Cervicogenic headache - How to recognize and treat

Area of Science:

• Neurology
• Pain Medicine
• Physical Therapy

Background:

• Cervicogenic headache (CEH) was first described nearly a century ago but gained clinical recognition late in the 20th century.
• CEH is defined by trigeminal symptoms arising from cervical disorders due to trigeminocervical convergence.
• Its presentation can overlap with migraine, leading to potential misdiagnosis.

Purpose of the Study:

• To comprehensively review the pathophysiology, clinical presentation, diagnosis, and management of cervicogenic headache.
• To highlight the diagnostic challenges posed by the overlap between CEH and migraine.
• To discuss current and emerging treatment strategies for CEH.

Main Methods:

• Literature review of cervicogenic headache, focusing on historical context, clinical features, and diagnostic criteria.
• Analysis of trigeminocervical convergence mechanisms in CEH.
• Overview of differential diagnoses, including migraine and tension-type headache.
• Summary of management options: physiotherapy, anesthetic blocks, and surgical interventions.

Main Results:

• CEH classically presents as unilateral headaches with cervical onset and trigeminal radiation, reduced neck mobility, and flexion strength.
• Symptoms include mild to moderate pain (pulsatile/compressive), nausea, photophobia, phonophobia, autonomic symptoms, and dizziness.
• Pain duration varies (days to weeks) with unpredictable frequency; whiplash injury history is common.
• Differential diagnosis must exclude migraine and tension-type headache.

Conclusions:

• Cervicogenic headache requires careful differential diagnosis due to its migraine-like features.
• Management strategies involve a multimodal approach including physiotherapy, anesthetic blocks, and potentially surgery.
• Understanding trigeminocervical convergence is key to diagnosing and treating CEH effectively.