Cervicogenic headache
Do you frequently experience headaches that seem to originate from your neck? Do you notice that neck movements or stiffness often accompany your headache? If so, you might be suffering from a cervicogenic headache.
What is a Cervicogenic headache?
Cervicogenic headache is a secondary headache caused by an underlying issue in the cervical spine and its components; bone, disc, soft tissues.
Cervicogenic headache is a “referred pain”; a pain perceived in the head from a source in the neck.
The term cervicogenic headache is commonly misused and does not simply apply to a headache associated with neck pain.
Neck pain is usually but not invariably present or not necessarily severe.
In fact; many headache disorders, including migraine and tension-type headache can be associated with neck pain.
There must be evidence of a disorder within the cervical spine or soft tissues of the neck known to cause a headache.
Usually, the headache starts from the neck or the back of the head and spreads forward, typically to the forehead or behind the eye. Typically, the pain is on one side of the head, it tends to be continuous and non-throbbing.
Associated neck symptoms include neck pain, stiffness, limited and painful range of motion, neck movements worsen the pain. Intermittent nausea and sensitivity to light or sound can be present which might lead to confusion with a migraine, but in cervicogenic headache these symptoms are not predominant as in migraine. Cervicogenic headache symptoms may overlap with other types of headaches, like tension-type headaches.
What causes cervicogenic headaches?
A dysfunction of the upper cervical spine, particularly the C2-C3 spinal segments and the occipital-cervical junction where the skull meets the neck are often implicated in cervicogenic headaches.
Conditions affecting the upper cervical structures triggering the pain can be:
- Poor posture
- Joint dysfunction
- Muscle tension and strain
- Disc herniation
- Root compression
- Whiplash or neck trauma
- Rheumatoid arthritis
Diagnosing cervicogenic headache
A detailed neurological evaluation including history and physical examination is necessary to determine if a cervicogenic issue is an underlying cause of the chronic headaches.
Other diagnoses such as migraine or tension-type headache, need to be excluded as should be other secondary causes of headaches. Neuroimaging studies such as X-rays, MRI of the cervical spine and/or brain help identifying structural abnormalities.
At the end, there should be clinical 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.
As per ICHD-3 classification; there should be evidence of causation demonstrated by at least two of:
- Headache has developed in temporal relation to the onset of the cervical disorder.
- Headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion.
- Cervical range of motion is reduced and headache is made significantly worse by provocative manoeuvres.
- Headache is abolished following diagnostic blockade of a cervical structure or its nerve supply.
Treatment options for cervicogenic headache
The treatment depends on the cause and individualized to each patient.
- Self-care: good posture, proper sleep positions.
- Physiotherapy.
- Therapeutic exercises: Strengthen and stretch neck muscles.
- Medications: NSAIDs, muscle relaxants.
- Nerve block injections.
- Appropriate, targeted treatment if a specific cause is found: disc herniation, root compression etc.
If you are experiencing persistent headaches accompanied by neck pain, it’s recommended to see your neurologist to avoid worsening of the underlying cause and progressing towards difficult to treat chronic headaches.
