Cervical radiculopathy is a medical condition caused by nerve compression in the upper spine. The nerve compression is caused by one of the following medical conditions:• herniated disc (rupture of the disc located between the vertebrae in your spine)
• cervical spinal stenosis (narrowing of the spinal canal)
• degenerative disc disease (impingement of the nerve by bony spurs when arthritis develops in the spine)
Unlike the lumbar or lower spine, the cervical spine has eight nerve roots that exit above the level of the corresponding vertebrae. For example, the C7 nerve root exits at the C6-C7 disk space. Therefore, a C6-C7 disc herniation leads to a C7 radiculopathy. Each cervical nerve root branches out, supplying sensory and motor fibers to the muscles, which allows the shoulder, arm, and hands to function. An irritated C7 nerve root can cause pain, weakness, and numbness/tingling (paresthesia) along the nerve's pathway. Lower cervical roots, especially C7 followed by C6, are more frequently affected by nerve compression than higher cervical roots. By now you are probably wondering how this is related to headaches? Let me explain further.Symptoms
While often not the first symptom described, many individuals with cervical radiculopathy suffer from headaches. When the upper cervical roots (C1-C4) are involved, the headache is described as a cervicogenic headache, defined by the International Headache Society (IHS) as being referred from the neck. You may be wondering about headaches caused by lower cervical nerve root compression (C5-C7), as these are by far the ones more commonly affected. In one study, conducted by Persson et al (in the European Spine Journal), of 275 patients with lower cervical radiculopathy, 161 patients reported headaches. The headaches were located on the same side as the affected nerve root and most commonly described as aching and radiating from the back of the head to the forehead. All of the patients with headaches reported tenderness when pressure was applied to the muscles in the neck on the same side as the compressed nerve root.
Additional symptoms of cervical radiculopathy include: same-sided shoulder and arm pain, numbness and tingling, and weakness. Sometimes the weakness and sensory symptoms are described without pain.Diagnosis
A thorough physical exam by your primary care physician may be all you need to diagnose cervical radiculopathy. One diagnostic test used is called the Spurling maneuver, in which your healthcare provider will press down on the top of your head when it is turned to the affected side. If this downward pressure reproduces your symptoms (pain, numbness, tingling), then this is a positive test and suggestive of a compressed nerve root.
Imaging such as magnetic resonance imaging (MRI), computed tomographic myelography (CT myelography), or electromyography (EMG) can confirm the diagnosis of a nerve root compression. When diagnosing cervical radiculopathy, your doctor will monitor for red flags such as spinal cord compression (where the actual cord is being compressed), signs of infection, stroke, cancer or other factors that indicate an alternate diagnosis. If you believe headache is a symptom of your pinched nerve, then your doctor will confirm to make sure there are no other causes.Treatment
Patients with cervical radiculopathy are usually managed conservatively. Medications such as non-steroidal anti-inflammatories like ibuprofen, opioids, anti-depressants like Effexor (venlafaxine), or muscle relaxants like Flexeril (cyclobenzaprine) may be helpful, especially for acute pain management. Oral steroids are sometimes used, but long-term use should be avoided due to potential side effects. Physical therapy is another complementary treatment to medication, as are cervical steroid injections. In the same study mentioned above (European Spine Journal), cervical nerve root blocks were performed in the 161 patients with headaches from lower cervical radiculopathy. Of these patients, 58% reported a significant reduction in their headache pain. After six to eight weeks, about one-third of patients who suffer from cervical radiculopathy will have persistent symptoms and are often referred to a spine specialist for surgical consideration.What Should I Do?
If you suspect a pinched nerve as the source of your headache, then speak with your healthcare provider. Do not let this headache disrupt your life and restrict activities you enjoy doing. While this may not be a condition that can be cured, with the help of your primary care physician, spine specialist, and physical therapist, you can find a therapy regimen or solution that works for you.
Eubanks JD. "Cervical radiculopathy: nonoperative management of neck pain and radicular symptoms." Am Fam Physician. 2010 Jan;81(1)33-40.
Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.
Persson L, Carlsson J, Anderberg L. "Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients." Eur Spine J. 2007 July;16(7):953-9.
Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. "Epidemiology of cervical radiculopathy. A population-based study from Rochester,Minnesota, 1976 through 1990." Brain. 1994;117(Pt 2):325-35.