The Mayo Clinic defines chronic headaches as headaches that occur 15 days or more a month, for at least three months. Chronic headaches are also classified by how long they last: more than four hours or less than four hours. Most chronic headaches last longer than four hours at a time. Chronic headaches with neck pain are less common than chronic migraines and usually involve an injury or disease condition within the neck.
Chronic Cervicogenic Headaches
The neck consists of seven vertebrae, the top three of which are most vulnerable to injury and wear and tear, according to Dr. Meridel Gatterman. The top three cervical vertebrae are also the most likely to refer pain to the back of the head and create a secondary type of headache, called a "cervicogenic headache." In a 2004 "Journal of Manipulative Physiological Therapy" article, Dr. Michele Moore defines cervicogenic headache as primarily occipital and/or sub-occipital head pain that originates and is referred from some joint, ligament, muscle, dura matter, intervertebral disc and/or nerve in the upper neck. There is usually associated pain in the upper neck as well, which is frequently described as dull, although the pain can become stabbing with head movement. The causes of chronic cervicogenic headaches are discussed below.
Arthritis of the Neck
The most common cause of chronic neck pain leading to headaches is osteoarthritis, which is the "wear and tear" type of arthritis. Anywhere in the neck is susceptible to osteoarthritis, although typically only the top three vertebrae refer pain to the head and create cervicogenic headaches. Osteoarthritis of the neck, also know as "spondylosis," involves deterioration of the spinal facet joints and intervertebral discs, which lead to the formation of bone spurs and bulging discs. Bone spurs, also called "ostephytes," and bulging discs can irritate cervical nerve roots. All of these degenerative processes can generate chronic, dull or sharp neck pain and refer pain to the back of the head. According to Merck, cervical spondylosis is the most common cause of spinal problems in Americans over the age of 55, and by age 60 most men and women show signs of it on x-ray. Trauma, often from a car accident, advancing age, poor posture and poor nutrition are all factors that increase the likelihood of osteoarthritis.
Rheumatoid arthritis and psoriatic arthritis, both types of inflammatory arthritis, can affect the upper neck and cause chronic cervicogenic headaches also, but they are much less common than osteoarthritis. Neck and head pain from inflammatory arthritic processes is typically throbbing and more severe.
Trauma to the Neck
Muscles, ligaments, tendons, joints, discs and nerves of the upper neck can all be injured and cause chronic neck pain, as well as head referral. Whiplash type events, either from falls, car accidents or athletic injuries, commonly cause facet joint impingements and slight misalignments within the neck that chiropractors and osteopaths call "subluxations." Poor posture, repetitive movements and stress also cause subluxations, which can lead to localized neck pain and chronic cervicogenic headaches.
Muscle Tension in the Neck
There are many muscles in the upper shoulders, neck and base of the head that can develop tension and inflammation and cause chronic neck and head pains. As cited on MedlinePlus, when neck and scalp muscles become tense and contract from stress, depression, a head injury and/or anxiety, tension headaches can occur. Tension headaches are the most common type of primary headache, and although a band-like constrictive pain around the head is most common, upper neck pain is not unusual. In addition to stress and anxiety, activities such as computer work, using a microscope, stomach sleeping and reading in bed can all trigger tension headaches.
Serious Diseases and Conditions
Although many serious diseases and conditions can cause chronic headaches, it is unusual for them to simultaneously also cause chronic neck pain. Brain tumors or abscesses in the occipital part of the head, bone cancer of the upper cervical vertebrae and Paget's disease of the skull could all produce and refer pain in both areas, but all are considered rare conditions.
References
- The Mayo Clinic: Chronic Headaches
- "Chiropractic Management of Spine Related Disorders"; Meridel Gatterman D.C.; 2001
- "Journal of Manipulative Physiological Therapy"; Upper Crossed Syndrome and Its Relationship; Michele Moore D.C.; April 2004
- Merck: Cervical Spondylosis
- MedlinePlus: Tension Headaches
