Cervicogenic Headache

Cervicogenic Headache

By Lori Montgomery MD CCFP

Introduction

Cervicogenic (say: SUR-vico jen-IK) headache is not a single disorder. It means that the source of headache is a problem in the neck. This can come from a wide range of other causes, from traumatic injury to arthritis. The International Headache Society is responsible for classifying headaches and deciding what to call them. They consider headache coming from whiplash injuries or myofascial pain as different headaches, but they have similar symptoms, and are treated in the same way. Cervicogenic headaches happen to about 1% (1 out 100) of the general population. They are a common cause of headache that happens daily.

Signs and symptoms

  • Pain is most often on one side of the head only.
  • It is often a dull or piercing pain, starting in the back of the head or the neck, and moving forward to the forehead or temples.
  • Headache can occur with pain and stiffness in the neck.
  • Headache can occur with pain or stiffness in the shoulder and arm on the same side.
  • Some people have some mild sensitivity to light and sound, and even nausea and vomiting with severe pain. This can cause confusion between headache and migraine.

Causes

A stated above, there are many causes of cervicogenic headache. We think that the reason neck pain causes headache is that there is a place in the upper part of the spinal cord where sensory nerve fibres from the neck meet sensory nerve fibres from the trigeminal nerve. This nerve transmits signals related to headache. This results in what we call referred pain. In this case, pain caused by structures in the neck is felt in the head.

Diagnostic tests

There is a set of diagnostic criteria established by the International Headache Society. It. includes a number of the signs and symptoms listed above. Sometimes, an injection of local anaesthetic can be done into the muscles in the back of the head. This temporarily blocks the greater occipital nerve. This results in a decrease in pain for many people with cervicogenic headache. The results are temporary, so this is a diagnostic test, not a treatment strategy. Other injections such as facet joint injections or medial branch blocks can help to diagnose the problem in a similar way.

Treatment approach

There is a lot of debate about the best way to treat a cervicogenic headache. Researchers are trying to find the best approach. Treatment should be aimed at the problem in the neck if possible. In most cases, this will involve physiotherapy and exercise to strengthen the deep, spine-stabilizing muscles.

Medicines

There are no medicines that are specific to cervicogenic headache. Sometimes, over-the-counter medicines such as anti-inflammatories or acetaminophen can stop or reduce the intensity of a headache. In cases of severe headache affecting function, opioids can be considered. However, be careful not to use any of these medicines on more than 10 days per month. Doing so can cause you to develop a medication overuse headache.
There is often some overlap between the symptoms of migraine and cervicogenic headache Migraine sufferers often describe neck pain as a trigger for migraine. In those cases, migraine medicines might be tried for a headache that seems to come from a problem in the neck.

Injections

Many researchers have studied injections of many types to treat cervicogenic headache. These include steroids, local anaesthetics, and botulinum toxin (Botox) injected into various structures in the neck. In very severe cases, spinal surgery has been tried as well. There are no convincing studies that show an improvement in headache after surgery.

Non-drug therapies

Studies have shown that non-drug therapies can help to reduce pain levels and enhance pain coping. These include:

  • relaxation
  • meditation
  • activity pacing
  • cognitive behavioural therapy

These self-management strategies can help you to improve your function so you can do more and enjoy life more.

For more information

Web sites

American Pain Foundation recommended links
www.painfoundation.org/page.asp?file=Links/Headaches.htm

TRIP Database (Resources for Evidence Based Medicine)
www.tripdatabase.com  

Headache Cooperative of New England
www.hacoop.org

World Headache Alliance
www.w-h-a.org

National Headache Foundation
www.headaches.org

NYU Medical Center/NYU School of Medicine
www.med.nyu.edu/painmanagement/patients/headaches.html

References

Mathew NT et al. Botulinum Toxin Type A (BOTOX®) for the prophylactic treatment of chronic daily headache: A randomized, double-blind, placebo-controlled trial. Headache. 2005;45(4)293-307.

Ribeiro S, et al. Cervicogenic headache. American Journal of Pain Medicine. 2005;15(2):48-58.

Saper JR, Dodick D, Gladstone JP. Management of chronic daily headache: Challenges in clinical practice. Headache. 45(s1):S74-S85.