When your headache is really a neck-ache

Imagine an electrical wire sparking in your brain, every few seconds, for 11 years.

That's how Bridie Downey describes the intense headaches that drove her to eight doctors, including the Mayo Clinic, in search of relief. It hurt to read, to watch television, just to sit and do nothing. She finally retired from her job with the Chicago Public Schools' food service.

"From the beginning, I had many doctors say it was stress from the job, that it was a nervous condition," she said. "But I knew it was more. I couldn't turn it off. Even when I was on vacation, in bed, even if I took sleeping pills, I had this thing in my head."

Eventually, a friend recommended a new doctor. And Downey, 76, of Arlington Heights, learned the problem wasn't in her head after all. It was in her neck.

Cervicogenic pain

Downey's headaches stemmed from the small vertebrae at the top of her cervical spine, said Dr. Daniel Hurley, a physiatrist at the Chicago Institute of Neurosurgery & Neuroresearch.

Pressure on these joints from bad posture, misalignment or injury can generate intense pain. Even tense neck muscles can jam these bones together, creating deep pain that migrates into the head, Hurley said.

A study published in September in the journal Cephalagia found 24 percent of patients with a slipped disc in the lower neck also complained of new headaches. Surgery relieved the pain in 80 percent of the patients.

Dr. Seymour Diamond, founder of the Diamond Headache Clinic in Chicago, said structural problems in the vertebrae can damage nerves that lead from the neck up into the scalp.

"It usually occurs in an older patient, which makes it easier to differentiate," Diamond said.

The trigeminal nerve -- believed to be the source of much headache pain -- is rooted in the brain stem at the top of the neck.

From a patient's perspective it can be hard to discern the source of headache pain. A pounding headache can make shoulder and neck pain feel like a vague echo.

"Once you get this headache pain, it all feels the same," Hurley said. "An ax in your head feels like an ax in your head, whoever stuck it there."

Complicating diagnosis is the fact that migraine and tension headaches can both lead to neck tension, which in turn can compound headaches.

"You get this vicious cycle," Hurley said. "People with miserable migraines get tight neck muscles, which can themselves trigger a headache."

Treatment

Hurley is one of a few doctors who will inject corticosteroids and anesthetics into the joints of the upper cervical spine. The delicate procedure is done under sedation with X-ray guidance.

The injections offer pain relief -- and clues.

"Partially, this is a test to ask your body, is your pain coming from here?" Hurley said.

Sometimes the injections are enough to relieve pain, but often they lead to surgery or other treatments. Hurley refers patients to acupuncture, physical therapy or a specialized type of chiropractic adjustment that focuses on the upper cervical spine.

Some patients need surgery to fuse joints or decompress a nerve. A very few might benefit from an electrical stimulator implanted at the base of the skull. Muscle relaxants can also help.

The injections are working so far for Greg Bowman. Bowman, 47, of Elgin, started getting intense headaches in December 2006. By January, the pain lasted all day and into the night.

"I'd come home from work at night and just collapse," he said. "I reached a point where I'd be asleep by 7:30 at night, then get up and go to work."

An MRI determined he has degenerative disk disease in his neck. Doctors at CINN are treating the disk disease with injections of corticosteroids to control inflammation and the injections relieve his headaches for a month or two. But Bowman also has a congenital skull defect that inhibits the flow of spinal fluid into his brain, which might be a second source of pain.

Eventually, Bowman might need surgery to correct the skull defect, known as Chiari malformation. The surgery involves removing a section of his skull and repositioning his cerebellum.

"People have good success with that surgery, but it would not be an easy decision," Bowman said.

A whole new life

Surgery ultimately cured Downey of her chronic headaches.

For more than a decade, Downey had tried one headache treatment after another. She had X-rays and MRIs. Doctors prescribed a host of drugs -- none of which worked -- and issued various diagnoses, from arthritis to fibromyalgia. At one point, Downey even became the leader of a fibromyalgia support group.

At CINN, doctors identified a pinched nerve in her neck. For eight months, they treated it with physical therapy, heat and massage, but the relief was always temporary. So two years ago a surgeon cut out the offending nerve.

"I had a remarkable recovery," Downey said. "The pain of the incision was nothing to this uncontrollable pain that had been going on."

Downey felt immediate relief; the headaches never returned. Now she can drive and travel.

"I had begun to think of myself as an invalid," she said. "Every day of my life, I just thank my stars. They gave me a whole new life."