Cervicogenic headache

The “cervicogenic headache” or “neck headache” is a secondary headache caused by stiffness or other challenge in the neck.
Joints, intervertebral discs and/or muscles and other soft tissues can contribute.

Cervicogenic headache is most often accompanied by neck pain and affects one side of the head, the same side as the neck pain.
The diagnosis is somewhat controversial, and has similarities with both tension headaches (from muscles) and migraines (often one-sided).

1

The headache is unilateral.

2

The headache originates from the upper neck.

3

You don’t need an X-ray or nerve block to be diagnosed.

Occurrence

The prevalence is 0.4-4% among people suffering from headaches and is most common for ages between 30 and 44.

Possible mechanisms
  • The upper nerve roots (level C1-C3) send pain signals from the head and neck.
  • The nerve roots send signals to the trigeminocervical nucleus in the brainstem, which also receives pain signals from the face via the fifth cranial nerve (V1-V3).
  • The connection with the trigeminocervical nucleus causes pain in the skull and to the eyes. 70% of all cases involve the joint between the second and third vertebra (C2-C3).

Physical trauma, such as whiplash causing strain or spasms in the muscles of the neck or shoulders, can make the area susceptible to more severe pain due to sensitization.

Other reasons can be:

Normal description of symptoms

Headaches are common:

  • One-sided and does not change sides.
  • Starts in the neck and radiates to the base of the skull (neck rosette), side of the head, forehead or around the eyes.
  • The intensity is moderate to severe.
  • Non-throbbing and non-sharp pain.
Other symptoms

Cervicogenic headache can in rare cases cause nausea, vomiting, sensitivity to light or sound. In such cases, migraine must be considered a more likely diagnosis.

Duration

The duration is variable and can last from hours to months.

Frequency

The pain can be intermittent (come and go) or constant.

Triggers

The headache is triggered by neck movements or pressure on the upper neck on the affected side. Physical trauma to the neck, such as whiplash, can trigger cervicogenic headaches.

Forverrende faktorer

Nakkebevegelser eller trykk mot øvre nakke på den berørte siden kan forverre en episode.

Mitigating factors

Movement or physical activity can relieve pain.

Book time

Treatment

Non-medical treatment:

There is good evidence for short- and long-term reductions in frequency, intensity and disability with manual and exercise therapy, including neck manipulation.

Medical interventions may include:

Diagnostic criteria for cervicogenic headache translated from International Classification of Headache Disorders, version 3:

  1. Any headache that meets criterion C
  2. Clinical and/or imaging diagnostic evidence of a disorder or lesion of the cervical spine or soft tissues known to cause headache
  3. Proof of causality demonstrated by at least two of the following:
    1. Headaches that have developed in temporal relation to the onset of the neck injury or the appearance of the lesion
    2. Headache that has significantly improved or disappeared in parallel with improvement in or resolution of the neck disorder or lesion
    3. Neck range of motion is reduced and the headache is made significantly worse by provocative maneuvers
    4. The headache is eliminated after diagnostic blockage of a neck structure or its nerve supply
  4. Not better explained by another ICHD-3 diagnosis.