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

Abstract

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.

Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches

“…The diagnostic significance of an isolated feature of musculoskeletal impairment has rightly been questioned because of the potential normal variability in a single measure such as range of movement (14, 15). To date, there has been no clinical sign or set of signs that has been helpful for diagnosis (44). Classically, musculoskeletal disorders are characterized by a pattern of coexisting impairments in the articular and muscular systems.…”

Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients

“…Headache, if asked for, is frequently reported by patients with cervical radiculopathy but in general not discussed in terms of nerve root compression in the lower cervical spine. On the other hand, affection of nerve structures in the upper cervical spine, including the C2 and C3 nerve roots and the occipital major nerve, are accepted as a cause of occipital headache [8]. The term cervicogenic headache [34], is often mentioned in the literature.…”

Headache Plus: Trigeminal and Autonomic Features in a Case of Cervicogenic Headache Responsive to Third Occipital Nerve Radiofrequency Ablation: Table 1

“…There are multiple sets of diagnostic criteria as well as differing opinions about the role of interventional approaches in diagnosis and treatment. As noted above, the clinical criteria for cervicogenic headache suffer from poor interrater reliability and specificity with regard to range of motion and precipitation by external pressure [6]. On the interventional end of the diagnostic spectrum, the IHS criteria for the diagnosis of cervicogenic headache include abolition of pain via blockade of nerves that innervate responsible cervical lesions.…”

“…Purely clinical diagnostic criteria for cervicogenic headache include unilateral pain, reduced range of neck movement, ipsilateral shoulder and arm discomfort, and mechanical precipitation of attacks by awkward neck positions or external pressure against occipital structures [5]. These criteria, however, have poor interrater reliability and specificity [6,7]. Others argue that in order to attain validity, a cervical source of the pain must be identified via diagnostic blocks [1].…”