Cervicogenic Headache: A Review Comparison with Migraine, Tension-Type Headache, and Whiplash
Curr Pain Headache Rep. 2010 Apr 29. [Epub ahead of print]
Neck pain and cervical muscle tenderness are common and prominent symptoms of primary headache disorders. Less commonly, head pain may actually arise from bony structures or soft tissues of the neck, a condition known as cervicogenic headache. The condition’s pathophysiology and source of pain have been debated, but the pain is likely referred from one or more muscular, neurogenic, osseous, articular, or vascular structures in the neck.
Cervicogenic headache is a well-recognized syndrome. Proposed diagnostic criteria differentiate cervicogenic headache from migraine and tension-type headache in most of the cases. The best differentiating factors include side-locked unilateral pain irradiating from the back and evidence of neck involvement attacks may be precipitated by digital pressure over trigger spots in the cervical/nuchal areas or sustained awkward neck positions. Migrainous traits may be present in some cases. Cervical lesions are not necessarily seen, and most common cervical lesions do not produce cervicogenic headache. Whiplash may occasionally induce headaches. This is suspected when the pain onset and the whiplash trauma are close in time. Whiplash related headaches tend to be short-lasting, admitting mostly a tension-type headache or a cervicogenic headache like phenotype. Neuroimaging abnormalities are not necessarily expected in cervicogenic headache. Whiplash patients must undergo cervical imaging mostly in connection with the trauma, as no abnormalities are pathognomonic in chronic cases.
The prevalence of cervicogenic headache in the general population is estimated to be between 0.4% and 2.5%, but in pain management clinics, the prevalence is as high as 20% of patients with chronic headaches. The mean age of patients with this condition is 42.9 years, and cervicogenic headache is four times more prevalent in women. Patients with cervicogenic headache have demonstrated substantial declines in quality of life measurements that are similar to those in patients with migraine and tension-type headache when compared with control subjects, but they demonstrate the greatest loss in domains of physical functioning when compared with the groups with other headache disorders.
Cervicogenic headache is a relatively common cause of chronic headache that is often misdiagnosed or unrecognized. Its presenting symptom complex can be similar to that of the more commonly encountered primary headache disorders such as migraine or tension-type headache. Early diagnosis and management by way of a comprehensive, multidisciplinary pain treatment program can significantly decrease the protracted course of costly treatment and disability that is often associated with this challenging pain disorder.
Related Source: Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies
