Cervicogenic Headaches

WHAT ARE CERVICOGENIC HEADACHES?

Cervicogenic headaches are headaches which result from spinal problems in the neck, such as disc degeneration or prolapse, or facet joint arthritis.

‘Cervico-’ means neck, and ‘-genic’ means origin.

Cervicogenic headaches are quite common and under-recognised.

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What may cause cervicogenic headaches?

Any type of neck condition can result in these types of headaches, including; degenerative cervical spine disease (arthritis), a disc prolapse in the neck, or a whiplash injury.

What are the symptoms of cervicogenic headaches?

Cervicogenic headaches typically cause pain at the back of the head. This pain may spread to the top of the skull and sometimes to the forehead or temple. It may also be associated with pain or discomfort behind the eye.

There is often, but not always, associated neck pain or discomfort, and sometimes the neck pain and headaches become more or less severe at the same time.

Nausea, poor concentration and irritability are frequent symptoms.

What are the other possible diagnoses?

Cervicogenic headaches may resemble occipital neuralgia, which is a condition that causes localised pain and neurological abnormalities in the distribution of the occipital nerves at the back of the head.

Migraines may also be confused with cervicogenic headaches. An opinion from a neurologist is frequently sought to be more certain of the diagnosis.

How are cervicogenic headaches treated?

It is important to try to determine exactly which structures in the neck are causing the headaches. Once this has been done, an appropriate treatment may be prescribed.

Initially, cervicogenic headaches are treated with pain medications and physiotherapy. Avoidance of aggravating activities is important.

Constant cervicogenic headaches arising from the facet joints may respond to percutaneous radiofrequency denervation (where the nerves over the joints are damaged by controlled heating through a needle in the back of the neck). A facet joint block with local anaesthetic (and often steroids) is usually performed first to confirm the diagnosis.

C2 radiofrequency pulse ganglionotomy is another technique which may benefit some patients, particularly if C2 nerve root compression is thought to be involved in the production of the headaches.

Cervicogenic headaches secondary to cervical disc prolapse or nerve root compression often (but not reliably) improve with microsurgical discectomy and fusion.

Peripheral nerve stimulation of the greater and lesser occipital nerves (also known as occipital nerve stimulation) is an effective technique in patients with cervicogenic headaches (as well as migraines and occipital neuralgia). It appears that around 70% of patients who are resistant to other conventional therapies may benefit from this fairly low-risk surgical technique.


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