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Headaches Arising from the Neck (Cervicogenic)

20th March, 2013

A Cervicogenic headache is a unilateral or bilateral pain localised to the neck and occipital region which may project pain to the head and/or face. Head pain is usually precipitated by neck movement, sustained awkward head positioning, or external pressure over the upper cervical or occipital regions on the symptomatic side.

Although cervicogenic headaches can occur at any age, it is commonly seen in patients between the ages of 20 and 60 and affects between 0.4-2.5% of the general population.

The condition's pathophysiology has been debated, but the pain is likely referred from one or more of the muscular, neurogenic (nervous), osseous (bony), articular (joints) or vascular structures in the neck (Bogduk N., 1992).

Commonly, cervicogenic headaches are unilateral and non-throbbing in nature. Restriction in movement of the neck is commonly seen and patient's can also experience shoulder, neck or arm pain on the same side. Pain is typically continuous and unrelenting but fluctuates in intensity and can last from hours to days. Occasionally, patients can experience symptoms similar to that of migraine such as nausea, photophobia, phonophobia, dizziness, ipsilateral blurred vision and difficulties on swallowing (Biondi D. et al 2000).

Management
A multidisciplinary approach should be taken when treating cervicogenic headaches using medications, manual therapy, injection therapy where necessary and in some cases surgery, although this is rare. Manual treatment such as Chiropractic, Physiotherapy and Osteopathy have been shown to be effective in treating this condition and should include spinal manipulation, massage techniques, stretch and exercise techniques, traction, postural and ergonomic assessment. Also helpful is the use of hot/cold packs, electrotherapy, stress management, relaxation therapy and supportive pillows (Biondi D., 2005).

Injections
Diagnostic anaesthetic blockade is helpful in definitive diagnosis of cervicogenic headaches of different origins. Cervical Epidural steroid injections are indicated in patients with multilevel disc or spine degeneration (Reale C., 2000). If diagnostic blockade is successful for temporary relief, radiofrequency facet joint denervation is indicated for longer term relief (Blume H.G., 2000). Occipital nerve block injections can also help alleviate the resulting headaches.

A course of physical therapy and rehabilitation is recommended after injection procedures to enhance functional restoration and effect a longer lasting analgesic benefit.

By Shelley Doole DC MChiro

References
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