Information on chronic pain and addicton

Christopher Frandrup, M.D., DABPM, FIPP

Month: February 2018

What Are Cervicogenic Headaches?

What Are Cervicogenic Headaches?

What Are Cervicogenic Headaches?

Cervicogenic headaches are a frequently underdiagnosed headache that can cause pain not only in the head but also in the sides of the face. While many people are familiar with tension headaches, cluster headaches, and migraines, cervicogenic headaches are in a category of their own that is less well-known.

What are cervicogenic headaches?

There are two categories of headaches – primary and secondary. In a primary headache, the head pain originates in the head itself. Secondary headaches arise due to conditions in other areas of the body. Cervicogenic headaches are headaches caused by pain originating in the cervical area of the spine. This means that cervicogenic headaches primarily involve the occipital nerve, located at the base of the skull. The trigeminal nerve that enervates the facial muscles may also be involved in this type of headache.

Most cervicogenic headaches are very different from other types of headache in pain quality and location. While other headaches may have pain in the front and sides of the skull, cervicogenic headaches have pain that is felt in the base of the skull and radiates up from the occiput. This pain does not increase when bending forward and does not present with an aura (as with some migraines).

Migraine medicine is generally not helpful for this type of headache. Cervicogenic headache sufferers also rarely experience nausea as a side effect. Diagnosis of these headaches is usually by process of elimination, but if treatment of neck pain helps relieve the headache, it may be a cervicogenic headache.

The incidence of cervicogenic headaches is estimated at anywhere from two to 22%. These types of headaches may be misdiagnosed as tension headaches. When this occurs, symptoms may be successfully treated, but the underlying causes remain, which means the headaches will reoccur.

Causes of cervicogenic headaches

The causes of cervicogenic headaches are various. Acute causes can include accident or injury (with automobile accidents being a common cause). Other more chronic causes can include:

  • Poor posture: Chronic compression of or pressure on the cervical spine can cause pain in the occipital nerve.
  • Weak neck muscles: Muscles that cannot properly support the head or maintain the stability of the neck during movement may lead to cervicogenic headaches.
  • Disc damage: Arthritis, age, or injury can damage the cervical vertebrae. Improper healing or bone growth can put pressure on the nerves in the neck and cause pain.

Cervicogenic headaches – who’s at risk?

There are many risk factors for cervicogenic headaches, some of which are preventable.

  • Smoking: Smoking increases the pace of disc degeneration and can cause pain in the entire musculoskeletal system, including the cervical spine.
  • Age: Older people are at risk due to natural wear and tear.
  • Occupation: Those who work at jobs where long periods of sitting occur are at risk, as are those with high-impact occupations where injury is common (e.g. professional sports, some types of construction, commercial fishing, etc.).
  • Poor sleep: Poor quality of sleep due to poor sleep posture is a risk factor for this type of headache.
  • Lack of exercise: Weak neck muscles and poor physical condition in general contribute to the development of neck pain of all types, including pain that leads to cervicogenic headache.

Other risk factors may include gender, as women are more likely to suffer from fracture of the vertebrae due to brittle bones, and poor nutrition.

Treatments for cervicogenic headaches

Treatment of cervicogenic headache is dependent on the cause of the headache. To treat pain initially, your doctor may recommend over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs). Prescription anti-inflammatories may be utilized to relieve pressure on the affected nerves.

If the pain is caused by damage to the vertebrae, your doctor may recommend a nerve block or a facet joint injection to anesthetize the nerve causing the pain. For bulging or herniated discs, the doctor may recommend removing the excess tissue that is applying pressure to the nerve.

For pain related to muscles in the neck putting pressure on the nerve, muscle relaxants are an option. This is a short-term option that should be followed by other muscle strengthening and alignment exercises to help support the head and keep the spine healthy.

Complementary therapies for cervicogenic headaches include biofeedback, massage therapy, acupressure, acupuncture, and chiropractic care. Your pain management specialist may recommend one or more of these techniques to relieve pain and pressure on the nerves.

Cervicogenic headaches – prevention

The best way to prevent cervicogenic headaches is to keep the muscles and bones of the neck healthy. Bone health begins with a healthy diet filled with calcium-rich foods. Muscular support for the neck and head is imperative. To that end, there are a number of lifestyle adjustments you can make.

  • Stretch: If you spend your day working at a computer, take some time off to stretch your neck, rolling it around slowly and bending forward and back.
  • Strengthen: Full body exercise daily, with a focus on the muscles of the upper back, can help build strong neck muscles.
  • Relax: We hold tension in the trapezius muscles of our upper back, which can lead to strain and pain in the muscles of our neck. Getting a massage to this area can help those large muscles release tension.
  • Sleep well: Choose a non-feather pillow that is relatively firm to keep your neck properly aligned and supported as you sleep.

Is Pain Hereditary?

Is Pain Hereditary? |

Is Pain Hereditary?

Chronic pain is a complex medical condition with no easy answers. While acute pain can often be traced to one particular injury or illness, why acute pain turns into chronic pain long after the accident occurs remains a mystery. This mystery is the focus of a new study that attempted to answer the question: is pain hereditary?

Is pain hereditary?

A report in the journal PAIN®, the official publication of the International Association for the Study of Pain (IASP) published by Wolters Kluwer, looked at this question in-depth. Researchers visited with families to investigate the role genetics might play in chronic pain. Amanda L. Stone of Vanderbilt University and Anna C. Wilson of Oregon Health & Science University developed a framework of chronic pain transmission, writing:

“Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family-centered and include at-risk children.”

To be clear, this report does not indicate a clear genetic marker for pain. The report looks at not only genetic evidence but also environmental factors. This framework includes five specific ways in which chronic pain risk might be passed from parent to child.

Is pain hereditary?

Researchers believe that nearly half of the risk of chronic pain can be genetically linked.

Is pain biological?

The report found that neurobiological development in children could be affected by a parent’s chronic pain, especially in early, formative years.

Is pain social?

Children with a parent in chronic pain may be more prone to “maladaptive” behaviors such as negative thinking and catastrophizing (exaggerated response to or worries about pain).

Is pain practical?

How parents in pain interact with their children seems to play a role in chronic pain transmission. Parents in pain may not be as active or display as much warmth towards their children. They may also be more permissive or inconsistent in their rules and parenting due to pain level fluctuations.

Is pain environmental?

Simply living in an environment where pain is a daily event can be stressful. Add in the high cost of chronic pain and a parent’s inability to contribute to the household. Children may be affected by this stress for years, well into adulthood.

Researchers Stone and Wilson created this framework to help understand the complex ways in which chronic pain is passed down from parent to child. Their work does not quite answer the question “Is pain hereditary?” They looked to see more if pain was prevalent across generations in families and to figure out what factors influenced that.

Genetics and disc degeneration study

Other studies have specifically looked for a genetic link in pain across generations. A study out of King’s College London found a specific gene that is connected to degeneration of discs in the lower back. This degeneration is connected to an increased risk of age-related lower back pain.

Dr. Frances Williams, senior lecturer from the department of twin research and genetic epidemiology at King’s College London, summed up the genetic link, noting:

“We have performed, using data collected from around the world, the biggest genome-wide association analysis of lumbar disc degeneration (LDD). We know that people whose discs wear out are at increased risk of episodes of lower back pain, but normal human discs are hard to get hold of to study so until now our knowledge of normal human biology was incomplete. We have identified a gene called PARK2 as associated with LDD. We have shown that the gene may be switched off in people with the condition.”

Research on pain perception in families

Other research into the hereditary link to pain found that genetics may play a role in the perception of pain itself. Tobore Onojjighofia, MD, MPH, with Proove Biosciences and a member of the American Academy of Neurology, looked at over 2,700 people with chronic pain. All of these patients were taking opioids for pain.

He asked participants to rate their pain as follows on a scale from one to ten:

  • Low: One, two, or three
  • Moderate: Four, five, or six
  • High: Seven, eight, nine, or ten

Patients who rated their pain as zero were not included in the findings.

Of the study participants, 9% had low pain perception, 46% had moderate pain perception, and 45% had high pain perception.

Researchers compared the ratings to the presence of certain genes.  They looked for variations in the DRD1, COMT, OPRK, and DRD2 genes. Their findings indicated certain commonalities in gene variants, including:

  • Low pain perception: The DRD1 gene variant was 33% more prevalent in the low pain group compared to the high pain group
  • Moderate pain perception: COMT and OPRK variants were 25% and 19% more prevalent than in those with a high pain perception
  • High pain perception: DRD2 variant was 25% more common than in those with moderate pain

These results indicate that even if pain itself is not hereditary, pain perception may be. The findings of this study confirm earlier research done by King’s College London. This study showed that those with increased pain sensitivity had less variation in their genes than people who were less sensitive to pain.

What the research means for patients

Studying genetic links to pain can lead to more targeted and individualized treatments tailored to an individual’s DNA. Ruth McKernan, chief scientific officer of Pfizer’s research unit noted that research findings on genetic links to chronic pain can result in tremendous progress for effective pain medication, saying:

“This study demonstrates the value of collaborative efforts between academia and industry. The genetic influence on normal pain processing in human volunteer populations will add to other approaches and help us prioritise potential new mechanisms for treating pain.”

Has your family experienced intergenerational chronic pain? And what do you think: Is pain hereditary?

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