Headache and neck

Cervicogenic headache (CeH) is a relatively common syndrome. The paroxysmal and rather intense head pain usually is unilateral, spreading from the back of the head to the frontal and temporal regions, and triggered by certain movements or sustained provocative head positions. Digital pressure over triggering areas at the upper nuchal area reproduces the spontaneous pain pattern. Available clinical criteria differentiate this picture from other headache disorders, although superposition may be present in some cases. The neck is involved with other pain disorders apart from CeH. Migraine may be induced by cervical trigger factors in some cases, and whiplash lesions produce CeH-like symptoms as well as others. Occipital neuralgia refers to pain restricted to the distribution of the affected nerve and should not be mistaken as CeH. There is no definite, universal treatment for CeH yet. Options include physical therapy, preventive medicines, anesthetic blocks, denervation procedures, and surgery. The treatment choice must be performed on individual basis.