Cervicogenic Headache



  • Chronic hemicranial pain, referred to the head from bony or soft tissues of neck
  • Trigeminal nerve nucleus, accessory (CN xi) and upper Cx nerves implicated
  • DDx- migraine, tension headache
  • Origin from musculoskeletal source in neck
  • May be precipitated by neck movement especially passive rotation to side of headache, neck in extension.
  • No Cx neurological signs
  • CT & MRI normal (no incressed incidence of cervical disc etc)
  • Check bloods for inflammatory markers and autoantibodies

Clinical characteristics

Unilateral (non-throbbing) head pain (without shift)

Precipitation of pain by neck movement

Ipsilateral non-radicular arm/shoulder pain

Trigger point in neck muscles

Diagnostic anaesthetic blockade

F > M

± assoc. N&V, photophobia, lacrimation etc

Little response to NSAIDs / Ergot / Triptans


Persisting or atypical symptoms may need invistigation to exclude : posterior fossa fumour, Arnold- Chiari malformation, cervical spondylosis / arthropathy, Cx disc or other nerve compression, AVM, vertebral artery dissection, and spinal tumors


Treatment (multifaceted)

Pharmacologic

  • TCADs
    • SSRIs generally ineffective
  • Antiepileptic drugs (gabapentin, carbamazepine)
    • Stabilizers of peripheral and central pain transmission
    • Gabapebtin usually for post herpetic neuralgia etc
    • Carbamazepine is effective in trigeminal neuralgia but will require GP to check LFTs and FBC
  • Muscle relaxants (baclofen)
    • Central action
  • NSAIDs (Nonselective cyclooxygenase inhibitors)
    • AVOID narcotics

Manipulative

  • Osteopathic manipulative
  • Physiotherapy
  • TENS
  • Biofeedback & psychotherapy

Anaesthetic

  • Anesthetic blockade - spinal roots, nerves, rami, or branches or muscular trigger points
  • Botulinum toxin injections
  • Occipital nerve stimulator

Surgical

  • Neurectomy
  • Nerve exploration and "release"
  • Joint fusion


Content by Dr Íomhar O' Sullivan 18/01/2008. Next review 18/01/2009