Timothy C. Hain, MD. Page last modified: June 18, 2009

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A cervical headache is one that derives from injury to 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).

Clinical Presentation.

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.

Treatment:

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

• Physical therapy
• Fiorinal or fioricet
• Non-steroidal analgesics (Celebrex, Ibuprofen , Naproxen, Vioxx).
• Other pain medications(e.g. Tylenol with codeine)
• Muscle relaxants (e.g. Flexoril, Zanaflex, Robaxin)

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

• Botox injection
• Facet blocks
• Radiofrequency thermocoagulation (RFTC) -- basically microwave treatment of the nerve (Uematsu et al, 1974)

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:

• Lord SM, Barnsley L, Wallis BJ et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. NEJM 1996:335 1721-1726
• Uematsu S, Urdrahey GB, Benson DW et al. Percutaneous radiofrequency rhizotomy. Surg Neurol 2:319-325, 1974