In our previous article, we discussed how persistent headaches and migraines may be driven by brainstem sensitisation, where the nervous system becomes more sensitive and amplifies normal information from the body.

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In this article, we'll explore how the upper cervical spine may contribute to headaches and migraines, explain the principles behind the Watson Headache® Approach, and discuss why identifying the correct spinal segment is so important.

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What Is the Difference Between a Headache and a Migraine?

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Although the terms are often used interchangeably, headaches and migraines are not exactly the same.

 

A headache refers to pain felt in the head. A migraine is a neurological condition that usually includes a headache but is often accompanied by a range of other symptoms. A migraine is like a worse headache. 

 

Many people find that after a migraine settles, they continue to experience a lingering headache for the remainder of the day.

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Migraines may also be associated with:

• Throbbing pain

• Pain on one side of the head

• Light sensitivity

• Sound sensitivity

• Visual disturbances

• Numbness or tingling

• Dizziness

• Nausea

• Aura before the migraine develops

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One way to understand migraines is to imagine your brainstem as a bucket.

Throughout the day, different factors slowly fill that bucket, including:

• Stress

• Poor sleep

• Hormonal changes

• Upper cervical joint irritation

• Genetics

• Illness

• Sustained posture

• Rotation or dysfunction around the C2 or C3 vertebrae, placing additional stress on the upper cervical joints

 

As the bucket fills, the nervous system becomes increasingly sensitive. Eventually, the bucket overflows—and that is when a migraine occurs.

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This analogy highlights an important point: migraines are rarely caused by a single trigger. Instead, they usually occur when several contributing factors combine and exceed your nervous system's threshold.

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Common Migraine Symptoms

 

Every person's migraine is different, but some of the most common symptoms we see in the clinic include:

• Pain travelling from the neck into the temple or behind the eye

• Pressure across the forehead on one or both sides

• Sharp or throbbing pain on one side of the head

• Visual disturbances

• Light sensitivity

• Sound sensitivity

• Fatigue

• Brain fog

• Difficulty concentrating

• Memory difficulties

• Emotional distress or low mood

• Pain referred into the jaw, teeth, ear or sinuses

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How Does the Upper Cervical Spine Contribute?

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The cervical spine consists of seven vertebrae (C1-C7).

 

The lower cervical nerves (C4-C7) mainly supply the shoulder and arm. Irritation here is more likely to cause pain, tingling or numbness travelling into the upper limb.

 

The upper cervical spine is different.

 

The nerves from C1, C2 and C3 project into the trigeminocervical nucleus within the brainstem, where they converge with sensory information from the trigeminal nerve supplying the head and face. As mentioned in the previous article, the brainstem is sensitized and the brain’s smoke alarm is more sensitive than normal. 

 

Because these pathways share the same processing centre, irritation arising from the upper cervical spine may be interpreted by the brain as pain within the head rather than pain in the neck.

 

This is why dysfunction involving the upper cervical joints can produce headaches.

 

The pattern of referral is often predictable.

 

C0/C1

The C0/C1 joint commonly refers pain as:

• A dull ache

• A constant pressure

• A vice-like band around the head

• Tension-type headaches that may persist throughout the day

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C2/C3

The C2/C3 segment typically refers pain:

• From the base of the skull

• Towards the temple

• Behind the eye

• As a throbbing or migraine-like headache

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Within the Watson Headache® Approach, the C2/C3 segment is considered the most common source of cervicogenic headache.

 

Dr Dean Watson's research has demonstrated that:

• C2/C3 is the most common headache-producing segment followed by C0/1

• Approximately 80% of patients demonstrate referral from both C2/C3 and C0/C1 (Dr Watson's PhD demonstrated this combination in 100% of participants).

• Headaches arising from C1/C2 are relatively uncommon, accounting for approximately 5% of cases, and are more frequently associated with previous trauma such as whiplash.

• C3/C4 is a very uncommon source of headache.

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Recognising these referral patterns helps clinicians identify which structures may be contributing to an individual's symptoms.

 

Could Your Neck Be Contributing?

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Some common signs that your neck may be contributing to your headaches include:

• Neck pain before or during your headache or migraine

• Headaches predominantly affecting one side of the head

• Headaches that switch sides between episodes

• Symptoms that gradually worsen throughout the day

• Headaches aggravated by neck movement

• Symptoms worsened by prolonged sitting or poor posture

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While these signs do not confirm that the neck is responsible, they are important findings that help guide a comprehensive assessment.

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Ocean is qualified in the Watson headache approach and has significant experience in treating persistent headache and migraine conditions, click here to book and appointment with Ocean today.

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