Cervicogenic Headache – Symptoms, Treatment, Causes, Exercises

Cervicogenic headache is a type of headache which involves hemicranial pain that tends to be chronic. The pain is often referred to the head from any soft tissues or bony structures on the neck. The mechanism of cervicogenic headache is rooted from the functional convergence of the trigeminal sensory pathway and the upper cervical pathways. The trigeminocervical nucleus in the upper cervical spinal cord sends pain signals to the sensory fibers in the upper cervical roots. As a result, there is referred pain from the neck to the face and head.

Cervicogenic headache has a different mechanism from other types of headache, but it can be similar in presentation to hemicranias continua, and tension-type and migraine headaches.

The presence of cervical muscle soreness and neck pain is common in primary headache types such as migraine and tension-type headaches. However, in the case of cervicogenic headache, the pain actually arises from the bony and soft structures of the neck, contrary to primary headaches where the neck pain is secondary to the headache. The exact roots of the headache are from problems in the vascular, articular, osseus, neurogenic, or muscular structures of the neck innervated by C1 to C3 cervical vertebrae.

The presence of cervicogenic headache is often initiated by awkward head position or neck movements.

Cervicogenic Headache Symptoms

Symptoms of cervicogenic headache include:

Ipsilateral headache

A headache is the most apparent symptom of cervicogenic headache. The headache usually arises on the same side where neck or arm discomforts are felt. The presence of pain on the occipital area or back of the head usually radiates to the forehead or temples. The quality of pain may be different from person to person. Others may experience an ice pick headache, while others may feel dull pain. The pain in the head usually starts at the base of the neck and progresses up to the head.

Restricted cervical range of motion

The main problem in cervicogenic headache can be traced to neck problems. Patients who suffer from a cervicogenic headache usually experience restricted motions of the cervical spine or neck stiffness. The base of the neck is often tender at the onset of headaches.

Arm, shoulder, and neck pain that tend to be ipsilateral

The discomfort also radiates to the arms and shoulders that occur on the same side of the headache. Patients who suffer from a migraine headache may also experience these discomforts, making the identification of cervicogenic headache difficult.

Sensitivity to light and sound

Similar to a migraine, the cervicogenic headache may also cause increased sensitivity to light and sound, which usually triggers neck and head discomforts.

Nausea and Vomiting

Nausea and vomiting are also classic signs of headaches due to the affectation of nerve roots in the brain stem.

Causes of Cervicogenic Headache

The main causes of cervicogenic headache are neck injuries which cause compression of the occipital nerves. There are various causes of headache including:

• Trauma

Trauma to the spine such as whiplash injury and other neck-related injuries may cause injury to the neck structures, thereby leading to compression of the cervical nerves and trigeminal nerve.

• Cervical osteoarthritis

The presence of joint degeneration in the cervical spine may also cause cervicogenic headache due to disruption in the nerve fibers as a result of nerve compression in the area.

• Tumor growth

Tumors that grow in the spine may also cause occlusion or compression of the adjacent nerves, thereby leading to cervicogenic headache.

• Frequent downward positioning of the head

Frequent reading or working with the head in a downward position puts strain on the neck muscles and nerves.

• Improper sleeping and work position

Chronic postural strain from poor working and sleeping positions creates repetitive stress on the neck area, leading to nerve irritation and vascular constriction.

• Inflammatory condition involving the neck and head

Presence of other inflammatory conditions in the neck may also predispose the occurrence of cervicogenic headaches.

• Conditions such as diabetes and vasculitis

The presence of these disorders usually affects the circulation in the body, including the neck. Vasculitis and diabetes usually result in affectations of the nerves due to poor blood supply in the area.

These causes of cervicogenic headache should be identified in order to differentiate cervicogenic headache from other primary headache types.

Treatment of Cervicogenic Headache

The treatments for cervicogenic headache often employ various modalities such as medications, physical therapy, psychological and behavioral therapies, anesthetic use, and surgery.

Pharmacologic therapy

Medications are used to relieve symptoms of the disorder. These may include:

Analgesics

Centrally acting analgesics as well as non-steroidal anti-inflammatory drugs are given to relieve pain in the neck, head, shoulders,and arms. Narcotic analgesics are rarely used for the treatment of chronic conditions due to the possibility of drug dependence. Analgesics may include acetaminophen, celecoxib, and naproxen.

Antidepressants

Antidepressants are also used for the management of neuropathic pain. Serotonin and norepinephrine reuptake inhibitors such as duloxetine and venlafaxine are most commonly used. The dosage of antidepressants for pain management is significantly lower than that for depression management.

Anticonvulsant drugs

Anticonvulsant drugs are also used for the treatment of neuropathic pain by stabilizing the nerve impulse transmission. These include divalproex sodium, gabapentin, topiramate, and carbamazepine. Liver enzyme should be monitored because these medications usually are hepatotoxic.

Muscle relaxant

Muscle relaxants may also be used to treat cervicogenic headache by relaxing muscles in the neck area, thereby reducing neck stiffness. These may include baclofen and tizanidine hydrochloride.

Botulinum toxin injections

These may be employed to reliefve muscle spasms in the neck.

Steroid injections

Steroids are also employed to reduce inflammation and pain in inflammatory disorders in the neck.

Physical Therapy

Physical therapy serves as a rehabilitative treatment for cervicogenic headache patients. Exercise programs geared in the neck and shoulder area help patients regain normal neck functions.

Psychological and behavioral therapies

These therapies, which serve as adjunctive therapies to allow increased tolerance to pain, use biofeedback, cognitive-behavioral therapy, and relaxation techniques.

Anesthetics

Anesthetics are sometimes injected in the cervical epidural area to provide temporary pain relief. The anesthesia is usually injected in the C2 and C3 levels.

Surgery

Surgery serves as a last resort for treatment of unresponsive patients. Surgical procedures may include the removal of cervical entrapment of the occipital nerve in the trapezius muscle.

ICD 9 code

Cervicogenic headache has an ICD 9 code of 307.81.