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CERVICAL HEADACHE

Timothy C. Hain, MD. Page last modified: April 21, 2012

You may also be interested in our many pages on migraine on this site

A cervical headache is one that derives from the neck. An example of a cervical headache is a headache associated with a whiplash injury. Lord et al found headaches associated with whiplash to occur in 88%. Dizziness is also common in this context. Using diagnostic blocks, Lord found 54% of these patients had pain originating from facet disease (Lord et al, 1996).

Many papers have been written on the subject. A search in mid-2010 for "cervicogenic headache" brought up 340.

Neck pain is a common consequence of whiplash injuries. Unfortunately, chronic neck pain is often a consequence.

Diagnostic criteria.

In the author's opinion, cervical headaches are generally localized to the posterior neck. They overlap with tension headache and migraine. Headaches are generally related to head position. They generally do not shift from side to side (like migraines). There is often local tenderness, spasm of neck muscles. The headache usually does not throb. Visual symptoms such as flashing lights or jagged lines of light are not found in cervical headaches (they are common in classic migraine). Cervical headaches may be relieved by massage.

More formally, Sjaastad and colleagues have published several iterations of criteria for cerviogenic headache. This is an abbreviated form of them (Sjaastad et al, 1998, 42-43)

Major criteria

  1. Symptoms and signs of neck involvement
    1. Precipitation of head pain by neck movement or pressure over the cervical or occiptal region
    2. restriction of range of motion in the neck
    3. ipsilateral neck, shoulder or arm pain
  2. Confirmatory evidence by diagnostic block
  3. Unilateral head pain

There are also a number of other criteria which are not required for diagnosis. Of course, persons with visual aura would be unlikely to have cervicogenic headache. Persons with sensory amplifications - -photophobia, phonophobia, osmophobia -- would be also be more likely to have migraine.

The most important criterian here is response to a diagnostic block. If a block has not been done, restriction of head flexion/extension and rotation are characteristic (Zwart, 1997)

Studies of these criteria have suggested that about 30% of patients with "cervicogenic headache" also meet criteria for migraine. Patients with tension headaches all had bilateral symptoms (so didn't meet criteria for CH).

Prevalence of cervicogenic headache.

Cervicogenic headaches are common (no surprise there). Nilsson (1995) found the prevalence to be about 2.5% in a random sample of 20-59 year olds in Denmark. In persons with headache, Pfaffenrath and Kaube (1990) reported that the prevalence was 13.8%. There was also co-occurence of migraine and tension.

Mechanism of cervicogenic headache.

trigeminocervical nucleus

(from http://www.savagebees.co.uk/images/fig3b%20trigeminal%20nerve.JPG).

Recent thought about headache among neurologists has emphasized the "convergence hypothesis" -- according to this idea, almost all headaches are mediated through similar circuitry. Pain input converges in the brainstem on the descending nucleus of the Vth cranial nerve. This nucleus goes into the upper cord as low as C4. After it crosses over and ascends to the thalamus.

Activation in the descending nucleus of V is inhibited by serotonin, and thus "triptan" medications for migraine, selective agonists for 5-HT1b and 1d, might be effective. A combination of an attempt to reduce the source of pain with physical measures such as physical therapy or blocks, and attempting to block the central perception of head pain with migraine medications, is the author's usual approach to this problem.

Tre+atment:

Treatment of cervical headache is generally eclectic: Common treatment measures include

Less commonly, a more invasive approach may be taken including injections to reduce neck spasm or blocks.

If there is a herniated disk, or other significant structural abnormality, surgery may be recommended. In order to determine if a destructive procedure is indicated (such as RDTC) a diagnostic ganglion block may be required.

References:

Copyright March 24, 2014 , Timothy C. Hain, M.D. All rights reserved. Last saved on March 24, 2014