Neck Pain and Headaches

What is neck pain and how common is it? 

Our neck, otherwise known as the cervical spine, is the most flexible part of the spine and is such an important part of our body and knowing where we are in space. Neck pain can be experienced anywhere in the neck, but can also be felt in the shoulder, shoulder blade region and the upper limb, otherwise known as referred pain. Much like LBP, neck pain is also VERY common and something we see a lot of as Physiotherapists. 

Who gets neck pain? 

Neck pain is more commonly reported in women compared to men, while the prevalence is similar for both men and women, with it being the most common at around age 50 and declining thereafter (Safiri et al., 2017). 

Much like LBP, neck pain can often come on for no apparent reason. A common neck presentation we see in the clinic is wry neck. Often patients will describe waking up with a very stiff and sore neck and often they feel stuck in a certain position. Other common neck presentations include whiplash associated neck pain (post motor vehicle accident or impact), tension related neck pain and general neck stiffness. Long term stiffness and pain is also really common, especially among the ageing population. As we get older, we tend to move less, and this can have a negative impact on our overall function and mobility. It’s worth remembering that other psychosocial factors such as stress or anxiety can manifest physically and contribute to neck or upper shoulder pain and stiffness.

Could my neck be contributing to headaches? 

The upper neck is a common contributing factor to headaches - these types of headaches are often referred to as cervicogenic headaches. The upper neck sends SO much information about where we are in space and other sensory information to the brain via the trigeminal nucleus. The trigeminal nucleus (located just above the neck) not only receives sensory information from the nerves of the upper neck, but also the trigeminal nerve (responsible for sending sensory information about the face to the brain). Convergence between the information coming from these two areas accounts for the cervical-trigeminal pain referral. Essentially, pain originating from structures of the upper cervical spine could be perceived in areas innervated by the trigeminal nerve, such as the area of the forid/temple region. 

Common symptoms? 

People with neck pain will often describe neck stiffness as well as pain. Neck pain can cause significant restrictions in range of movement as well as tightness and spasm through neck and shoulder muscles. 

As mentioned, the neck can also contribute to referred pain in the arm, otherwise known as radicular pain, which suggests nerve involvement. The neck can also be attributed to different types of headaches such as cervicogenic and tension headaches. 

Often when people seek care for neck pain, they also mention ‘degenerative changes’, which have been found on an x-ray or an MRI. While neck pain is often attributed to such degenerative changes, this is often not the case. We now know that degenerative changes are common and don’t often correlate with symptoms. That is, you can have findings on imaging, but have no pain at all. Neck pain, like all pain, is more complex. 

Keep in mind that there is a small percentage of neck pain that is sinister in nature, much like with some LBP. Once again, it is important to consult a Healthcare Professional to determine whether any further investigation is necessary. 

How can Physio help? 

Your Physiotherapist will conduct a thorough assessment, to determine possible causes and contributing factors of your neck pain. This assessment also includes the exclusion of anything sinister (otherwise known as Red Flags). While we know that a smaller proportion of people will present with pain that is sinister in nature, it is really important not to miss these presentations. 

Provided there are no Red Flags or contraindications, your Physio will then work with you to establish some goals for your treatment and then create an individualised treatment plan. This may include education, activity modification, exercise to improve strength and or mobility and manual therapy for symptom relief. Neck pain can often have a massive impact on day to day activities such as driving, working, typing etc. Your Physiotherapist will provide individualised treatment to ensure you can get back to your regular routine as soon as possible!