Cervicogenic Headache: The Basics

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Cervicogenic headache is a headache disorder that is sometimes mistaken for and even misdiagnosed as Migraine. Cervicogenic headache is referred pain perceived in the head from a source in the neck. It’s a secondary headache, which means that another illness or physical issue causes it. In the case of cervicogenic headache, the cause is a neck disorder or lesion. Although cervicogenic headache is not a form of Migraine, a cervicogenic headache can trigger a Migraine attack.

In the field of “headache medicine,” the gold standard for diagnosing and classifying migraine and other headache disorders is the International Headache Society’s International Classification of Headache Disorders, 3rd edition (ICHD-3). Here is the most recent information on cervicogenic headache from ICHD-3:

11.2.1 Cervicogenic Headache

Description:

Headache caused by a disorder of the cervical spine and its component bony, disc, and/or soft tissue elements, usually but not invariably accompanied by neck pain.

Diagnostic criteria:

A. Any headache fulfilling criterion C

B. Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache

C. Evidence of causation demonstrated by at least two of the following:

  1. headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
  1. headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
  1. cervical range of motion is reduced and headache is made significantly worse by provocative manoeuvres
  1. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:

Features that tend to distinguish 11.2.1 Cervicogenic headache from 1. Migraine and 2. Tension-type headache include side-locked pain, provocation of typical headache by digital pressure on neck muscles and by head movement, and posterior-to-anterior radiation of pain. However, although these may be features of 11.2.1 Cervicogenic headache, they are not unique to it, and they do not necessarily define causal relationships. Migrainous features such as nausea, vomiting and photo/phonophobia may be present with 11.2.1 Cervicogenic headache, although to a generally lesser degree than in 1. Migraine, and may differentiate some cases from 2. Tension-type headache.

Tumours, fractures, infections, and rheumatoid arthritis of the upper cervical spine have not been validated formally as causes of headache, but are nevertheless accepted as such when demonstrated to be so in individual cases. Cervical spondylosis and osteochondritis may or may not be valid causes fulfilling criterion B, depending on the individual case. When cervical myofascial pain is the cause, the headache should probably be coded under 2. Tension-type headache. However, awaiting further evidence, an alternative diagnosis of A11.2.5 Headache attributed to cervical myofascial pain is included in the Appendix.

Headache caused by upper cervical radiculopathy has been postulated and, considering the now well understood convergence between upper cervical and trigeminal nociception, this is a logical cause of headache. Pending further evidence, this diagnosis is found in the Appendix as A11.2.4 Headache attributed to upper cervical radiculopathy.

Diagnosing cervicogenic headache

In diagnosing cervicogenic headache, doctors look for the anatomical source of the pain. Nerve blocks are often used for this purpose. By administering nerve blocks, the doctor can determine which nerve is causing the pain. To confirm the diagnosis of cervicogenic headache, the headache must be relieved by nerve blocks.

Treating cervicogenic headache

Treatment for cervicogenic headache should target the cause of the pain (in the neck) and varies depending upon what works best for the individual patient. Treatments include nerve blocks, physical therapy and exercise, Botox injections, and medications. Physical therapy and an ongoing exercise regimen often produce the best outcomes.

Sources:

Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd edition (beta version).” Cephalalgia. July 2013 vol. 33 no. 9 629-808 10.1177/0333102413485658

Silberstein, Stephen D.; Lipton, Richard B.; Dodick, David W. Wolff's Headache and Other Head Pain. New York. Oxford Press. 2008.

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