What are the causes and symptoms of cervicogenic headaches?

From the Guidelines

Cervicogenic headaches should be managed with conservative approaches, including physical therapy and pain management, rather than relying on medical imaging for diagnosis, as there is no evidence that imaging is diagnostic for the etiologies of cervicogenic headache. These headaches typically present as unilateral pain that starts in the neck and radiates to the front of the head, often mimicking migraine or tension headaches. Treatment should begin with conservative approaches including physical therapy focusing on neck stretching and strengthening exercises, performed 2-3 times weekly for 4-6 weeks, as recommended by recent guidelines 1. Pain management can include over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (500mg twice daily) for acute episodes. For persistent pain, prescription muscle relaxants such as cyclobenzaprine (5-10mg at bedtime) may help. Postural correction is essential—maintaining proper ergonomics at workstations and avoiding prolonged neck flexion when using electronic devices. Heat or cold therapy applied to the neck for 15-20 minutes several times daily can provide relief. Some key points to consider when managing cervicogenic headaches include:

• The importance of conservative management, as there is no evidence that medical imaging is diagnostic for the etiologies of cervicogenic headache 1
• The role of physical therapy in managing cervicogenic headaches, including exercises to improve neck mobility and strength
• The use of pain management medications, such as ibuprofen and naproxen, for acute episodes, and prescription muscle relaxants, such as cyclobenzaprine, for persistent pain
• The importance of postural correction and avoiding prolonged neck flexion when using electronic devices. If conservative measures fail, medical interventions like cervical facet joint injections or occipital nerve blocks may be considered, as recommended by recent guidelines 1. These headaches occur because dysfunction in the upper cervical spine can affect the trigeminocervical nucleus, where sensory nerve fibers from the upper cervical nerves converge with fibers from the trigeminal nerve, causing referred pain to the head.

From the Research

Definition and Diagnosis of Cervicogenic Headaches

• Cervicogenic headache (CeH) is caused by the disorder of the cervical spine and its anatomical structures 2
• The diagnosis of cervicogenic headache is based on clinical criteria mentioned by the International Headache Society (IHS) and Cervicogenic Headache International Study Group (CHISG) 3
• Cervical nerve block may confirm the nociceptive source in majority of cases and is included in CHISG criteria 3
• Non-invasive diagnostic methods like echogenicity of muscles, diffusion tensor imaging (DTI) and single-photon emission tomography (SPECT) are proposed by some authors for avoiding complications associated with blocks 3

Treatment and Management of Cervicogenic Headaches

• Patients who fail to respond to conservative therapies can undergo interventional treatment 2
• Occipital nerve blocks, cervical facet joint injection, atlantoaxial (AA) joint injection, deep cervical plexus block, cervical epidural injection may be reasonable options in refractory cases of CeH 2
• Radiofrequency ablation (RFA) was found to have favorable long-term outcomes, while better safety has been reported with pulsed therapy 2
• Conservative physical therapy management, including therapist-driven cervical manipulation and mobilization, self-applied cervical mobilization, cervico-scapular strengthening, and therapist-driven cervical and thoracic manipulation, can be effective in reducing pain and disability 4
• A combination of therapist-driven cervical manipulation and mobilization with cervico-scapular strengthening was most effective for decreasing pain outcomes in those with CGH 4
• Mainstay of management is physical therapy, and surgical interventions for cervical degenerative disease may relief an associated headache but such interventions are not performed solely for cervicogenic headache 3

Clinical Approach and Recommendations

• A standardized approach to diagnosing cervicogenic headaches can aid in confirmation of the diagnosis and facilitate further research into this condition 5
• An evidence-led approach to assessment and clinical management of CGH is necessary for effective treatment 6
• A practical diagnostic algorithm based on the most current criteria can help clarify the approach to diagnosing cervicogenic headaches 5