Cervicogenic Headache

There are many causes of recurrent headache that can persist for many years. Three common types are tension-type headache, migraine, and headaches secondary to a disorder in one of the top three or four joints in the neck. These neck-related headaches are commonly called cervicogenic headache (CGH). CGH is usually felt on one side of the head. It is always the same side and, unlike migraine, neck headaches do not swap sides. CGH is of mild-to-moderate intensity and is always accompanied by neck pain. Most typically, the pain begins in the neck and then spreads to a headache.

CGH can be a perplexing pain disorder that is refractory to treatment if it is not recognized. The condition’s pathophysiology and source of pain have been debated, but the pain is likely referred from one or more muscular, neurogenic, osseous, articular, or vascular structures in the neck.

The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibres from the upper cervical roots. This functional convergence of upper cervical and trigeminal sensory pathways allows the bidirectional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.

Clinical Presentation

Unilateral “ram’s horn” or unilateral dominant headache (Excluding those with bilateral headache or symptoms that typify migrane headaches).
Exacerbated by neck movement or posture
Tenderness of the upper 3 cervical spine joints
Association with neck pain or dysfunction
Definitive diagnosis made through selective nerve blocking through injection of specific sites
Compared to migraine headache and control groups, cervicogenic headache group patients tend to have increased tightness and trigger points in upper trapezius, levator scapulae, scales and suboccipital extensors
Weakness in the deep neck flexors
Increased activity in the superficial flexors
Atrophy in the suboccipital extensors and so the deep muscle sleeve which is important for active support of the cervical segments becomes impaired
Upper trapezius, sternocleidomastoid, scalenes, levator scapulae, pectoralis major and minor, and short sub-occipital extensors have been implicated

Differential Diagnoses