Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 


80% of all headaches are muscle contraction/ cervicogenic/ and analgesic rebound

The failure to diagnose cervicogenic headaches is the medical reason so many women are treated with multiple medications without success!

Additional Articles:
Chiropractic View on Muscle Headaches
Dentist's View on Muscle Headaches

The cervicogenic headache refers to the headache that develops primarily in women and is a headache "caused by the neck." There are three aspects to consider in this headache which is purely mechanical in nature:

  1. There are nerve roots that exit under the skull and travel through the five layers of muscles in the neck. When one gets a "stiff neck," the muscle spasm can constrict the nerve. The pain from this nerve, located at the base of the skull and approximately one inch from the midline, is referred to the forehead. Therefore, muscle contraction or cervicogenic headaches are felt as a tightening band across the forehead and into the eyes.
  2. Women are "constructed" differently from men. They lack the trapezoid development or "back muscles" that are needed to hold the head up straight. Women, more often then men, assume a "head forward" position. With the head drooping forward, there is considerable strain on the trapezoid neck muscles and the nerves. Therefore, posture is the number one contributing factor to cervicogenic headache.

    And women have to contend with the weight of breast tissue on the bra straps that cut into the trapezoid muscles. Since the breasts swell before the menses, the additional weight can cause additional strain on the muscles. As such, it is common to find an increase in the incidence of cervicogenic headaches prior to menstruation.

  3. The injection of a few milliliters of a local anesthetic into the area of the occipital nerve will release the muscle spasm (trigger point) and immediately relieve the headache. These areas have been noted by Bonnie Prudent in her book on Myo-therapy . Whether called tender spots, or myo-fascial spots, or trigger points, they are areas of muscle spasm.
    There is no medicine or diagnostic test that is as inexpensive or as accurate in making the diagnoses as is injection at the time of the headache.

Under these circumstances, it is easy to see why so many headache patients take medication almost every day. They get Analgesic Rebound, which means they get headaches from the medication they are taking for the headache! For example, caffeine dr inks and drugs cause muscle contraction and many temporarily relieve muscle spasm. However, after 3-6 hours of sleep, the caffeine effect wears off and the individual wakes up with a headache. Then they take more caffeine!


  • Cervicogenic headaches and muscle contraction headaches are the most common and most misunderstood origin of "headache" pain.
  • Analgesic Rebound refers to individuals who take many medications including over-the-counter preparations almost daily for headache.
  • The only diagnostic test is the OCCIPITAL NERVE BLOCK-- it proves both diagnostic and therapeutic. Relief usually occurs in seconds.
  • The patient who gets temporarily relief with OCCIPITAL NERVE BLOCKS needs physical therapy and a muscle relaxation program.
  • With OCCIPITAL NERVE BLOCKS, patients can often stop many of the daily medications and work with their physician and therapist toward improvement of the underlying posture position.
  • Failure to respond to therapy may indicate a chronic fatigue or depressive state. Further evaluation may be appropriate at that time.

    The articles listed above describe how various specialists treat cervicogenic headaches.

    • Edward Lichten, M.D., is a gynecologist with interest and publication in the hormonal managment of disease

    • Dennis Dobritt, D.O., is an anesthesiologist and director of the Pain Institute at Providence Hospital in Southfield, Michigan

    • Paul Roubal, Ph.D., P.T., is a doctor of physical medicine and director of the Physical Therapists of Troy, Michigan

    • Mitchell Elkiss, D.O., is a neurologist, director of the Gertrude Levin Pain Clinic and in practice at Providence Hospital.

Lichten's Pearls

There are multiple levels of cervical root involved in chronic headache.
1. Occipital nerve C2-3
2. C-6
3. Subscapularis


Treatment plan

1. Inject 3cc of 1% lidocaine with 1/2cc of dexamethasone at C2-3 notch (1 inch lateral to midline)

2. Palpate the C5-6 lateral vertebrae for triggers. Usual location is directly lateral. Inject 1cc here.

3. Palpate the supra-spinatus (trapezoid between neck and acromion (shoulder) for tightness. One inch from plum line of ear is the scapular notch. Tenderness there shows the subscapularis muscles to be in spasm and fixing the scapula-shoulder complex from moving. Injections into the subscapulais may be needed to resolve the pain issues.