Cervicogenic Headache

DEFINITION

This is a unique type of headache that is related to cervical spine disorders including facet joint arthritis, whiplash injuries, muscular tightness, soft tissue injuries and in some cases degenerative discs. The headache symptoms can be in the back of the head or can refer to the frontal region, the temples and can be on and off or constant. In most cases, it starts with a degree of neck pain which intensifies and translated into headache. It is not associated with light sensitivity or nausea which is common presentation in migraine headaches. It is mostly on one side of the head but bilateral headache is sometimes seen. Rotation and extension of the neck (looking up) can trigger this headache. The degenerative type is often an aging spine disease but a younger population often develops this because of sports injury or car accident (whiplash injuries).

DIAGNOSIS

Clinicians rely on a detailed history, physical examination, and imaging and diagnostic injections to make such a diagnosis. In most cases imaging is done to determine any severe and alarming changes that may require surgical intervention, including fractures, tumors, large herniation and cord compression. These finding are uncommon but it is medically necessary to understand the anatomy in full detail before any invasive treatments including spinal injections or surgery. X-ray is the first test of choice and if physical therapy does not help the symptoms, then an MRI is indicated. Often MRI of the brain and spine is ordered. In Cervicogenic headache the brain MRI should be normal and cervical MRI may demonstrate degenerative changes in the facet joints, discs and soft tissues. Your clinician can correlate the findings on the MRI to your symptom presentation and examination. Some of the MRI findings (especially in age 40 and up) are not going to have clinical significance, including minor disc bulges. The best diagnostic test to determine if the facet joints are the source of your headache is diagnostic cervical facet injection or diagnostic medial branch block.

NON-SURGICAL TREATMENT

Most patients get better if they spend 10 visits in a physical therapy program and combine this with NSAISDS (motrin, advil, naproxen). In some cases, muscle relaxants can help expedite improvement but they can be sedating. Correcting desk ergonomics and sleeping hygiene (firm memory foam pillow, sleeping surfaces) and observing a healthy balance between using electronic devices (Cell phones and tablets, Laptops) and intermittent breaks in between use can improve the symptoms in most cases. Another factor to consider is the use of headsets instead of traditional phone for individuals who spend more than 30 min a day on the phone. Acupuncture, Trigger point injections, chiropractic care and therapeutic soft tissue manipulation and message can be good adjunct treatments. Chiropractic manipulation can be risky if there is spine instability or in older patients with possible plaques in the blood vessels of the neck. If the above combined treatments are not effective, minor procedures including occipital nerve block, trigger point injections and Cervical Rhizotomy can improved the neck pain and headache and improve quality of life. The cervical rhizotomy can be repeated once per calendar year if the symptoms return to a severity that requires repetition of treatment.

SURGICAL TREATMENT

In the majority of cases surgery is not indicated but in rare cases, cervical fusion (ACDF) is recommended to immobilize the painful segment of the neck that triggers the headache.