Cervicogenic Headache: Diagnosis [Clinical Review Discussion]

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: