From the Guidelines
For patients with posterior headaches and cervical degenerative disc disease (ddd), I recommend a conservative approach prioritizing physical therapy and lifestyle modifications over immediate imaging, given the high likelihood of spontaneous resolution or improvement with conservative measures. The American College of Radiology suggests that in the absence of red flag symptoms, imaging may not be required at the time of initial presentation 1. Key considerations in managing these patients include:
- Identifying and addressing any underlying causes of neck pain or radiculopathy, such as poor posture, stress, or degenerative changes in the cervical spine
- Implementing a physical therapy program focusing on cervical stretching and strengthening exercises, which can be performed 2-3 times weekly for 4-6 weeks
- Complementing physical therapy with daily home exercises and applying heat to the neck for 15-20 minutes several times daily to reduce muscle tension
- Maintaining proper ergonomics at workstations and practicing good posture throughout the day to reduce mechanical stress on the cervical spine
- Considering over-the-counter analgesics like ibuprofen or naproxen for acute pain relief, as needed, under the guidance of a healthcare provider It's essential to note that most cases of acute cervical neck pain with radicular symptoms resolve spontaneously or with conservative treatment measures 1, highlighting the importance of a thorough clinical evaluation and a stepwise approach to management.
From the Research
Posterior HA with DDD Cervical
- The posterior HA with ddd cervical refers to a condition where there is headache (HA) associated with degenerative disc disease (DDD) in the cervical spine.
- According to 2, chronic axial neck pain and cervicogenic headache are common problems, and the severity and duration of pain drive the treatment process.
- The study 3 mentions that radicular pain can be caused by herniation of the nucleus pulposus, spinal stenosis, or degenerative changes to the vertebrae, which may be relevant to the condition of posterior HA with ddd cervical.
- Cervicogenic headache is a distinct type of headache that is usually under-diagnosed, resulting in suboptimal quality-of-life, as stated in 4.
- The mainstay of management for cervicogenic headache is physical therapy, and surgical interventions for cervical degenerative disease may relieve an associated headache, but such interventions are not performed solely for cervicogenic headache, as mentioned in 4.
- Interventional techniques, including cervical epidural steroid injection (CESI), have been proposed to treat cervicogenic headache, as described in 5.
- Cervical facet injections with steroids have been used to alleviate cervicogenic headache secondary to cervical facet arthropathy, as reviewed in 6.
Treatment Options
- Strength training of anterior, posterior, and interscapular muscle groups coupled with body mechanics training is prescribed for patients with slight to moderate pain, as stated in 2.
- Spinal injection is usually prescribed based on the results of radiographs and MRI, as mentioned in 2.
- Epidural corticosteroid injection should be ordered if MRI reveals spinal stenosis of the central or lateral canal, or a disc herniation, as stated in 2.
- Medial branch blocks and intra-articular steroid injections can be ordered based on the joints that are most tender or where disc space narrowing is greatest, as mentioned in 2.
Diagnosis
- The diagnosis of cervicogenic headache is based on clinical criteria mentioned by the International Headache Society (IHS) and Cervicogenic Headache International Study Group (CHISG), as stated in 4.
- Cervical nerve block may confirm the nociceptive source in majority of cases and is included in CHISG criteria, as mentioned in 4.
- 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, as stated in 4.