Cervicogenic Headache

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Cervicogenic Headache

Cervicogenic headache (CH) was only recently recognized by the International Headache Society as a distinct headache diagnosis. It is described as pain originating in the structures of the cervical spine and characterized as a deep, non-throbbing, recurring headache. Its prevalence has been estimated to be as high as 16% of the population.(1)

(1) Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol 1991; 44(11):1147-1157

Clinical Reviews

Cervicogenic Headache: Prevention

The recognition of cervicogenic headache (CH) as a distinct and separate form of headache is relatively recent. First mentioned in the literature in the late 1940’s, it wasn’t until 1983 the descriptive term "cervicogenic headache" was coined by Sjaastad et al. Many conditions have existed throughout the ages, yet have only limited information as to risk factors and prevention. It should not be surprising that only one risk factor has been published in the scientific literature for CH. The only factor that has been identified is trauma, usually whiplash injury.

Cervicogenic Headache: Diagnosis

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. However a consensus of scientific study has identified structures of the upper three cervical vertebrae as a most common source of pain.

Cervicogenic Headache: Therapy

There several interventions for the treatment of cervicogenic headache (CH) but most have varying results. The exception is cervical manipulation. As Haldeman and Dagenais state in their critical review, “the only treatment approach supported by a reasonable body of controlled trials is cervical manipulation.” Other treatments discussed below may amplify the practitioner's results and should also be considered.

Medical Subject Heading (MeSH) Information

MeSH Term: Post-Traumatic Headache

Scope Note: Secondary headache attributed to TRAUMA of the HEAD and/or the NECK.

MeSH Synonyms:

Post-Traumatic Headache
Headache, Post-Traumatic
Headaches, Post-Traumatic
Post Traumatic Headache
Post-Traumatic Headaches
Cervicogenic Headache
Cervicogenic Headaches
Headache, Cervicogenic
Headaches, Cervicogenic

Applicable MeSH Subheadings:

blood
cerebrospinal fluid
classification
complications
diagnosis
drug therapy
epidemiology
etiology
history
immunology
metabolism
pathology
physiopathology
prevention and control
psychology
radiography
rehabilitation
surgery
therapy

One-Click Literature Search

Cervicogenic Headache OR Post-Traumatic Headache AND Prevention

Cervicogenic Headache OR Post-Traumatic Headache AND Diagnosis

Cervicogenic Headache OR Post-Traumatic Headache AND Therapy

Informative Links

MedlinePlus: Headache

MedlinePlus will direct you to information to help answer health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

Current Clinical Trials Relating to Cervicogenic Headache OR Post-Traumatic Headache

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

Treximet for Prevention of Post Traumatic Headache Associated With Cognitive Dysfunction

(Status: Recruiting)

Botulinum Toxin Injection in Neck Muscles in Cervicogenic Headache

(Status: Completed)

Galantamine in the Treatment of Post-Traumatic Headache

(Status: Recruiting)

Naratriptan for the Treatment of Post Traumatic Headache Associated With Cognitive Dysfunction

(Status: Terminated)

Study of Rizatriptan in the Treatment of Acute Attacks of Post-traumatic Headache in U.S. Military Troops

(Status: Recruiting)

Medical Therapies for Chronic Post-Traumatic Headaches

(Status: Recruiting)

Chiropractic and Acupressure for Headaches

(Status: Recruiting)

Multi Cervical Unit Measures of Cervical Isometric Strength and Range of Motion: A Pilot Study

(Status: Recruiting)

Management of Headache Disorders: A Clinical Trial Screening for Prognostic Patient Characteristics

(Status: Terminated)

Ultrasound Guided Diagnostic Cervical Medial Branch Block

(Status: Not yet recruiting)

Manual Physical Therapy and Exercise for Mechanical Neck Disorders

(Status: Completed)

Spinal Manipulation for Treatment of Chronic Headaches

(Status: Completed)

Shi-style Cervical Manipulations for Cervical Radiculopathy

(Status: Recruiting)

An Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated With Traumatic Brain Injury

(Status: Recruiting)

The Study of Cognitive Rehabilitation Effectiveness for Mild Traumatic Brain Injury

(Status: Recruiting)

Structural and Functional Neuroimaging Studies of Combat Veterans

(Status: Recruiting)

Efficacy of Massage Therapy in the Treatment of Generalized Anxiety Disorder (GAD)

(Status: Active, not recruiting)

The Effects of Doxazosin on the Cardiovascular and Subjective Effects of Cocaine

(Status: Recruiting)

18 Clinical Trials Returned

Prevention of Migraine Headache

Dwain M. Daniel, D.C.

I have reviewed many topics for ChiroAccess over the past few years and one of the most consistent findings is the lack of prevention studies for most non-life threatening conditions. Migraine headache is an exception.

ChiroACCESS |

October 3, 2011

Whiplash Update

ChiroACCESS Editorial Staff

This past year a substantial number of peer reviewed publications addressing whiplash associated disorders (WAD) have appeared in the scientific literature. These manuscripts examine a broad spectrum of topics including neurologic sequela, psychological issues, diagnosis, treatment, prevention, prognosis and compensation.

ChiroACCESS |

September 1, 2011

Losing Your Mind From Back Pain

ChiroACCESS Editorial Staff

It might sound strange but multiple studies now document the morphologic changes in the brain as a result of chronic pain. The brain gets smaller! The morphological changes involve a decrease in cortical grey matter and white matter volume.

ChiroACCESS |

July 6, 2011

Chiropractic Effectiveness with Headache

ChiroACCESS Editorial Staff

Headache is one of the most common conditions seen in chiropractic offices. Over the last decade headache represented 13% of chiropractic patient’s presenting complaints. A new Dutch study of chronic tension type headache (CTTH) compared treatment from medical providers in general practice (GP) to chiropractic. That study concluded that “Manual therapy is more effective than usual GP care in the short- and longer term in reducing symptoms of CTTH.”

ChiroACCESS |

June 9, 2011

Diagnostic Imaging Case Report: A 39-year-old male reports headaches and neck pain

Jack Henry, DC, DACBR

A 39-year-old male reports with progressive headaches and neck pain over the last two months. No history of recent trauma was reported. Physical exam findings were not provided at the time of reading.

Radiology Diagnostics, LLC |

March 8, 2011

Chiropractic Management of Migraine Headache

ChiroACCESS Editorial Staff

Just as puzzles are completed piece by piece, the evidence for the positive effects of chiropractic care for migraines is slowly filling in and revealing a clearer picture. That picture depicts a more meaningful role for chiropractic care in both the prevention and treatment of migraine headache.

ChiroACCESS |

February 16, 2011

"Death After Chiropractic": Support for the Safety of Cervical Manipulation

ChiroACCESS Editorial Staff

A recent study (July 2010) published in Chiropractic and Osteopathy provides additional support for the safety of cervical manipulation. The authors evaluated spinal manipulation, spinal mobilization and instrument assisted manipulation using an Activator instrument. They concluded that although the sample was small “it appears that all three methods of treating mechanical neck pain had a long-term benefit for subacute neck pain, without moderate or serious adverse events associated with any of the treatment methods”.

ChiroACCESS |

August 4, 2010

Cervicogenic Headache Diagnosis with the Flexion Rotation Test

ChiroACCESS Editorial Staff

New research continues to confirm the importance of a simple flexion rotation test (FRT) in the differential diagnoses of headaches. Many headache cases are often similar in terms of presenting symptom and the FRT has demonstrated in multiple research studies to be highly sensitive to identifying cervicogenic headache from migraine and multiple headache forms.

ChiroACCESS |

June 14, 2010

More Evidence Supporting the Effectiveness of Chiropractic Spinal Manipulation for Cervicogenic Headache

ChiroACCESS Editorial Staff

A study published in the February 2010 issue of The Spine Journal added additional evidence supporting the effectiveness of chiropractic spinal manipulation (SMT) for cervicogenic headache (CGH).

ChiroACCESS |

March 5, 2010

Diagnostic Imaging Case Report: A 14-year-old male reports with chronic headaches

Jack Henry, DC, DACBR

A 14-year-old male reports with chronic headaches, particularly at night. No history of recent or past significant trauma was reported. Neurological and orthopedic exams were essentially unremarkable.

Radiology Diagnostics, LLC |

February 9, 2010

Children, Backpacks and Back Pain

ChiroACCESS Editorial Staff

Over a third of the children in the United States have back pain they associate with wearing backpacks. Recently several studies were published that provide a better picture of the risks associated with the ergonomic loading of backpacks. From this research there is additional information that each chiropractor should be aware of in order to prevent unnecessary backpack related injuries to children.

ChiroACCESS |

January 20, 2010

Botulinum Toxin A

(Cervicogenic Headache: Therapy)

Although botulinum injections are sometimes used, three different reviews have determined there is insufficient evidence to conclude botulinum injection is indicated for the treatment of CH (10-12).

Published On

January 2, 2007

Cervical Range of Motion

(Cervicogenic Headache: Diagnosis)

A 2006 study of 27 patients with CH found reduced cervical flexion/extension compared to migraine and asymptomatic groups (p = 0.048). This study also found painful hypomobile cervical segments were....

Published On

January 2, 2007

Corticosteroid Injection

(Cervicogenic Headache: Therapy)

Again, only limited studies have been performed using corticosteroid injection in the treatment of CH. Generally speaking, favorable results were short term, lasting up to 8 weeks (13).

Published On

January 2, 2007

Cranial Tender Points

(Episodic Tension-type Headache: Diagnosis)

According to Loder and Rizzoli, muscle tenderness is the most common physical finding in ETTH (4). Jensen et al. in two separate studies demonstrated that increased pericranial tenderness on....

Published On

December 31, 2009

Diagnostic Anesthetic Blockade

(Cervicogenic Headache: Diagnosis)

This procedure is rarely performed due to cost, safety and availability. Additionally, it is only of value when evaluating the first three cervical spinal nerves and their rami. Elimination of pain....

Published On

January 2, 2007

Diagnostic Imaging

(Cervicogenic Headache: Diagnosis)

Neither radiographic examination nor MRI have been able to distinguish CH from asymptomatic populations based on imaging (13;14).

Published On

January 2, 2007

Electrotherapy

(Cervicogenic Headache: Therapy)

A Cochrane review found the evidence for the use of galvanic current, transcuteanous nerve stimulation, magnets and electrical muscle stimulation in the treatment of CH to be “lacking, conflicting or....

Published On

January 2, 2007

Exercise

(Cervicogenic Headache: Therapy)

Only limited investigations of exercise as an intervention in the treatment of CH have been performed. One study combined exercise with spinal manipulation and found the higher the patient’s headache....

Published On

January 2, 2007

Flexion-Rotation Test

(Cervicogenic Headache: Diagnosis)

Only two studies have evaluated this test but results have been very encouraging as to its sensitivity and specificity in the diagnosis of CH. In one study of 56 subjects, 86% of symptomatic....

Published On

January 2, 2007

Intro

(Cervicogenic Headache: Prevention)

Although there can be other pain sources, involvement of the zygapophyseal joints in the upper 3 cervical vertebrae is considered a common source of pain in CH (2). In order to determine the....

Published On

January 2, 2007

Localized Intraoral Inflammation

(Episodic Tension-type Headache: Diagnosis)

Friedman has published a series of articles supporting an inflammation hypothesis as a mediator of headache by reporting tenderness and increased temperature in the apical area of the maxillary third....

Published On

December 31, 2009

Manipulation

(Cervicogenic Headache: Therapy)

Although fewer studies have been performed than one would like, there is a growing body of evidence supporting cervical manipulation as an effective intervention in the treatment of CH. A recent....

Published On

January 2, 2007

Menstruation

(Episodic Tension-type Headache: Prevention)

Several authors have identified the menstrual cycle as a precipitating factor for ETTH (7;9;14). The relationship is sufficiently strong for Arjona et al. to propose menstrual tension-type headache....

Published On

December 1, 2009

Muscle Tightness

(Cervicogenic Headache: Diagnosis)

Zito et al found a correlation in muscle tightness and CH in their study. Specifically tightness of the upper trapezius, levator scapula, scalenes, and suboccipital extensors were related to CH (9).....

Published On

January 2, 2007

Nerve Blockade

(Cervicogenic Headache: Therapy)

Nerve blockade is accomplished through a variety of methods to include radiofrequency (14), anesthetic injection (15) and surgically implanted nerve stimulators (16). Only limited evidence exists as....

Published On

January 2, 2007

Other

(Episodic Tension-type Headache: Prevention)

Many other precipitating factors have been identified in the literature with lesser evidence. These include sleep deprivation, frequent traveling (7), consumption of alcohol, withdrawal....

Published On
December 1, 2009

Other Procedures

(Cervicogenic Headache: Diagnosis)

There is limited, strongly-conflicted evidence that the following are of value in providing a diagnosis of CH or differentiating CH from other forms of headache:
A. Head forward posture (10)

Published On

January 2, 2007

Pharmacologic Treatment

(Cervicogenic Headache: Therapy)

Effectiveness of drugs in the treatment of CH is largely anecdotal. As one author stated medications “are only suggested as potential treatments based on the anecdotal experiences of clinicians who....

Published On

January 2, 2007

Posture Training

(Cervicogenic Headache: Therapy)

Anecdotal evidence claims a relationship between posture, particularly head-forward posture, and CH. Evidence to support this relationship is almost non-existent. Two case reports were located that....

Published On

January 2, 2007

Stress/Tension

(Episodic Tension-type Headache: Prevention)

Observational studies form the basis of the evidence for stress/tension as a precipitating factor for ETTH and several separate studies have come to this conclusion. According to a study of 1319....

Published On

December 1, 2009

Surface Electromyography (SEMG)

(Episodic Tension-type Headache: Diagnosis)

A study of 547 patients, 378 with a history of ETTH, found the diagnostic value of SEMG is limited. Resting muscle tension was elevated in chronic headache but not in ETTH patients (8). In a second....

Published On

December 31, 2009

Trigger Points/Temporomandibular Joint Disorders

(Episodic Tension-type Headache: Prevention)

Whether these conditions are precipitating factors or simply coexist with ETTH is a matter of debate. Svenssen argues the conditions overlap and one is not necessarily responsible for the other (17).....

Published On

December 1, 2009

Water Deprivation

(Episodic Tension-type Headache: Prevention)

Although only very limited evidence has been published relating to water deprivation as a trigger for ETTH, a wealth of anecdotal information recognizes its role in headache. An interesting study of....

Published On

December 1, 2009

Weather

(Episodic Tension-type Headache: Prevention)

The weather has been implicated as a precipitating factor by several authors. Rasmussen found weather changes were a precipitating factor in approximately 27% of ETTH patients (9). Wober et al. in....

Published On