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Cervicogenic Headache: Diagnosis
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Lead Author(s):Â
Dwain M. Daniel, D.C.
How this evidence was rated:
Strength of Recommendation Taxonomy (SORT)
Strength of Recommendation Taxonomy (SORT)
Legend:A = consistent, good quality patient oriented evidence;
B = inconsistent or limited quality patient oriented evidence;
C = consensus, disease oriented evidence, usual practice, expert opinion or case series;
D = all or the preponderance of existing evidence is negative.
For more information on the Strength of Recommendation Taxonomy (SORT), please click here.
Published on
January 2, 2007
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By definition cervicogenic headache can arise from any pain-generating source in the neck that refers pain to the head. Muscles, nerves, joints, ligaments and discs have all been implicated in the genesis of cervicogenic headache (CH) (1). However a consensus of scientific study has identified structures of the upper three cervical vertebrae as the most common source of pain (2-5).
An accurate diagnosis of CH can be a challenge to any physician. In one study, 4 female patients had a standing diagnosis of migraine. Each had only limited response to typical migraine treatments. All were given occipital nerve blocks with relief lasting up to 2 months, indicating the headaches were cervicogenic in nature, not migraine (6). Based on this study and clinical observation of many physicians, it is obvious CH has symptoms common to several other presentations of headache. Some authors have even concluded that it is not possible to differentiate CH from migraine due to the significant overlap of symptoms (7). This difficulty in diagnosis is demonstrated by the wide range of prevalence in the scientific literature, from .4% (7) to 35.4% (8). Few clinical tests have been developed that differentiate cervicogenic headache; consequently careful history taking, examination and observation are essential in providing a proper diagnosis.
In the clinical testing portion of this paper very recent and promising testing procedures will be discussed.
Clinical characteristics of CH follow (2;4;8):
1. Pain is recurrent, moderate to severe, lasting up to 72 hours
2. Although sometimes bilateral, there is a profound unilateral dominance
3. Pain arises in the neck and radiates to the occulo-temporo-frontal areas
4. Pain is characterized as deep, constant and non-throbbing
5. Associated symptoms similar to migraine can exist but are usually limited to decreased neck movement
6. Pain on palpation of the neck, neck movement, and Valsalva’s maneuver can trigger headache
The International Headache Society has developed the following chart to aid in diagnosis:
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References
1.Â
Antonaci F, Bono G, Mauri M, Drottning M, Buscone S. Concepts leading to the definition of the term cervicogenic headache: a historical overview. J Headache Pain 2005; 6(6):462-466.
2.Â
Chou LH, Lenrow DA. Cervicogenic headache. Pain Physician 2002; 5(2):215-225.
3.Â
Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J 2001; 1(1):31-46.
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Biondi DM. Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc 2000; 100(9 Suppl):S7-14.
5.Â
Bogduk N. Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep 2001; 5(4):382-386.
6.Â
Yi X, Cook AJ, Hamill-Ruth RJ, Rowlingson JC. Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain 2005; 6(10):700-703.
7.Â
Fishbain DA, Lewis J, Cole B, Cutler RB, Rosomoff RS, Rosomoff HL. Do the proposed cervicogenic headache diagnostic criteria demonstrate specificity in terms of separating cervicogenic headache from migraine? Curr Pain Headache Rep 2003; 7(5):387-394.
8.Â
Jensen S. Neck related causes of headache. Aust Fam Physician 2005; 34(8):635-639.
9.Â
Hall T, Robinson K. The flexion-rotation test and active cervical mobility--a comparative measurement study in cervicogenic headache. Man Ther 2004; 9(4):197-202.
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Ogince M, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in C1/2-related cervicogenic headache. Man Ther 2007; 12(3):256-262.
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Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther 2006; 11(2):118-129.
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Drottning M, Staff PH, Sjaastad O. Cervicogenic headache (CEH) after whiplash injury. Cephalalgia 2002; 22(3):165-171.
13.Â
Coskun O, Ucler S, Karakurum B, Atasoy HT, Yildirim T, Ozkan S et al. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia 2003; 23(8):842-845.
14.Â
Fredriksen TA, Fougner R, Tangerud A, Sjaastad O. Cervicogenic headache. Radiological investigations concerning head/neck. Cephalalgia 1989; 9(2):139-146.