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Cervicogenic Headache: "A Pain in the Neck"

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Updated July 17, 2014

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Cervicogenic Headache:
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What is a Cervicogenic Headache?

A cervicogenic headache is a disorder in which head pain is referred from the neck. This type of headache is typically one-sided or unilateral, like a migraine. But, unlike a migraine, those with cervicogenic headache have reduced range of motion of their neck and precipitation of their headache by certain neck movements. Patients may also have same-sided shoulder or arm pain associated with the headache. Nausea, vomiting, photophobia, and phonophobia can occur with a cervicogenic headache, but to a lesser intensity and frequency than in migraine attacks.

The exact cause of this type of headache is still not clear. The first three spinal nerves, or C1-C3 of the upper or cervical spine where your neck lies, are thought to be involved in the majority of cases of cervicogenic headache. A spinal nerve carries signals from the spinal cord to corresponding areas of your body. The first three spinal nerves, C1-C3, provide sensation and movement to the head and neck, so if irritated or compressed, a headache may develop.

How is Cervicogenic Headache Diagnosed?

The diagnosis of this condition is challenging, as its symptoms overlap with other types of headaches. In addition, there is no consensus on exactly how this disorder is diagnosed. There are two sets of criteria described by different groups, the International Headache Society (IHS) and the Cervicogenic Headache International Study Group (CHISG). Below is a summary with explanation for the criteria described by IHS:

• Head and/or face pain is referred from a source in the neck. This can be demonstrated through clinical signs or through diagnostic anesthetic blockade of an upper neck or cervical structure or nerve.

• There must be clinical, laboratory, and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of the headache.

• Pain resolved within 3 months after successful treatment of the disorder causing the headache.

To clarify the criteria above, an example of a clinical sign would be a patient who has pain when a doctor presses on her upper cervical spine joints, or has limited range of motion of her neck.

A diagnostic blockade refers to an experienced doctor injecting an anesthetic or numbing agent into the area of the neck causing the pain. If the headache resolves with numbing of the nerve thought to be responsible, then a diagnosis of cervicogenic headache is supported.

An example of imaging evidence is a magnetic resonance imaging or MRI of the cervical spine.

What Else Could It Be?

If you suspect your head pain is being referred from your neck, a team of doctors can help tease apart a diagnosis of cervicogenic headache from other headache disorders. Remember, migraines and tension-type headaches, two of the most common types of headaches, cause similar symptoms of neck pain and muscle tenderness in the back of the head or upper neck. A less common medical condition, occipital neuralgia, can also mimic a cervicogenic headache. A person with occipital neuralgia has sharp, jabbing or burning pain along the occipital nerve, which exits the spinal cord in the upper spine and runs along the back of the head extending to the scalp and forehead. Hemicrania continua is yet another headache disorder that can mimic cervicogenic headache.

Other more serious medical conditions that may cause neck pain and headache include:

Internal Carotid or Vertebral artery dissection
• Brain or Spinal Tumor
Meningitis

Treatment of Cervicogenic Headache

Physical therapy is the initial treatment for cervicogenic headache, followed by steroid or anesthetic injection into the suspected joint space of the upper or cervical spine. Radiofrequency neurotomy is another form of therapy, in which radio waves are transmitted to the affected nerves through needles that create heat. The heat deactivates the nerve so it cannot send any more pain signals to the brain. Biofeedback, relaxation, and cognitive-behavioral therapy have also been examined as therapeutic options. Surgery is the last option for a patient when other treatment modalities fail.

Take Home Message

The criteria for a cervicogenic headache is multifaceted. Due to the controversy, as well as complexity surrounding the diagnosis of this disorder, a team of doctors is usually needed to make the diagnosis. Regardless, if you believe your neck is the source of your headache, please speak with your headache specialist so that you can be sure you are getting the proper treatment.

Sources

Biondi David. Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies. J Am Osteopath Assoc. April 1, 2005 vol. 105 no. 4 suppl 16S-22S.

Biondi, D. Bajwa ZH. Cervicogenic Headache. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2013.

Headache Classification Subcommitte of the International Headache Sociey. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004; 24 Suppl 1:9.

Sjaastad O, Bovim G. Cervicogenic headache. The differentiation from common migraine. An overview. Funct Neurol. 1991 Apr-Jun;6(2):93-100.

Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache. 1998;38:442.

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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