Headache and the lower cervical spine: long-term, postoperative follow-up after decompressive neck surgery

A retrospective search for headache sufferers was conducted among patients operated on for cervicobrachialgia, and the operative results were evaluated. We also tried to classify the preoperative headache according to current headache classification systems. A total of 187 patients were operated on with Smith-Robinson's method, or by "simple" foraminectomy/ facetectomy. Headache was present in 23, and 17 of these could be followed up for an average post-operative observation period of 8.5 years. The operation seemed to result in headache improvement in 15 patients, i.e., excellent in 7; good in 2; moderate in 6; in other words: "excellent"/"good" in 53%. Improvement of neck pain was found in 15 patients (excellent in 5; good in 4; moderate in 6). The headache characteristics were generally compatible with the criteria for cervicogenic headache (CEH) (1990 version). CEH can probably stem from a pathology in the lower cervical spine. This should probably be taken into account when evaluating the individual patient with symptoms reminiscent of CEH. This headache may benefit from operations directed towards the cervical spine.