Information on chronic pain and addicton

Christopher Frandrup, M.D., DABPM, FIPP

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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.

6 Moves for a Stronger Upper Back

Gym-goers are notorious for only working the muscles they can see in the mirror. That’s a strength-training cardinal sin because you miss out on arguably the most important quadrant of the body for strength and size: the upper back.

Building a big back isn’t easy, but it also isn’t complicated. You only have to do a few things:

  • Pick up heavy things off the floor
  • Pull heavy things toward your body
  • Pull yourself up off the floor

With those three types of movements in mind, here are the six best exercises to build an upper back worth showing off:

1. Deadlifts
No other exercise hits more muscle groups at once than the deadlift. The upper back plays a crucial role in stabilizing the weight during deadlifts, making them an essential choice if you want a big, strong upper back. Aim for 2–3 sets of 8–10 reps.

You can perform them with a barbell:

If you’re newer to the exercise, try them with a kettlebell and a sumo stance.

2. Barbell Bent-Over Rows
Using a barbell lets you add more weight, leading to greater strength and muscle gains. The bent-over row will also improve your deadlift strength because the mechanics of the two exercises are similar.

Here’s how to do a bent-over row with a barbell:

Perform 2–3 sets of 5–12 reps with moderate to heavy weight. Do these at the beginning of your workout because they challenge the entire body, and doing them in a fatigued state makes it difficult to keep good form.

3. Single-Arm Dumbbell Rows
The dumbbell row is one of the most versatile back exercises because you can use any weight you want for low reps, high reps or anywhere in between. Plus, it’s plenty safe for your lower back because you can support yourself on a bench with your opposite hand and leg.

Two to three sets of 8–12 reps per arm work best, but you can do as many as 20 reps per side for a deep burn. Do these after your heavier back exercises such as bent-over rows and deadlifts.

4. Standing Single-Arm Cable Rows
Cable rows add a level of versatility to your upper back training because you can alter the angle of your elbow and wrist as you pull, letting you hit your back muscles from different angles. The standing position also enforces core stability, as you have to use your abs to resist rounding or arching your lower back.

Stick with higher reps and lighter weight for these, opting for 2–3 sets of 8–15 reps per arm. If you don’t have access to a cable machine, wrapping a resistance band around a stationary object works too.

5. Pull-Ups
Pull-ups are one of the best back exercises in existence, but until you have a certain level of strength and can do 10 or more bodyweight pull-ups, your back muscles won’t get much stimulation from the move. So, to reap the benefits, you need to practice your pull-ups and increase the number of reps you can do.

Stick with the previously mentioned exercises first, and practice them 2–3 times per week with multiple sets of low reps (3–5 reps per set) with band-assisted pull-ups to build your technique. Once you’re proficient with the exercise, pull-ups can then be a valuable upper back builder.

6. Inverted Rows
The next-best body-weight alternative to pull-ups is the inverted row, which lets you use the resistance of your own body to strengthen your upper back. Simply grab a barbell set up in a power rack at about hip-height, and you’re good to go.

The key to effective inverted rows is keeping your body in a straight line from head to toe. Make sure to squeeze your abs and glutes so your hips don’t sag toward the floor. Do 2–3 sets of 8–20 reps, and get a tight squeeze in your shoulder blades at the top of each rep.

Back to Basics
Building a strong upper back is entirely possible with a few basic exercises. Pick the deadlift and row variations that work best for you, and you’ll be on your way to a bigger, better upper body.

Prescription drug use reduced in medical marijuana states

In the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and classes of other drugs fell sharply.  In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses, and 562 fewer doses of anti-anxiety medication – and 1,826 fewer doses of painkillers in a given year.

-The Washington Postdreamstime_s_39200918

FDA approves new implant for opioid dependence

The U.S. Food and Drug Administration today approved Probuphine, the first buprenorphine implant for the maintenance treatment of opioid dependence.  Probuphine is designed to provide a constant, low-level dose of buprenorphine for six months in patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program… (continue)

Poor sleep can worsen your mood and pain.

I have always promoted a good nights sleep for my patients to promote healing and pain relief.  Now there is an addition reason to avoid sleep deprivation.  It turns out a bad night can make you crabby.  Two recent studies in the Journal of Psychosomatic Research assessed a group of college students on emotional responses to positive and negative images.  The students were divided into two groups and were asked to completed a simulated work-shift.  One group had five hours sleep beforehand and the other group was kept awake for 24 hours.  Both groups showed diminished emotional response to positive imagery.  As the night wore on the response be even less.  Basically, they were less and less likely to be uplifted by positive images.   “The human brain is naturally more attentive to negative events,” says June J. Pilcher, study co-author and psychologist at Clemson University.  This gives us a tendency to over react to minor negative events, such as a traffic jam, especially when we are overly tired.

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