried to keep it as brief as possible but didn’t want to miss anything out. It feels like I’ve hit a hundred brick walls trying to sort this problem out so any help or advice anyone can give me would be much appreciated.

- Philip

your best bet would be to start looking at your activities of daily living? what is your occupation?
if you are scoliotic, then your cervical spine will have to also adapt to below changes in the chain, you might have a forward head with regards your posture...
when the headache starts? what relieves it...

These muscles generally overwork when you have a forward neck posture and the deep flexors of your neck are weak, they take up the role of stabilizers, something they are not used to...so the begin to ache...

cervicogenic headaches, several theories to the cause, some say trapped nerves with muscle, others say within the upper cervical joints...

exploring your activities of daily living and occupation may give some insight into predisposing factors...its one thing to get treatment that helps temporarily, its another to maintain effect gained...

an understanding of your general posture is necessary, and if anything at all, working the deep flexors of your neck is necessary...

Ask yourself if you have the adequate support for your head and neck when you sleep...or what your sleeping position is like....

Do you get any aura (blinding flashing lights or colors) when this headache comes?

T

Hi, thanks very much for your reply.

I definitely do have a forward head with regards to posture and have had for years. I am a PhD student and spend all of my time at a computer or doing close work hunched over circuit boards. The only thing which triggers headaches is when I go to sleep, I have tried different positions and pillow heights and they help slightly but don't stop me getting the headaches. The only thing which seems to make them go away is to stand up and start my day - then they will start to fade.

I have never experienced any aura but when the headaches are really bad sometimes I can see my vision pulsing with my heartbeat.

Can you recommend any exercises to strengthen the deep flexors in the neck and help to alleviate a forward head carriage?

Philip

dear philip 101

checkout the physio video section of this site, there is a posted video for activating the deep neck flexors...consult with your local physio for how to progress these exercises

cheers

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

Dear SigMIk and Philip101

Lmao...stalking is such a strong word, far from it, on the contrary I am enjoying your comments as i find them logical and make sense. Philip101's headaches seem to have a vascular component to it, I only say this cos I saw a gentleman (elderly man) who also presented with something similar. He was presenting with two forms of headaches, one that occurred after a meal with an aura (which i put down to a migrane), the second that occurred when he bent his neck sometimes hitting him whilst he is walking, this headache was strong enough to cause temporary blindness and unstaediness (this I put down to a vascular reason probably due to his cervical spondylosis).

It is perhaps best to have an accepted definition of what a cervicogenic headache is, in lay mans terms headache that starts from the neck or Headaches that results from problems with the neck. Philip101, do you have neck pains?


I would relate headaches with disturbances to vision to a vascular element or a migraine only because cervicogenic headaches, while they can make around the eyes, they usually dont cause visual disturbances (unless degenerative like our man above) however they are related somewhat to certain cervical movements. This I have seen many times. Why it doesnt fit the pattern of a true cervicogenic headache is sleep is the main aggravator and rising up in the morning relieves it (with a cervicogenic headache it will still be there even when you wake up). Cervicogenic headaches often do not to cover the entire head (with the cases I have seen).

There might be some element of a cervicogenic pattern to it as you have rightly said predominantly because neck muscles will alway tense up, I find that in cervicogenic headaches the distribution of the nerves in question always seem tender (the mandibles, the eyebrows, scalp) especially when you roll the skin underneath your fingers. Is this the case with you Philip101? This not a full on diagnostic criteria, I only say this from what I have noticed clinically. If a headache were truly cervicogenic, interventions focus on the cervical spine to normalize the tension and improve range should make the difference, however it doesnt seem like this is the case for you (i dont know what treatments you've had from the osteopath or physio).

When we get up from lying to sitting or standing, our blood pressure usually goes up primarily as the heart takes command of the demand placed on it against gravity...it gives preference to our vital organs particularly the brain because its above...

In theory, these would be the advantages of carrying out deep flexor exercises...less strain on the abnormal recruitment of neck stabilizers...possibly a reduction in the cervicogenic component of your headache if it is the problem...
secondly better posture will indirectly mean better cervical spine movement, more room for blood flow to the brain

Like SigMik has suggested perhaps your blood pressure drops too low when you are in the recumbent position? Low blood pressure and headaches most likely would have other symptoms as well, dizziness as you rise up from sleep (likely), some nausea (likely)...

Exploring your day to day activities activities should be your own form of investigation...i would start of with what Im eating, when im eating, what Im eating before exercise or if i have eaten prior to exercise or not...


However, all headaches can present during sleep periods. Not having the right amount of sugar in the system before sleeping can cause night headaches, Also after exercising, if you become hypoglycemic, this can present as a headache (it is sensible to think that there would be an increase in bloodflow if you get hypoglycemic which might explain your feeling of blood rushing, however this does not explain why you get this feeling when your head is bent almost everytime, and your age does not support the possibility of a degenerative spine...cant say, dont have x-ray eyes as this might suggest a cervicogenic origin).

having a stressful day can present with night headaches, being a guy who occassionally has a pint or two with friends I always have night time headaches after this. One thing is definite, you headache is unlikely to be cervicogenic in its entirety if it is at all....

The advice to see a neurologist is a sensible one, Do you feel your headaches are getting worse?

Cheers

I've had an increased number of patients present to me with cervicogenic headaches in the past few years.

We've tried this pillow with a few patients and had decent results so far; Clevive Cervicogenic Headache Pillow

As other have said above, good sleep pressure is fundamental for reducing these headaches.

Hello. In fact, the pillow alone is not enough, although it can help in certain cases. I can recommend one more model, but a little later.