Neck pain doctor for Creve Coeur. That headache starts in your neck.

NECK PAIN · CREVE COEUR

A headache that starts at the base of your skull and finishes behind your eye is not a migraine, and it will not respond to migraine treatment.

Getting here from Creve Coeur

North on I-270 to the Natural Bridge exit. It is a short and predictable drive from most of Creve Coeur, and it avoids the inner belt entirely. Parking is at the door.

Why this page is about headache

Because the most common thing we correct in people arriving from the western suburbs is a headache that has been managed as a primary headache disorder for years without anybody examining the neck.

Cervicogenic headache is referred from the upper cervical segments through the trigeminocervical nucleus, where input from the neck and input from the trigeminal system converge on the same second-order neurons. It is side-locked, it starts at the back and moves forward, and it is provoked by neck position rather than by the usual migraine triggers.

The workup that is usually missing

Not imaging. Range of movement measured properly, with attention to rotation in flexion — the position that isolates C1-2. Segmental palpation of the upper cervical joints for reproduction of the headache. The sternocleidomastoid and the suboccipital muscles, both of which refer into the head. And the greater occipital nerve where it crosses the skull base.

None of that requires equipment and all of it is more informative for this diagnosis than a scan. A headache workup that has never included somebody examining the neck is incomplete regardless of how thorough it was otherwise.

What we ask you to record after a block

Hourly for six hours, on a simple zero-to-ten. Those first hours are the local anesthetic and they answer whether the target was right — which is the entire diagnostic value of the procedure.

An impression given a week later is not a substitute. Impressions compress, and a diagnostic block interpreted from one is a block largely wasted.

What separates it from migraine

It is side-locked and stays on the same side. It starts in the neck or the back of the head and moves forward rather than the other way round. It is provoked by neck position and by pressure over the upper cervical segments. And it usually arrives without the full migrainous package — the nausea, the light and sound sensitivity, the aura.

Where those features are present alongside it, both diagnoses can be true at once. Treating only the one recognized first is why a great many people improve halfway and then stop.

What we do that a headache clinic does not

We examine the upper cervical spine segment by segment and we can test it. Where palpation reproduces the headache, a diagnostic block answers whether that joint is generating it — within hours, not after a months-long medication trial.

That testing step is the whole reason to come here rather than repeat a workup that has already been done well elsewhere.

What a first appointment settles

Whether there is a cervical contribution, how large it is, and what would confirm it. You leave with a named structure or a named test, not a further trial of something.

The detail of how each treatment works is on the cervicogenic headache page; this appointment is about establishing whether that page describes you.

Medication overuse, which has to be addressed

Frequent use of acute headache medication drives a chronic daily headache of its own, and treating that with anything while the overuse continues produces a poor result attributed to the wrong thing. If you are taking triptans, combination analgesics or opioids on more than about ten days a month, that is the first conversation.

When both diagnoses are true

Frequently. Somebody can have migraine and a cervicogenic component at the same time, and treating only the one that was recognized first is why a great many people improve halfway and stop. Partial responses are diagnostic information rather than failures.

Where we are

12174 Natural Bridge Rd, Suite 302
St. Louis, MO 63044

Suite 302. Parking at the door. The building is the three-story one with the lit entrance canopy.

Over fifty, and the one thing that cannot wait

New-onset headache over the age of fifty raises giant cell arteritis, which is the one condition on this website that is genuinely time-critical. Scalp tenderness, jaw pain on chewing, and any visual symptom make it urgent rather than routine.

It is uncommon and it causes irreversible visual loss when it is missed. Naming it here is not alarmism — it is the reason a new headache in an older adult gets treated differently from a headache somebody has had for twenty years.

The muscles that produce most of the confusion

The sternocleidomastoid refers into the forehead, behind the eye, the ear and the jaw. The suboccipital muscles refer into the back and side of the head as a deep ache. Upper trapezius refers up the side of the neck to the temple.

Between them they reproduce almost the entire symptom set without a single joint being abnormal, which is why the workup so often ends up at the eye, the ear or the sinuses first. Finding them takes minutes and requires nothing but hands.

What to bring

A headache diary covering at least a month, ideally three: days with any headache, days with migrainous features, and what medication was taken on each. That record decides more than any imaging you could bring, and it is the single most useful thing to arrive with.

Also bring the list of preventives already tried and at what doses. A drug abandoned at a subtherapeutic dose has not really been tried, and that distinction changes what happens next.

Two things worth checking before you come

Whether the headache is strictly one-sided, and whether it changes with how long you have been at a screen. Both are quick to observe over a week and both narrow the diagnosis considerably.

If the answer to either is yes, the upper cervical spine belongs in the assessment, and it is the part most likely not to have been examined yet.

What Creve Coeur patients ask

I have tried three migraine preventives. Why would this be different?

Because they target a mechanism that is not the one generating this pain. A poor response to reasonable migraine treatment is itself diagnostic information. Where the practice sits in St. Louis.

Do I need another scan?

Usually not. This is a diagnosis made by examination, and imaging is directed at excluding other things rather than at confirming it. What the first visit covers.

How long before I know if this is the answer?

A diagnostic block gives an answer within hours. That is the point of doing one rather than trialling treatments for months. How a cervicogenic headache is identified.

Do you treat migraine as well?

We treat chronic migraine with botulinum toxin where the criteria are met, and we are clear about where those criteria sit. Where the practice sits in St. Louis.

Related reading

• Cervicogenic headache
• Occipital nerve block
• Atlantoaxial injection
• Botox for neck and headache
• Sternocleidomastoid spasm
• Neck pain doctor in St. Louis