The vertebral column is made of vertebrae. Each vertebra is separated by a disc of a definite size. These discs prevent sliding of vertebrae on each other, avoid friction between them, maintain stability of the column and confer protection to the spinal cord.
As the person ages, the disc undergo degeneration. They gradually lose their water content and the hard outer layer becomes brittle. The discs become weak and are not able to absorb more of pressure placed on them. Thus the disc gets damaged. The inner layer of the disc increases and pushes the outer layer which causes the disc to bulge beyond its normal boundaries. They bulge into the spinal cord or the surrounding nerves and cause painful symptoms. When disc bulges out in the cervical (or the neck) region, it is called cervical disc bulge or disc herniation of the neck. It causes pain in the neck and stiffness of the neck region which hinders the flexible movement of the neck. The pain then moves to other parts including the shoulder, arm, hand and fingers. It can be either a sharp or burning pain.
Can Cervical Disc Bulge Cause Headaches?
In some cases of cervical disc bulge or bulging disc in the neck, the pain is first experienced in the neck region. Later this pain radiates to lower jaw or to the top of the head and into the one or both the eyes. Although the problem is in the neck, the pain moves away from where it originated and is experienced at a different place. This is called ‘referred pain’. Cervical disc bulge or the bulging disc in the neck can also cause significant amount of headaches. The headache resulting from cervical disc bulge is called as cervicogenic headache (CGH) and is felt at the back and top of the head. It is also called as Neck headache and accounts for 4% to 22% of all headaches observed. It can be reduced by fixing the neck problem.
Cervicogenic headache occurs due to shared nerve tract. The main nerve that transmits messages from the face to the brain shares a pin nucleus with the spinal nerves located in the neck region. The brain is not able to detect the precise location of this pain from neck region. This pain is misunderstood by the brain as the headache is located in the head instead of the neck region.
The other symptoms of headache due to cervical disc bulge or bulging disc in the neck include sensitivity to light and noise, nausea, irritation and symptoms that increase with head and neck movements. Although a regularly encountered headache, Cervicogenic headache has not originated in the head. This is in contrast to that of the migraines and cluster headaches, which originate in the head and are extremely painful.
Diagnosis of Headache Due to Cervical Disc Bulge or Bulging Disc in the Neck
The diagnosis includes the physical examination of the patient along with certain questions. The neck region will be examined for stiffness and muscle tightness. Further tests are recommended to know the reason for headache and these include:
- Series of X-rays especially the open-mouth view of the skull
- EMG or MRI or CT scans to check for the nerve compression or the joint damage in the neck region. This may not be essential in all cases.
- Diagnostic nerve blocks: Once the cause is understood that it is CGH, then diagnostic nerve block is performed to know the location of pain along the neck. Injections are delivered in the following areas of the neck:
- Occipital nerve block
- Atlantoaxial joint block given at C1-C2
- Facet/joint block given at C2-C3
The physician has to perform a number of diagnostic blocks to arrive at a proper conclusion regarding the source of pain. This requires a lot of patience to determine the exact location. Once the location is known right treatment can be given.
Treatment for Headache Caused Due to Cervical Disc Bulge or Bulging Disc in the Neck
Headache due to bulging disc in the neck is often mistaken for migraine or cluster headache. Hence proper diagnosis is important for the right treatment to be started. Once the cervicogenic headache has been diagnosed, it is important to determine which structures in neck are causing the pain using diagnostic nerve block.
- Initial line of treatment for headache due to cervical disc bulge is administration of pain killer drugs and physiotherapy. Drugs given to mitigate pain include NSAIDS (non-steroidal anti-inflammatory drugs), anti-seizure drugs, tricyclic anti-depressants and migraine drugs such as Fiorinal are prescribed. Physiotherapy should not be very aggressive since it will increase the pain.
- When pain medication is not successful and diagnostic nerve block determines the location, then following interventional pain procedures are applied to treat headache due to cervical disc bulge:
- When it is confirmed by diagnosis that constant cervicogenic headache arises from facet joints, then percutaneous radiofrequency denervation treatment is given. It involves damaging the nerves over the joints by controlled heating through needle in the back of the neck.
- When C2 nerve root compression is involved, then C2 radiofrequency pulse ganglionotomy technique is used.
- In some cases, primary causes of neck pain are nerve root compression or cervical disc prolapse followed by cervicogenic headaches. Such cases may improve with use of microsurgical discectomy and fusion.
- Other low risk surgical technique is used for peripheral nerve stimulation for treating headaches caused due to cervical disc bulge or bulging disc in the neck.
- Physical therapy, chiropractic adjustments, myofascial release help to relieve or reduce the headache.
- Some specific exercises are to be followed to have long lasting relief from neck pain and headaches.
Conclusion
Thus, the bulging disc in neck causes neck pain which then causes significant headaches. Headache due to bulging disc in the neck has to be diagnosed correctly so that right treatment procedure can be applied. In addition, performing physical exercises confers long lasting relief from such headaches.
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