Cervicogenic Headache: Evaluation of the Original Diagnostic Criteria

Abstract

A variety of headaches are frequently associated with the occurrence of neck pain. The purpose of this paper was to describe the adherence to diagnostic criteria of a series of patients enrolled on the basis of two clinical criteria: (1) unilateral headache without side-shift, and (2) pain starting in the neck and spreading to the fronto-ocular area. One hundred and thirty-two patients (36 male and 96 female) entered the study. Sixty-two patients were assigned to Group A (patients fulfilling criteria 1 and 2), 40 to Group B (criterion 2 only) and 12 to Group C (criterion 1, only). Eighteen subjects were excluded because X-rays of the neck were not available. Patients were evaluated regardless of whether or not they fell into one or more of the following diagnostic categories: cervicogenic headache (CEH), migraine without aura (M) and headache associated with disorders of the neck (HN) (IHS definitions). Fulfillment of the diagnostic criteria for CEH was found to be particularly frequent in Group A. A higher frequency of CEH diagnosis was found when two criteria were used (Group A) than in Group B (P = 0.001); in the former group a higher mean number of diagnostic criteria for CEH were also present (P = 0.001). Group A patients more frequently presented pain episodes of varying duration or fluctuating, continuous pain and moderate, non-excruciating, non-throbbing pain than Group B patients (P = 0.04 and P = 0.08, respectively). In Group C patients, the frequency of these two criteria was relatively low (17%) especially of the first mentioned variable. The presence of at least five of the seven 'pooled' CEH criteria (present in > or = 50% of the patients) might be deemed a reliable cut-off point, allowing the headache to be diagnosed as 'probable' CEH. If patients fulfilling M or HN criteria in addition to the CEH criteria are added to the 'pure' CEH group a total of 74% of Group A patients may have a CEH picture. The temporal pattern of pain and the quality of pain in Group A showed good sensitivity and specificity (> or = 75) when compared with Group B; therefore, the chances of diagnosing a definite CEH are significantly more frequent in patients presenting with unilateral pain that also begins as a neck pain. Head/neck trauma and radiological abnormalities in the cervical spine were not significantly associated with CEH, M or HN diagnoses. An improvement of the current diagnostic IHS criteria might make it possible to avoid the existing, partial overlap of CEH with HN and M. Extensive use should be made of the GON, and other, blockades in the routine work-up of CEH, both in the differential diagnosis and in the mixed forms (CEH + M, and CEH + HN), in order to improve the efficiency of the current diagnostic system.

Diagnosing cervicogenic headache

“…The combination of pain first felt in the neck and then spreading unilaterally to the frontal area on the same side fortifies the suspicion that one may be faced with a case of CEH. The site and radiation of pain, the temporal pattern and the mechanical precipitation of attacks, both iatrogenically and subjectively, are important aspects of the clinical picture and may help in distinguishing between CEH on the one hand and migraine and TTH on the other [13,14]. In patients with bilateral pain, but still with a preponderance on the usual side, anaesthetic blockades become mandatory even in clinical practice.…”

Greater occipital nerve blockade in migraine, tension-type headache and cervicogenic headache

“…Pain, stemming from the neck, usually spreads to the oculofrontotemporal area [3,4]. It is moderate in intensity, appears more frequently in women, and is associated with signs and symptoms linking it to the neck [4,5]. Although unilaterality of pain was a strict criterion as defined in the original criteria for CH diagnosis, recent reports proposed that it might also be bilateral [3].…”

“…There are still some unresolved questions about the differential diagnosis of CH, TTH and MWOA. Although some reports indicated that anaesthetic blockade of GON is accepted as a diagnostic tool for CH, some studies showed the effectiveness in patients with TTH or MWOA [4,[7][8][9][10]. The aim of this placebo-controlled, randomised and double-blind study was to evaluate the diagnostic value of GON blockade in patients with CH, TTH and MWOA.…”

“…Pain, stemming from the neck, usually spreads to the oculofrontotemporal area [3,4]. It is moderate in intensity, appears more frequently in women, and is associated with signs and symptoms linking it to the neck [4,5].…”

“…However, there are few reports about the usefulness of GON blockade in patients with migraine without aura (MWOA) and tension-type headache (TTH) [3][4][5].…”