Cervicogenic headache (Cervical dysfunction/spondylosis)

Question 1

Facts

Answer 1

Headache from neck disorders

• often referred to as occipital neuralgia

can be caused by abnormalities in any structure innervated by the upper two cervical nerves C2, C3 (usually the C1–2, C2–3 facet joints).

far more common than realised

Pain from cervical structures can be referred retro-orbitally and over one-half of the head.

The headache is often incorrectly diagnosed as migraine but clinical examination of the neck helps differentiation.

The neck may be responsible for so-called ‘tension’ headache but clinical differentiation can be more difficult

Question 2

The explanation

Answer 2

for referral of pain from disorders of the upper cervical spine to the head and eye is that:

some afferent fibres from the upper three cervical nerve roots converge on cells in the posterior horn of the spinal cord (which can also be excited by trigeminal afferent fibres), thus conveying to the…….

Question 3

Clinical features

Answer 3

usually sited in the occipital region

radiates to the parietal region, vertex of skull and behind the eye

usually present on waking and settles during the day.

There is usually a history of trauma including an MVA or blow to the head.

associated with stiffness and grating of the neck.

tenderness to palpation over the C1, C2 and/or C3 levels of the cervical spine, especially on the side of the headache

Question 4

Treatment

Answer 4

Physiotherapy modalities:

• hydrotherapy
• muscle energy therapy
• mobilisation
• manipulation (from experts) and
• neck exercises (very important)

Supportive neck pillow

NSAIDs for cervical spondylosis

For intractable cases consider:

• mobilisation under general anaesthesia
• injections of corticosteroids around
• or surgical section of the greater occipital nerve