Cervicogenic Headaches (CGH)

Introduction

Cervicogenic headaches (CGH) are headaches which are originated from a cervical (neck) pathology. CGH represents a challenging condition to treat in physical therapy, pain clinics and neurology offices. This is because the headache results from pain that is outside of the head, and specifically in the cervical spine. Commonly, CGH is seen in weight-lifters and in patients who have sustained a whiplash injury or a concussion and who go on to develop neck pain. Headaches which develop 3 months or later after a concussion are usually not due to a brain injury and suggest CGH. CGH is frequently accompanied by a reduced range of movement in the neck. It is often confused for a migraine or a tension headache.

Clinical Presentation

CGH is a unilateral (one-sided) headache which initially starts from the back of the head and neck and then goes on to migrate to the front. Occasionally, it is associated with arm discomfort on the same side. There is a less common variant of CGH, wherein the head and neck pain is bilateral (both sides) and is exacerbated by specific neck positions and occupations such as carpentry, truck driving or hairdressing. Sustained postures in these occupations, or specific neck movements aggravates the neck pain which can come before or occur concomitantly with the headache.

Recent studies have shed light on the development of CGH – specific muscle imbalance patterns have been observed in patients with CGH. The specific patterns of muscle tightness and weakness is known as “Upper Crossed Syndrome” which consists of tight upper trapezius and chest muscles, together with weak cervical flexor and lower trapezius muscles. A forward head posture has also been observed in patients with CGH, which imposes more stress on the upper cervical bones.

Diagnosis

Patients with CGH have normal brain imaging, thereby ruling out any cranial pathologies to account for the headache. The diagnostic criteria for a CGH are as follows:

i) Source of the pain must be in the neck and perceived in the head or face

ii) Evidence that the pain can be attributable to the neck

iii) Demonstration of clinical signs that can implicate the neck

OR

iv) Following a nerve blockade of a cervical (neck) structure, the headache is abolished

In view of the above criteria, diagnosis of CGH remains challenging. Imaging of the cervical spine is not sufficient to diagnose a CGH, and there are no specific radiologic signs found by researchers surveying this condition. Indeed, Plain X-Rays, CT or MRI scans are indicated to rule out sinister conditions (e.g. brain tumour, arterio-venous malformations or aneurysms) rather than rule in CGH.

Treatment

Physical therapy is typically considered as first-line treatments for CGH. If physical therapy fails to alleviate symptoms, interventional procedures such as a facet joint block injections can provide immediate relief of CGH, as these procedures rapidly resolve the origin of the pain in CGH.  Cervical Radiofrequency ablation is a safe office based procedure that can prevent headaches from occuring from 6 months to 2 years.

References for Further Reading (Page, 2011, Chua et al., 2012)

Chua, N. H. L., Suijlekom, H. V., Wilder-Smith, O. H. and Vissers, K. C. P. (2012) 'Understanding cervicogenic headache', Anesthesiology and pain medicine, 2(1), pp. 3-4.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821111/

Page, P. (2011) 'Cervicogenic headaches: an evidence-led approach to clinical management', International journal of sports physical therapy, 6(3), pp. 254-266.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201065/

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Created on Jun 8th 2019 09:10. Viewed 434 times.

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