Cervicogenic Headache

Cervicogenic headache refers to head pain originating from the pathology in the neck. The term cervicogenic headache was first introduced by Sjaastad and colleagues in 1983. However, the concept of cervicogenic headache is controversial and not well accepted by the majority of neurologists. The International Headache Society published its first diagnostic criteria in 1998 and revised it 2004. Patients with cervicogenic headache often have histories of head and neck trauma. Pain may be unilateral or bilateral. Pain is frequently localized in the occipital area. However, pain may also be found in the frontal, temporal or orbital regions. Headaches may be triggered by neck movement or sustained neck postures. This headache is constant with episodic throbbing attacks, like a migraine.

Patients may have other symptoms mimicking a migraine, such as nausea, vomiting, photophobia, phonophobia, and blurred vision. Cervicogenic headache is often misdiagnosed as migraine(10). History of head injury and detail physical examination on the occipital and upper cervical area often can help differential diagnosis. Patient with cervicogenic headache may have tenderness over the suboccipital, C2, C3, or C4 regions, or over the third occipital nerve.

Cervicogenic headache does not respond well to migraine medications. Treatment should be focused on the removal of pain source from the occipital-cervical junction. Initial therapy is directed to physical therapy modalities and NSAIDs. Interventional treatment, such as greater occipital nerve block, cervical facet joint block, and botulinum toxin injections, often provides effective pain relief.