Cervicogenic headache
Clinical characteristics
Unilateral (non-throbbing) head pain (without shift)
Precipitation of pain by neck movement
Ipsilateral non-radicular arm/shoulder pain
Trigger point in neck muscles
Diagnostic anaesthetic blockade
F > M
+/- assoc. N&V, photophobia, lacrimation etc
Little response to NSAIDs / Ergot / Triptans
- Chronic hemicranial pain, referred to the head from bony or soft tissues of neck
- Trigeminal nerve nucleus, accessory (CN xi) and upper Cx nerves implicated
- DDx- migraine, tension headache
- Origin from musculoskeletal source in neck
- May be precipitated by neck movement especially passive rotation to side of headache, neck in extension.
- No Cx neurological signs
- CT & MRI normal (no incressed incidence of cervical disc etc)
- Check bloods for inflammatory markers and autoantibodies
Persisting or atypical symptoms may need invistigation to exclude : posterior fossa fumour, Arnold- Chiari malformation, cervical spondylosis / arthropathy, Cx disc or other nerve compression, AVM, vertebral artery dissection, and spinal tumors
Treatment (multifaceted)
Pharmacologic
- TCADs
- SSRIs generally ineffective
- Antiepileptic drugs (gabapentin, carbamazepine)
- Stabilizers of peripheral and central pain transmission
- Gabapebtin usually for post herpetic neuralgia etc
- Carbamazepine is effective in trigeminal neuralgia but will require GP to check LFTs and FBC
- Muscle relaxants (baclofen)
- Central action
- NSAIDs (Nonselective cyclooxygenase inhibitors)
- AVOID narcotics
Manipulative
- Osteopathic manipulative
- Physiotherapy
- TENS
- Biofeedback & psychotherapy
Anaesthetic
- Anesthetic blockade - spinal roots, nerves, rami, or branches or muscular trigger points
- Botulinum toxin injections
- Occipital nerve stimulator
Surgical
- Neurectomy
- Nerve exploration and "release"
- Joint fusion
