Herniated disc pain turning the head can occur with particular types of cervical disc pathologies. However, just because a person demonstrates one or more bulging, herniated or ruptured discs in the neck does not mean that they will have neck pain upon rotation of the head, nor does it mean that they will inherently have any pain at all. Most herniated discs are not painful or symptomatic to any significant degree. Some herniations can create symptoms through specific mechanisms and some of these are the type of disc problem that can create rotational neck pain.
Since turning the head to the side is a normal activity that we must perform many times each day, patients with this variety of pain are often put in difficult positions. Either they have to manage the considerable pain caused by the activity or they must curtail their physicality and not turn their head to one or both sides. Neither choice is desirable.
This focused essay delves into the reasons why herniated disc pain might flare-up upon turning the head to one side or both. We will explain the actual mechanisms for pain generation and provide guidance for patients who are currently suffering from this disturbing symptom set.
Herniated Disc Pain Turning Head Definitions
Turning the head is defined as looking to the left or right. This differs from looking upwards (neck extension) or looking downwards (neck flexion). Turning the head to the side is also called rotational movement of the neck.
In the cases of painful rotation, symptoms might be elicited in many possible scenarios. Pain might begin immediately upon rotation, but usually begins once the neck reaches a certain degree of movement. Typically, this pain threshold occurs about 1/2 to 2/3 of the distance towards maximum comfortable rotation. Pain might occur when the neck is rotated to both sides or only to one specific side. This is logical given the manner in which herniated discs can create pain and how the spine moves when the neck is rotated. In most patients, pain is generally worse when turning to one side compared to the other, with one side being the primary causative mechanism and the other side being secondary. Purely unilateral pain is the next most common expression of rotational disc pain. Bilateral pain that is equally severe when turning the head to either side is the least commonly reported symptom set. There is no more common side for pain in unilateral pain complaints, with left and right being equally represented.
Research has shown that all manner of herniations can cause pain upon head rotation. Disc bulges, herniations, ruptures, extrusions and sequestrations can all create rotational pain complaints. However, the most common type of disc abnormality is the intact bulging disc, so it is no surprise that this type of irregularity is the most often cited as being causative for rotational neck pain, as well.
Does it Hurt to Turn Your Head?
Herniated discs will bulge or rupture in a definite direction and pattern. The most common type of herniation is called posterolateral or paramedial. This means that the majority of the bulging portion of the disc is facing towards one side or the other. Direct central disc bulges are less common and anterior bulges are the least common of all.
Central herniations have a greater chance of exerting force against the spinal cord, while paramedial herniations can influence either then spinal cord or more commonly, the spinal nerve root on the side where the bulge occurs. Statistically, central herniations are rarely affected by turning the head, while paracentral herniations are the most common type of disc abnormality associated with rotational neck pain.
Paramedial herniations demonstrate the majority of their bulging portion on one side. Turning the head will cause the vertebrae to rotate also, limiting the space for the spinal cord or spinal nerves in the already diminished space taken up by the herniation. In essence, the herniated disc might or might not be effacing or compressing neurological tissue when the head is in a neutral position, but it does impinge on the nerve tissues when the head is turned. This is what causes the flare-up of symptomatic activity. Even if the herniation does not directly compress a nerve when the head is turned, the foraminal space is likely to narrow when the head is turned. If the herniation is already decreasing the patency of this space, then rotation of the neck can close it off enough to create pain.
Another possible explanation for rotational neck pain associated with a herniated disc is a sequestered disc fragment that has broken away from the herniated disc and has come to rest within the foraminal pathway. Once again, when the head is turned, the combination of the vertebral rotation and the disc fragment might influence the nerve, thereby generating pain. This scenario is far less common, but is possible, especially when the disc fragment calcifies and forms a solid blockage that directly impinges on the nerve.
Herniated Disc Pain Turning Head Guidance
Since rotational neck pain is movement-dependent, it is difficult to study in traditional ways. Diagnosticians should never assume that a herniated disc is the underlying cause of pain unless it is verified to be so through objective and complete evaluation. We advise the following practices be utilized to determine the relationship between the disc and the movement of the head:
Diagnostic imaging should be taken with the head turned to a symptomatic or near symptomatic degree, if possible. CT scan or MRI will provide the best visualization of the disc pathology during rotation of the neck.
The patient should undergo nerve conduction testing for the level suspected of creating the pain, if a compressive neuropathy is suspected.
Meanwhile, patients are cautioned not to assume that any diagnosed intervertebral abnormality is the source of their pain, since most disc bulges are innocent and coincidental to symptoms that are experienced. There are many other possible explanations for rotational neck pain and these should be ruled out before any treatment is performed on the disc, especially if the diagnosis is not objectively verified through the above recommendations.
Even if the disc is responsible, many of these types of pain syndromes resolve organically, without any treatment needed at all. Time tends to decrease pain in many symptomatic disc bulges, with the exception of calcified disc fragments that might be definitively pressuring the spinal cord or spinal nerve when the head is turned. These types of conditions might not resolve naturally and might require surgical intervention to cure.