Question
is it common for someone that broke his neck to suffer from headaches? what can be done?
My Boyfriend broke his neck 2.5years ago. His was blown away by an aircraft. He broke vertebrae 2,5,6,7. he had the halo for a while, than hard collar, soft collar, then pain still continue for a while. He had surgery done, about 6 months ago-plates,since one of the vertebrates was out of place. The headaches still continues, he did the steroid shot, nothing... is there something that can be done to get rid of the headaches?

Answer
Dear Tamar,

I would suggest that you have a chiropractic physician evaluate the structure and function of the neck, especially the upper joints of the neck. Most musculoskeletal headaches originate in the upper joints of the spine, and a chiropractor can work on the joints of the spine even if surgical stabilization has occurred.  

I in fact have two separate patients in my office right now that I work on who have had previous neck surgery to include fusions.  The chiropractor can adjust the joints above and below the surgical fusion sites with their hands, or utilize an instrument over the surgical sites to send vibrational impulses into the joint space which will help to alleviate pain transmission. Most neck fusions occur on the front of the spine rather than the back and allow for continued joint function.  Obviously the chiropractor will need to see the post surgical x-rays to ascertain the present condition.

However, often some chiropractors will refuse to treat the neck if there has been a previous surgical fusion.  They are afraid to address it at all...I have seen this in patients I treat in my office. You need to find a chiropractor who has been educated on the surgical procedures, and how to treat the patient effectively without placing too much pressure at the surgical sites. (although these surgical sites are really super strong)  

Additionally, I am positive some soft tissue work will need to be done.  Muscle spasms and trigger points can refer pain into the neck, head and face from multiple sites. If you research the work or Janet travel (Travell and Simons), they have written the predominant source of information on trigger points for health care providers, you will be able to see the referral patterns. To clarify muscle spasms hurt locally, especially when pressed, but trigger points will refer pain away from the original source when pressed.  This will need to be addressed with fibrous release type deep tissue work, such as Active Release Technique (ART, Graston Technique, or SASTM Technique)

Lastly, I am going to include some research information below for you to appreciate.  It is technical and complicated, but I think you will be able to get the big picture after reading through it.  Not to mention you can give it to the treating chiropractor if you wish.

Hope this helps Tamar.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

Anatomy and Physiology of Headache.
Biomedicine and Pharmacotherapy:  1995, Vol. 49, No. 10, 435-445

Nikoli Bogduk

FROM ABSTRACT:
All headaches have a common anatomy and physiology.

All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.

DR. BOGDUK ALSO NOTES:
The brainstem contains a region of grey matter called the trigeminocervical nucleus. This nucleus is causally continuous with the grey matter of the dorsal horn of the spinal cord. The trigeminocervical nucleus is 揹efined by its afferent fibers.?[Key Point]

The trigeminocervical nucleus receives afferents from the following sources:
         1) Trigeminal Nerve (Cranial Nerve V)
         2) Upper three cervical nerves
         3) Cranial Nerve VII (Facial Nerve)
         4) Cranial Nerve IX (Glossopharyngeal Nerve)
          5) Cranial Nerve X (Vagus Nerve)
All of these afferents terminate on common second-order neurons in the trigeminocervical nucleus.

Trigeminal Nerve afferents will descend to the level of C3 and perhaps as low as C4. The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. 揂ll nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.?br>
Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.

The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which includes cranial nerves V, VII, IX, X, and C1-C3. 揂ny structure innervated by these nerves is capable of causing headache.?br>
揟he C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.?br>
The C1 spinal nerve passes across the posterior arch of the atlas behind its superior articular process, descending in front of the C1 transverse process to descend as a part of the cervical plexus.

C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles. The sensory root of C1 can be found with the motor roots of the spinal accessory (cranial nerve XI) nerve.

The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint; its dorsal root ganglion is opposite the midpoint of the C1-C2 facet joint.

The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.

The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura mater between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.

In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [Important]

The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.

The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.

The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.

The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.

The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.

The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.

The posterior cranial fossa and its contents are innervated by cervical nerves.  Stretch on the dura mater can initiate mechanical pain. [Important]

揤ertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.?br>
Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.

Injury and damage to the alar ligaments can cause upper cervical pain and headache. The diagnosis is made with upper cervical rotational CT scanning, showing significant greater unilateral rotation. [Suncoast Healthcare orders FLAR study MRI sequencing of the upper cervical spine when alar or transverse ligament injury is suspected:  the techniques has good visualization of the damage]

**Posterior cervical muscle tears are not a cause of chronic headache.**

C2 neuralgia is a neurogenic headache that can be caused by 搒car tissue following trauma to the lateral atlanto-axial joint.?[Important]  [Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]

KEY POINTS FROM SUNCOAST HEALTHCARE PROFESSIONALS
1) All headaches have a common anatomy and physiology.
2) All headaches are mediated by the trigeminocervical nucleus, and are initiated by noxious stimulation of the endings of the nerves that synapse on this nucleus, by irritation of the nerves themselves, or by disinhibition of the nucleus.
3) The brainstem and upper cervical spinal cord contains a region of grey matter called the trigeminocervical nucleus.
4) The trigeminocervical nucleus is 揹efined by its afferent fibers.?[Key:  Chiropractic adjustments stimulates mechanoreceptive afferents]
5) The trigeminocervical nucleus receives afferents from the following sources:
         A) Trigeminal Nerve (Cranial Nerve V)
         B) Upper three cervical nerves
         C) Cranial Nerve VII (Facial Nerve)
         D) Cranial Nerve IX (Glossopharyngeal Nerve)
         E) Cranial Nerve X (Vagus Nerve)
**All these afferents terminate on common second-order neurons in the trigeminocervical nucleus.
6) Trigeminal nerve afferents will descend to the level of C3 and perhaps as low as C4.
7) The trigeminocervical nucleus is the sole nociceptive nucleus of the head, throat and upper neck. 揂ll nociceptive afferents from the trigeminal, facial, glossopharyngeal and vagus nerves and C1-C3 spinal nerves ramify in this single column of grey matter.?br> 8) Pain in the forehead can arise as a result of stimulation by cervical afferents of second-order neurons in the trigeminocervical nucleus that happen also to receive forehead afferents.
9) Pain in the occiput (primarily innervated by C2) may arise from trigeminal nerve stimulation.
10) Because the ophthalmic branch of the trigeminal nerve extends the farthest into the trigeminocervical nucleus, cervical afferent stimulation is most likely to refer pain to the frontal-orbital region of the head.
11) The stimulation of any neurons that activate the trigeminocervical nucleus can cause headache, which included cranial nerves V, VII, IX, X, and C1-C3. 揂ny structure innervated by these nerves is capable of causing headache.?[Key Point]
12) Structures innervated by C1-C3:
         A) Dura mater of the posterior cranial fossa
         B) Inferior surface of the tentorium cerebelli
         C) Anterior and posterior upper cervical and cervical-occiput muscles
         D) OCCIPUT-C1, C1-C2, and C2-C3 joints
         E) C2-C3 intervertebral disc
         F) Skin of the occiput
         G) Vertebral and Carotid arteries
         H) Alar and transverse ligament
         I) Trapezius and Sternocleidomastoid muscle
13) 揟he C1 and C2 spinal nerves are distinctive in that they do not emerge through intervertebral foramina.?br> 14) C1 spinal nerve does not supply the skin, but does supply sensory innervation to the suboccipital muscles.
15) The C2 spinal nerve crosses the posterior aspect of the C1-C2 facet joint and innervates it.
16) The anterior primary rami of C1-C2-C3-C4 join and form the cervical plexus to innervate the prevertebral muscles: longus capitis, longus cervicis, rectus capitis anterior, rectus capitis lateralis, sternocleidomastoid and trapezius.
17) The anterior primary rami of C1-C2-C3 form the recurrent meningeal branches of the sinuvertebral nerves. These nerves innervate the anterior surface of the upper cervical dura mater, and then pass through the foramen magnum to innervate the dura matter between the pituitary gland to the anterior occiput (the clivus). They also innervate the medial portion of the C1-C2 joint capsule, the transverse and alar ligaments.
18) In the posterior cranial fossa, C1-C3 sinuvertebral nerves add components to cranial nerve X (vagus) and XII (hypoglossal). [WOW!  Anatomical proof there is a direct connection with chiropractic adjustments and improvements with abdominal organ system!]
19) The anterior primary rami from C1-C3 join the vertebral nerve, the plexus of nerves that travels with the vertebral artery, and supplies sensory branches to the fourth part of the vertebral artery.
20) The posterior primary rami of C1 innervate the 4 suboccipital muscles: inferior oblique, superior oblique, rectus capitis posterior major, rectus capitis posterior minor.
21) The motor component of the C2 posterior primary rami innervates the longissimus capitis and splenius.
22) The sensory component of the C2 posterior primary rami becomes the greater occipital nerve. It winds under the inferior oblique muscle, ascends and pierces the shared aponeurosis of the trapezius and sternocleidomastoid muscle to supply the posterior scalp.
23) The motor components of the C3 posterior primary rami also innervate the longissimus capitis and splenius muscles as well as the C2-C3 multifidus muscle.
24) The sensory component of the C3 posterior primary rami runs across the posterior aspect of the C2-C3 facet joint (which it innervates) and ascends as the third occipital nerve to supply the suboccipital region.
25) Nociception pain can be initiated by the accumulation of inflammatory chemicals.
26) Nociception pain can be caused by mechanical stimulation following a 揹istortion of a network of collagen?such as ligament or dura mater. [Important: this supports the mechanics of subluxation]
27) Central pain involves no tissue damage but results from dysfunction of the descending pain inhibitory pathways. [Important: the journal Pain in November 1996 suggests that spinal adjusting relieves pain because it activates the descending pain inhibitory system.]
28) Stretch on the dura mater can initiate mechanical pain. [Important: there exists a connective tissue bridge between C1-C2 that attaches to the inferior oblique muscle and attaches to the dura mater. Biomechanical problems in this region can stretch the dura mater, initiating mechanical pain.]
29) The posterior cranial fossa and its contents are innervated by cervical nerves.
30) 揤ertebral artery disease, such as an aneurysm becomes an important differential diagnosis of what otherwise might seem to be neck pain with referred pain to the head.?br> 31) Arthritis of the upper cervical synovial joints (including C2-C3) can cause neck pain and headache.
32) Injury and damage to the alar ligaments can cause upper cervical pain and headache.
33) Posterior cervical muscle tears are not a cause of chronic headache.
34) C2 neuralgia is a neurogenic headache that can be caused by 搒car tissue following trauma to the lateral atlanto-axial joint.?[Important:  Fibrosis of the C1-C2 facet joint affecting the adjacent C2 root]