Cervicogenic Headaches

A frequently misdiagnosed condition, cervicogenic headache (CH) is a secondary headache provoked by a disorder of the cervical spine, causing referred symptoms of pain which are perceived as a headache.

There are numerous different types of recognised headache disorders, the three most common types of primary headaches are tension type headaches, migraines and cluster headaches.

Patients suspected of Cervicogenic Headaches must be thoroughly assessed to exclude primary headaches or other secondary causes of headache, where neck pain and cervical muscle tenderness may be present.

Cervicogenic Headache Symptoms

Typically, headaches are described as a continuous dull ache felt primarily in the occipital region and sometimes in the neck itself. In some cases, pain may radiate to the forehead, orbital region or temples. CH is usually felt only on one side and may or may not be associated with neck pain. Episodes vary in duration depending on the individual, from intermittent attacks of pain lasting days, to constant pain with or without acute attacks.

Symptoms may worsen during movement of the neck or a sustained neck posture and in more severe cases there may be other associated symptoms such as dizziness, nausea, blurred vision, photophobia and phonophobia.

What Causes Cervicogenic Headaches?

In cases of Cervicogenic Headaches, pain is a result of a disorder of the bone structure or soft tissues in the cervical region – a complex network of cervical vertebrae, joints, ligaments, muscles, veins, arteries and nerve roots.

A convergence of sensory pathways occurs between the sensory nerve fibres of the upper cervical spinal cord and the descending tract of the trigeminal nerve – the largest of the cranial nerves, responsible for providing sensations and muscle function to the face. The interaction of the sensory pathways between the cervical and cranial region allow the bidirectional referral of painful symptoms between the neck and the head. Therefore, the symptoms of a disorder originating in the cervical region, may be felt in the head rather than in the neck itself.

The source of CH more frequently originates from issues in the C2, C3 and C4 joints in the neck region.

cervical vertebrae

Trauma to the cervical spine is the most common cause of Cervicogenic Headcahes. Fractures or soft tissue damage may occur as a result of impact such as severe whiplash caused by a car crash, another injury to the neck, or a direct blow to the neck from a fall or physical abuse. Other possible causes are tumour, infection and rheumatoid arthritis. There is ongoing debate as to whether age related degenerative spondylosis is related to CH.

Diagnosis

Many of the symptoms of CH mimic those of the migraine such as nausea, photophobia, phonophobia, dizziness and blurred vision; this significant overlap can cause misdiagnosis.

Differential diagnosis of Cervicogenic Headaches can be recognised using the following criteria:

  • There is evidence of a lesion or disorder to either the cervical spine or soft tissues in the neck
  • The headache developed in relation to the onset of the above disorder
  • Tenderness upon palpation is found over the greater or lesser occipital nerve, and/or soft tissues in the upper or middle cervical region
  • Pain is localised to the cervical and occipital region and may also radiate to other regions of the face
  • There is a restriction of range of motion in the neck and stiffness
  • Pain is aggravated by sustained awkward neck positions
  • Resolution of the cervical disorder or lesion significantly improves the headache
  • The use of diagnostic anaesthetic cervical nerve blocks abolish the headache

Other forms of diagnostic testing may lend support to the diagnosis such as MRI and CT scans.

Treatment

This should be focused on targeting the source of the pain in the neck, the cervical disorder or lesion. Treatment often includes the use of nerve blocks, a mixture of anaesthetic and steroid, typically a GON (Greater Occipital Nerve) block or a medial branch block – radiofrequency denervation may also be useful. Nerve blocks not only provide in many cases effective pain relief, but also have the added benefit of allowing better participation in physio therapy activities. Certain medications such as non-steroidal anti-inflammatories may be useful, but this type of headache does not respond well to medications used for migraine treatment.

Visit a pain management clinic where a specialist can devise an individual patient plan of combined treatments to provide the best possible outcome.

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