Cervicogenic Headaches

By: Dellvin Nguonly (edited by Dr.  Trainor)

The World Health Organization estimates that approximately 50% of young adults are consistently affected by headaches globally.¹ With so many different causes and types of headaches, it can be hard to know what the best course of treatment is. The most common cause of headaches include cluster headaches, tension-type headaches, and migraines.¹ Over-the-counter medications including Aspirin, Tylenol, and Ibuprofen comprise the typical treatment regimen, usually with great success. Occasionally, headaches persist despite this, and other considerations must be taken as chronic pain can significantly impact a patient’s quality of life.

In young adults, chronic headaches can be caused by a variety of reasons. Most commonly between the ages of 30 to 44 years old, cervicogenic headaches is a less common, but ever-prevalent cause of chronic headaches related to neck pain.² Cervicogenic headaches are proposed to be caused by referred pain arising from irritation of the spinal nerves of neck at the levels of C1, C2, and C3 in relation to the corresponding cervical spinal structures.^3,4 Studies have shown that approximately 70% of cases of suspected cervicogenic headaches involve the C3 spinal nerve and its interaction at the C2-C3 zygapophyseal joint.³

Signs and symptoms of this condition of chronic pain include unilateral pain stemming from the neck continuing throughout the affected side of the skull.² The pain may be associated with reduced range of motion and main with movements of the neck and shoulder on the affected side.² Although the more common types of headaches can present similarly, symptoms common with migraines including photophobia, nausea, and vomiting are not typically noticed.

Although imaging studies may be conducted to rule out other structural causes of headaches, radiologic imaging of the cervical spine is not sensitive enough for definitive diagnosis of cervicogenic headaches.^2,5 Instead, diagnosis is based on a complex set of criteria as outlined by the Headache Classification Committee of the International Headache Society (IHS) in The International Classification of Headache Disorders (ICHD) guide.⁶ However, diagnostic anesthetic blocks of suspected joints can be an alternative route of diagnosis that is performed by pain specialist physicians. With this procedure, anesthetic medication is injected into the joint space to blunt the pain response output by the irritated nerve or nerves in question. With significant relief of neck and head pain via this procedure, diagnosis of cervicogenic headaches can be determined.

First line treatments of suspected cervicogenic headaches is physical therapy.² Studies have shown that up to 70% of patients have reported a reduction of 50% or more in pain overall with the use of manipulative therapies and exercise regimens.⁷ With the failure of first line and conservative treatments, more invasive therapies offer alternative strategies for pain relief. Intraspinal nerve blocks can achieve temporary pain relief of these headaches, while radiofrequency ablation can be used as a long term solution for pain control.² Although nerve decompression surgery is typically performed only as a last resort, other treatment modalities including local steroid injections have also shown promise in treating cervicogenic pain.^2,8

The pain specialists at The Denver Spine and Pain Institute can provide this full spectrum of care for cervicogenic headaches including medication therapy, physical therapy, peripheral nerves blocks, steroid injections, and radiofrequency nerve ablations. If you suspect you may have cervicogenic headaches that have left you with persistent, uncontrolled pain, reach out to The Denver Spine and Pain Institute today to learn about your options and the next steps to a pain free lifestyle.

References

1. WHO. Headache disorders. World Health Organization. 2016;
2. Al Khalili Y, Ly N, Murphy PB. Cervicogenic Headache. StatPearls. 2022.
3. Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. Oct 2009;8(10):959-68. doi:10.1016/S1474-4422(09)70209-1
4. Lane R, Davies P. Post traumatic headache (PTH) in a cohort of UK compensation claimants. Cephalalgia. Apr 2019;39(5):641-647. doi:10.1177/0333102418812091
5. Pfaffenrath V, Kaube H. Diagnostics of cervicogenic headache. Funct Neurol. Apr-Jun 1990;5(2):159-64.
6. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. Jan 2018;38(1):1-211. doi:10.1177/0333102417738202
7. Jull GA, Stanton WR. Predictors of responsiveness to physiotherapy management of cervicogenic headache. Cephalalgia. Feb 2005;25(2):101-8. doi:10.1111/j.1468-2982.2004.00811.x
8. Zhou L, Hud-Shakoor Z, Hennessey C, Ashkenazi A. Upper cervical facet joint and spinal rami blocks for the treatment of cervicogenic headache. Headache. Apr 2010;50(4):657-63. doi:10.1111/j.1526-4610.2010.01623.x