Highlights
- Cervicogenic headache is often misdiagnosed, emphasizing the need for precise diagnostic criteria.
- Effective management combines physical therapy, ergonomics, and preventive strategies for symptom relief.
Overview and Definition
Cervicogenic headache (CGH) is a chronic, unilateral headache originating from dysfunction in the cervical spine, especially involving the upper cervical nerves (C1 to C3). It is triggered or worsened by neck movement and reduced cervical range of motion. CGH is often misdiagnosed due to symptom overlap with migraines and tension-type headaches, requiring specific diagnostic criteria to confirm its cervical origin.
Epidemiology and Risk Factors
CGH affects 0.4% to 4% of headache sufferers and accounts for 15–20% of chronic headache cases, primarily impacting adults aged 30 to 44. It occurs equally in males and females, though some studies note higher rates in women. CGH commonly follows neck trauma such as whiplash. Risk factors include cervical spine disorders (fractures, disc degeneration, nerve compression), neck injury, muscle imbalance, poor posture, and stress.
Clinical Features and Pathophysiology
CGH presents as unilateral head pain with accompanying neck stiffness, limited neck mobility, and sometimes shoulder or arm pain. Pain arises from nociceptive signals transmitted from cervical structures to the trigeminocervical nucleus in the brainstem, causing referred head pain. Structural issues like facet joint arthropathy and disc pathology contribute, but sensorimotor dysfunction and impaired neuromuscular control are key factors. Postural abnormalities such as forward head posture worsen symptoms.
Diagnosis
Diagnosis relies on clinical evaluation showing unilateral head pain associated with neck movement and reproduction of symptoms by neck motion or pressure. Imaging helps exclude other causes but often shows no abnormalities. Diagnostic cervical nerve blocks that relieve pain confirm the cervical source. Differential diagnosis is critical to distinguish CGH from migraines, tension headaches, and secondary headache disorders.
Treatment
Management is multidisciplinary, focusing on physical therapy, postural correction, and ergonomic adjustments to improve cervical function and reduce pain. Physiotherapy includes manual therapy, mobilization, and strengthening exercises targeting cervical and scapular muscles. Pharmacological treatments have limited efficacy, while injection therapies such as cervical nerve blocks and radiofrequency ablation provide relief in refractory cases. Preventive measures emphasize neck exercises, stress management, and ergonomic modifications.
Prognosis
The clinical course of CGH varies from episodic to chronic. Early diagnosis and treatment improve outcomes by preventing chronicity. Physical therapy has proven effective in reducing pain and medication use. Postural correction and sensorimotor training contribute to long-term symptom control and functional improvement.
Research and Future Directions
Ongoing research aims to refine diagnostic criteria and develop evidence-based treatments. Studies emphasize the role of sensorimotor dysfunction and propose targeted rehabilitation focusing on motor control and proprioception. Injection therapies show promise, while conventional migraine medications are generally ineffective for CGH. Future efforts include better diagnostic tools, larger clinical trials, and exploration of neurophysiological mechanisms to optimize management strategies.
The content is provided by Sierra Knightley, Scopewires
