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Headache Associated With Cervical Radiculopathy and Myelopathy Following Anterior Cervical Spinal Surgery: A
Tarun Mattikalli1,2, Alexander J Schupper2, Jonathan Lee1
1Departments of Orthopedic Surgery.
Study Design:
Systematic review.
Objective:
To systematically review the impact of anterior cervical spine surgery, specifically anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA), on headache symptoms associated with cervical radiculopathy and myelopathy.
Summary Of Background Data:
Headache symptoms are frequently reported in patients with cervical spine radiculopathy and myelopathy, including but not limited to cervicogenic headache (CGH), a secondary headache disorder attributed to cervical spine structures. Although such headaches are frequently reported to improve following anterior cervical procedures, diagnostic inconsistency and unclear pathophysiology have contributed to limited widespread clinical recognition and management consensus.
Methods:
Following PRISMA guidelines, a systematic search of Medline, EMBASE, and Cochrane was conducted. Inclusion criteria required studies to report outcomes related to headache improvement or resolution following ACDF or CDA. Due to substantial heterogeneity in outcome metrics, surgical approach, and reporting standards, a qualitative synthesis was performed.
Results:
Following screening of 1089 records, 23 studies met criteria for inclusion, comprising 4428 patients with follow-up durations between 3 months and 13 years. Significant improvement or resolution of headache was consistently reported across included studies. Seven studies used the neck disability index (NDI) headache subscore, and additional improvements were observed using the visual analogue scale (VAS), International Headache Society (IHS) criteria, and numeric pain rating scale (NPRS). Most studies found no significant difference in headache relief between ACDF and CDA. However, variability in diagnostic criteria, lack of standardized headache instruments, and inconsistent subgroup analyses limited comparability, and the risk of bias was moderate to serious in most cohort studies.
Conclusions:
Low-to-moderate quality evidence suggests anterior cervical procedures may be associated with improvement in headache symptoms. While both ACDF and CDA show potential sustained benefit, the strength of evidence is constrained by heterogeneous methodology and nonstandardized outcome reporting. Future studies using validated headache diagnostic criteria and headache-specific instruments are warranted to guide diagnosis, treatment selection, and outcome prediction.
