Cervicogenic Headache. Radiological Investigations Concerning Head/Neck

Fredriksen, Torbjørn A; Fougner, Reidun; Tangerud, Åse; Sjaastad, Ottar

doi:10.1046/j.1468-2982.1989.0902139.x

Cited by 32 publications

(15 citation statements)

References 10 publications

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“…(31) or by Fredriksen et al. (32), which underlines, at the present time, the fundamental importance of basing the diagnostic work‐up of such patients on the clinical picture. Our data also support previous notions indicating that radiological abnormalities, when present, are probably not specific for CEH.…”

Section: Discussionmentioning

confidence: 87%

Cervicogenic Headache: Evaluation of the Original Diagnostic Criteria

et al. 2001

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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.

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Section: Discussionmentioning

confidence: 87%

Cervicogenic Headache: Evaluation of the Original Diagnostic Criteria

et al. 2001

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“…No differences were found between CEH patients and control subjects. Fredriksen et al [24] showed a slightly increased incidence of degenerative changes of inferior cervical region in patients with CEH than control subjects by using cervical X-ray and tomography, but the figures did not reach a statistical significance. Vincent and Luna [25] found no significant changes on MRI scans of the cervical spine in patients with CEH.…”

Section: Diagnostic Issuesmentioning

confidence: 94%

Cervicogenic headache

SilvaJr.¹,

Bordini²

2006

Current Science Inc

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“…One study found no significant radiographic abnormalities of the head or cervical spine in patients with cervicogenic headache 10 . Another found no differences between patients with cervicogenic headache and normal subjects with respect to morphologic abnormalities on radiographs of the neck or radiographic hypomobility of the neck 11 .…”

Section: Challengesmentioning

confidence: 98%

“…Yet even the proponents acknowledge that “it is highly questionable whether such satisfactory results could be obtained by physicians who were not experienced at diagnosing headache syndromes.” Even if reliability is accepted, there is no evidence that any of these features are valid signs of a cervical disorder. Nor has radiography revealed any signs of a cervical lesion 10,11 …”

Section: Conflictsmentioning

confidence: 99%

Distinguishing Primary Headache Disorders from Cervicogenic Headache: Clinical and Therapeutic Implications

Bogduk

2005

Headache Currents

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The objectives of this article are to encapsulate the literature on the clinical aspects of cervicogenic headache, in order to help readers understand how cervicogenic headache can be distinguished from other primary headaches, and how it might be treated. Cervicogenic headache has evolved as a contentious and controversial entity. Tensions have developed concerning how it should be diagnosed, and if it at all exists as an entity. The literature is summarized and appraised in the form of a narrative review. Two conflicting approaches have been used to define cervicogenic headache. One has pursued the definition according to clinical features, but the validity of this approach has not been established. The other approach ignores clinical features and seeks instead to establish the diagnosis by demonstrating a cervical source of pain in the head. For that purpose diagnostic blocks have been used to pinpoint sources of pain in the upper cervical joints. Few treatments have been tested and validated for this condition. In conclusion, cervicogenic headache can be suspected but not diagnosed on the basis of clinical features. The diagnosis ultimately requires diagnostic blocks. Intra-articular steroids may be a useful treatment. Complete relief of headache can be achieved by radiofreqeuncy neurotomy in patients whose headache stems from the C2-3 zygapophysial joint.

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Cervicogenic Headache. Radiological Investigations Concerning Head/Neck

Cited by 32 publications

References 10 publications

Cervicogenic Headache: Evaluation of the Original Diagnostic Criteria

Cervicogenic Headache: Evaluation of the Original Diagnostic Criteria

Cervicogenic headache

Distinguishing Primary Headache Disorders from Cervicogenic Headache: Clinical and Therapeutic Implications

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