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Cervicogenic Headaches - Causes, Symptoms, Diagnosis, and Treatment

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It is a chronic headache that usually starts in the neck, followed by a reduced range of motion. Read the article to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At March 8, 2023
Reviewed AtAugust 25, 2023

What Is Cervicogenic Headache?

Often confused with a migraine or a primary headache syndrome, cervicogenic headache is referred pain that starts in the neck due to irritation caused by cervical structures. It is common in people in their thirties and forties with a slight female dominance.

Typical symptoms include unilateral neck pain and reduced neck range of motion (ROM). The pain occurs in episodes of varying duration and severity and frequently radiates to the temple (also known as the occult frontotemporal area).

The pain does not resolve with over-the-counter medication and often needs medical intervention. It responds well to physical therapy but has a higher chance of recurrence. If left untreated, it can lead to debilitating conditions.

What Causes Cervicogenic Headache?

The pain is caused when the cervical nerves (specifically C1-C3) are irritated by the cervical structures. Cervical nerves are spinal nerves that arise from the cervical region of the spinal cord, and the cervical structures are the neck vertebrae located below the skull.

The irritation can be caused by a multitude of factors, some of which are as below:

  1. Degeneration of the cervical spine.

  2. Cervical disc problems.

  3. Cervical spine alignment problems.

  4. Rheumatic diseases like ankylosing spondylitis and rheumatoid arthritis.

  5. Head and neck trauma.

  6. Motor vehicle accidents often cause whiplash injury.

  7. Non-vehicle accidents like falls, direct neck trauma, etc.

  8. Head trauma.

  9. Problems of the head and shoulder muscles due to bad posture, sedentary work, awkward positions, etc.

When any of the above-mentioned factors are present, the cervical nerves (C1- C3) relay pain to the head and neck through the trigeminal (fifth cranial nerve). This happens through a process called functional convergence.

Functional convergence in the context of referral cervical pain is established when the sensory nerve fibers of the (descending) trigeminal nerve interact with the sensory fibers from the upper cervical roots, allowing the bidirectional referral of painful sensations between the neck and the trigeminal receptive fields of the face and the neck.

What Are the Symptoms of Cervicogenic Headache?

The symptoms of cervicogenic headache:

  1. Pain in the nape of the neck.

  2. Limitations of head and neck.

  3. Pain above or behind the eye.

  4. Facial pain.

  5. Temple pain.

  6. Forehead pain.

  7. Shoulder pain.

  8. Temporomandibular joint pain.

How Is Cervicogenic Headache Diagnosed?

The non-specific symptoms of this condition make diagnosis difficult. Nevertheless, the provider should obtain thorough medical history, perform a physical examination, and request necessary investigations to support the diagnosis. Physical examination may have one or more of the below-mentioned observations:

  1. Limitations of neck movements and pain on movement.

  2. Sensitivity in the neck muscles with manual pressure.

  3. Trigger points and tension in the neck and shoulder muscles.

  4. Weakness in the deep cervical flexor muscles (muscles that tilt the head forward).

  5. Aggravation of pain when pressure is applied to the nape of the neck.

  6. Postural problems like upper-crossed syndrome.

International headache disorders (ICHD-3) have established criteria to help diagnose cervicogenic headaches. They are:

  1. Any criteria that qualify the definition of headache.

  2. Evidence of the lesion within a cervical spine or soft tissue capable of causing a headache.

  3. Evidence of cause must be demonstrated by at least of the following:

  • Headache should have developed in the temporal region in correlation with the cervical lesion.

  • Headache should resolve in continuation with the improvement of the cervical lesion.

  • Provocation maneuvers should worsen the pain and reduce cervical motion.

  • Headaches should disappear after a diagnostic cervical block.

  • It should correlate with any other ICHD-3 subtypes.

How Is Cervicogenic Headache Treated?

There is no standard guideline for the treatment of cervicogenic headaches. A better understanding of the condition in recent years has helped to consider mechanistic approaches (that target central sensitization), ablative therapies (that focus on primary receptive sources), and physical therapies that relieve pain in the secondary areas. Some of the treatment options that have been successful in the past are mentioned below:

1. Physical Therapy - It is the first line of treatment for cervicogenic headaches; this includes manipulative therapy and a therapeutic exercise regimen. The former stimulates the neural inhibitory system (in the spinal cord) and activates the descending inhibitory system (in the trigeminal tract).

Physical therapy should always be slow at first because it tends to worsen the condition before it gets better. The exercise may include muscle strengthening and cervical traction. Anesthesia can be used while performing this to improve the patient's tolerance.

2. Interventional Therapy - A specialty that uses medical imaging guidance to perform minimally-invasive procedures to diagnose or treat the condition.

In cervicogenic headaches, this therapy uses injections to address the pain. For example, intra-articular and facet injections have been used to reduce cervicogenic pain caused due to osteoarthritis and whiplash injury.

3. Pharmacologic Therapy - This uses drugs like Pregabalin, Gabapentin, Duloxetine, etc., to reduce pain; however, the relief these drugs provide is temporary.

4. Ablation Therapy - This includes coblation (cold abulation) and neuromodulation; the effectiveness of these procedures in treating cervicogenic pain is yet to be determined.

Some of the at-home procedure that has been shown to reduce pain are-

  • Exercise - This includes techniques to improve posture and strengthen the neck and the core muscles.

  • Low-Intensity Whole Body Exercise - This includes yoga, pilates, walking, tai chi, and swimming.

  • Resolving Sleep Problems - Following proper sleep hygiene and correcting lying posture and sleep environment can be done.

  • Stress Management - Some techniques to manage stress, like cognitive therapy, psychotherapy, meditation, and yoga, helps to reduce pain effectively.

  • Acupuncture - This involves the placement of thin needles at strategic points to reduce pain.

  • Botulinum Injection - Botulinum (a type of poison) used in therapeutic doses can temporarily paralyze the muscles causing neck spasms.

Can Cervicogenic Headache be Avoided?

A few tips to avoid cervicogenic headaches are:

  1. Avoid single-sided heavy handling.

  2. Sit in the proper position at the desk.

  3. Take frequent breaks from continuously sitting at the desk.

  4. While using technology, like a phone or laptop, place it at eye level to avoid straining the neck.

  5. Protect the neck and shoulders from extremely warm or cold air.

Conclusion:

Cervicogenic headache is caused due to referral pain from the neck due to irritation of the cervical structures. It can be avoided by following simple home remedies like maintaining ergonomic posture, avoiding stress, and following proper sleep hygiene. However, if the condition does occur, it can be resolved with physical and interventional therapy. The prognosis is usually very good, but if the condition worsens, it is advised to consult the doctor immediately.

Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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