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Cervicogenic headache

Authors
Zahid H Bajwa, MD
James C Watson, MD
Section Editor
Jerry W Swanson, MD, MHPE
Deputy Editor
John F Dashe, MD, PhD

INTRODUCTION

Neck pain and cervical muscle tenderness are common and prominent symptoms of primary headache disorders [1]. Conversely, it is plausible that head pain can be referred from bony structures or soft tissues of the neck, a condition called cervicogenic headache [2]. Nevertheless, there has been debate regarding the existence of cervicogenic headache as a distinct clinical disorder, as well as its underlying pathophysiology and source of pain [3-7].

This topic will review the definition, etiology, diagnosis, and treatment of cervicogenic headache.

ETIOLOGY AND ANATOMY

There is evidence that headache can be caused by referred pain from the upper cervical joints [6].

The anatomic locus for cervicogenic headache is the trigeminocervical nucleus in the upper cervical spinal cord, where sensory nerve fibers in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibers from the upper cervical roots (figure 1) [8]. This functional intersection of upper cervical and trigeminal sensory pathways is thought to allow the bidirectional transmission of pain signals between the neck and the trigeminal sensory receptive fields of the face and head.

The first three cervical spinal nerves and their rami are the primary peripheral nerve structures that can refer pain to the head (figure 2):

                 

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Literature review current through: Nov 2016. | This topic last updated: Mon May 02 00:00:00 GMT+00:00 2016.
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References
Top
  1. Blau JN, MacGregor EA. Migraine and the neck. Headache 1994; 34:88.
  2. Sjaastad O, Saunte C, Hovdahl H, et al. "Cervicogenic" headache. An hypothesis. Cephalalgia 1983; 3:249.
  3. Pöllmann W, Keidel M, Pfaffenrath V. Headache and the cervical spine: a critical review. Cephalalgia 1997; 17:801.
  4. Leone M, D'Amico D, Grazzi L, et al. Cervicogenic headache: a critical review of the current diagnostic criteria. Pain 1998; 78:1.
  5. Frese A, Evers S. Biological markers of cervicogenic headache. Cephalalgia 2008; 28 Suppl 1:21.
  6. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8:959.
  7. Rana MV. Managing and treating headache of cervicogenic origin. Med Clin North Am 2013; 97:267.
  8. Bogduk N. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther 1992; 15:67.
  9. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Third occipital nerve headache: a prevalence study. J Neurol Neurosurg Psychiatry 1994; 57:1187.
  10. Cooper G, Bailey B, Bogduk N. Cervical zygapophysial joint pain maps. Pain Med 2007; 8:344.
  11. Dwyer A, Aprill C, Bogduk N. Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine (Phila Pa 1976) 1990; 15:453.
  12. Bogduk N, Marsland A. The cervical zygapophysial joints as a source of neck pain. Spine (Phila Pa 1976) 1988; 13:610.
  13. Bogduk N, Marsland A. On the concept of third occipital headache. J Neurol Neurosurg Psychiatry 1986; 49:775.
  14. Schofferman J, Garges K, Goldthwaite N, et al. Upper cervical anterior diskectomy and fusion improves discogenic cervical headaches. Spine (Phila Pa 1976) 2002; 27:2240.
  15. Park SW, Park YS, Nam TK, Cho TG. The effect of radiofrequency neurotomy of lower cervical medial branches on cervicogenic headache. J Korean Neurosurg Soc 2011; 50:507.
  16. Sjaastad O. Cervicogenic headache: comparison with migraine without aura; Vågå study. Cephalalgia 2008; 28 Suppl 1:18.
  17. Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine (Phila Pa 1976) 1995; 20:1884.
  18. Sjaastad O, Fredriksen TA. Cervicogenic headache: criteria, classification and epidemiology. Clin Exp Rheumatol 2000; 18:S3.
  19. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J 2001; 1:31.
  20. Bogduk, N. Distinguishing primary headache disorders from cervicogenic headache: clinical and therapeutic implications. Headache Currents 2005; 2:27.
  21. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1990; 30:725.
  22. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 1998; 38:442.
  23. Jull G, Amiri M, Bullock-Saxton J, et al. Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches. Cephalalgia 2007; 27:793.
  24. Bogduk N. The neck and headaches. Neurol Clin 2004; 22:151.
  25. Fredriksen TA, Fougner R, Tangerud A, Sjaastad O. Cervicogenic headache. Radiological investigations concerning head/neck. Cephalalgia 1989; 9:139.
  26. Knackstedt H, Kråkenes J, Bansevicius D, Russell MB. Magnetic resonance imaging of craniovertebral structures: clinical significance in cervicogenic headaches. J Headache Pain 2012; 13:39.
  27. Delfini R, Salvati M, Passacantilli E, Pacciani E. Symptomatic cervicogenic headache. Clin Exp Rheumatol 2000; 18:S29.
  28. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  29. Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002; 22:15.
  30. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain 1993; 55:99.
  31. Lord SM, Barnsley L, Bogduk N. The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain. Clin J Pain 1995; 11:208.
  32. Stolker RJ, Vervest AC, Groen GJ. The management of chronic spinal pain by blockades: a review. Pain 1994; 58:1.
  33. Schellhas KP. Facet nerve blockade and radiofrequency neurotomy. Neuroimaging Clin N Am 2000; 10:493.
  34. Bovim G, Berg R, Dale LG. Cervicogenic headache: anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain 1992; 49:315.
  35. Campos CR, Calderaro M, Scaff M, Conforto AB. Primary headaches and painful spontaneous cervical artery dissection. J Headache Pain 2007; 8:180.
  36. Saeed AB, Shuaib A, Al-Sulaiti G, Emery D. Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. Can J Neurol Sci 2000; 27:292.
  37. de Sousa JE, Halfon MJ, Bonardo P, et al. Different pain patterns in patients with vertebral artery dissections. Neurology 2005; 64:925.
  38. Tfelt-Hansen P, Lous I, Olesen J. Prevalence and significance of muscle tenderness during common migraine attacks. Headache 1981; 21:49.
  39. Kaniecki RG. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology 2002; 58:S15.
  40. Waelkens J. Warning symptoms in migraine: characteristics and therapeutic implications. Cephalalgia 1985; 5:223.
  41. Jansen J, Bardosi A, Hildebrandt J, Lücke A. Cervicogenic, hemicranial attacks associated with vascular irritation or compression of the cervical nerve root C2. Clinical manifestations and morphological findings. Pain 1989; 39:203.
  42. Jansen J, Markakis E, Rama B, Hildebrandt J. Hemicranial attacks or permanent hemicrania--a sequel of upper cervical root compression. Cephalalgia 1989; 9:123.
  43. Hildebrandt J, Jansen J. Vascular compression of the C2 and C3 roots--yet another cause of chronic intermittent hemicrania? Cephalalgia 1984; 4:167.
  44. Sharma RR, Parekh HC, Prabhu S, et al. Compression of the C-2 root by a rare anomalous ectatic vertebral artery. Case report. J Neurosurg 1993; 78:669.
  45. Pikus HJ, Phillips JM. Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second cervical root. Headache 1995; 35:621.
  46. Pikus HJ, Phillips JM. Outcome of surgical decompression of the second cervical root for cervicogenic headache. Neurosurgery 1996; 39:63.
  47. Kuritzky A. Cluster headache-like pain caused by an upper cervical meningioma. Cephalalgia 1984; 4:185.
  48. Lance JW, Anthony M. Neck-tongue syndrome on sudden turning of the head. J Neurol Neurosurg Psychiatry 1980; 43:97.
  49. Bogduk N. An anatomical basis for the neck-tongue syndrome. J Neurol Neurosurg Psychiatry 1981; 44:202.
  50. Linde M, Hagen K, Salvesen Ø, et al. Onabotulinum toxin A treatment of cervicogenic headache: a randomised, double-blind, placebo-controlled crossover study. Cephalalgia 2011; 31:797.
  51. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002; 27:1835.
  52. Hall T, Chan HT, Christensen L, et al. Efficacy of a C1-C2 self-sustained natural apophyseal glide (SNAG) in the management of cervicogenic headache. J Orthop Sports Phys Ther 2007; 37:100.
  53. Nilsson N. A randomized controlled trial of the effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1995; 18:435.
  54. Borusiak P, Biedermann H, Bosserhoff S, Opp J. Lack of efficacy of manual therapy in children and adolescents with suspected cervicogenic headache: results of a prospective, randomized, placebo-controlled, and blinded trial. Headache 2010; 50:224.
  55. Haas M, Spegman A, Peterson D, et al. Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Spine J 2010; 10:117.
  56. Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997; 20:326.
  57. Racicki S, Gerwin S, Diclaudio S, et al. Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther 2013; 21:113.
  58. Bodes-Pardo G, Pecos-Martín D, Gallego-Izquierdo T, et al. Manual treatment for cervicogenic headache and active trigger point in the sternocleidomastoid muscle: a pilot randomized clinical trial. J Manipulative Physiol Ther 2013; 36:403.
  59. Shin EJ, Lee BH. The effect of sustained natural apophyseal glides on headache, duration and cervical function in women with cervicogenic headache. J Exerc Rehabil 2014; 10:131.
  60. Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia 2016; 36:474.
  61. Anthony M. Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol 2000; 18:S59.
  62. Nagar VR, Birthi P, Grider JS, Asopa A. Systematic review of radiofrequency ablation and pulsed radiofrequency for management of cervicogenic headache. Pain Physician 2015; 18:109.
  63. Lord SM, Barnsley L, Wallis BJ, et al. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996; 335:1721.
  64. Stovner LJ, Kolstad F, Helde G. Radiofrequency denervation of facet joints C2-C6 in cervicogenic headache: a randomized, double-blind, sham-controlled study. Cephalalgia 2004; 24:821.
  65. Haspeslagh SR, Van Suijlekom HA, Lamé IE, et al. Randomised controlled trial of cervical radiofrequency lesions as a treatment for cervicogenic headache [ISRCTN07444684]. BMC Anesthesiol 2006; 6:1.
  66. Gabrhelík T, Michálek P, Adamus M. Pulsed radiofrequency therapy versus greater occipital nerve block in the management of refractory cervicogenic headache - a pilot study. Prague Med Rep 2011; 112:279.
  67. Govind J, King W, Bailey B, Bogduk N. Radiofrequency neurotomy for the treatment of third occipital headache. J Neurol Neurosurg Psychiatry 2003; 74:88.
  68. Hamer JF, Purath TA. Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or third occipital nerve. Headache 2014; 54:500.
  69. van Suijlekom HA, van Kleef M, Barendse GA, et al. Radiofrequency cervical zygapophyseal joint neurotomy for cervicogenic headache: a prospective study of 15 patients. Funct Neurol 1998; 13:297.
  70. Lee JB, Park JY, Park J, et al. Clinical efficacy of radiofrequency cervical zygapophyseal neurotomy in patients with chronic cervicogenic headache. J Korean Med Sci 2007; 22:326.
  71. Halim W, Chua NH, Vissers KC. Long-term pain relief in patients with cervicogenic headaches after pulsed radiofrequency application into the lateral atlantoaxial (C1-2) joint using an anterolateral approach. Pain Pract 2010; 10:267.
  72. Slipman CW, Lipetz JS, Plastaras CT, et al. Therapeutic zygapophyseal joint injections for headaches emanating from the C2-3 joint. Am J Phys Med Rehabil 2001; 80:182.
  73. Narouze SN, Casanova J, Mekhail N. The longitudinal effectiveness of lateral atlantoaxial intra-articular steroid injection in the treatment of cervicogenic headache. Pain Med 2007; 8:184.
  74. Joseph B, Kumar B. Gallie's fusion for atlantoaxial arthrosis with occipital neuralgia. Spine (Phila Pa 1976) 1994; 19:454.
  75. Ghanayem AJ, Leventhal M, Bohlman HH. Osteoarthrosis of the atlanto-axial joints. Long-term follow-up after treatment with arthrodesis. J Bone Joint Surg Am 1996; 78:1300.
  76. Schaeren S, Jeanneret B. Atlantoaxial osteoarthritis: case series and review of the literature. Eur Spine J 2005; 14:501.