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Cervicogenic headache is a syndrome characterised by pain that is referred to the head from structures of the neck, including bone, joint, soft tissue and nerves. Associated symptoms may include neck/upper limb symptoms of pain, stiffness or sensory changes. Other symptoms such as dizziness, nausea, vomiting, auditory, visual and olfactory disturbance, and “aura” may arise.
The trigeminocervical nucleus is an area in the upper cervical cord where sensory nerve fibres in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) interact with sensory fibres from the upper cervical roots. This allows for the bi-directional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head. Convergence of sensorimotor fibres in the spinal accessory nerve and upper cervical nerve roots with the descending tract of the trigeminal nerve may also be responsible for the referral of cervical pain to the head.
Cervicogenic headaches are estimated to affect approximately 2.5%
of the adult population and account for 15–20% of all chronic
and recurrent headaches.
Imaging of the neck (X-ray, MRI, CT) is appropriate in limited situations to assist in evaluating overall health of the cervical spine and assess for significant pathophysiology. More often than not, clinical assessment will be more informative in diagnosis of cervicogenic headache, by reproducing or altering headache symptoms.
Early assessment should be conducted by a skilled physiotherapist to ascertain whether the headache is referred from a neck origin, and screen for other causes. Physiotherapy assessment will often include tests for deep cervical flexor muscle function; which is known to be altered in upper neck and headache related disorders. Biofeedback may be used to assist measurement.
Management will depend on the cause of headache and can include manual therapy for joint restriction, soft tissue tightness, and/or neural restriction. Exercises for deep cervical flexor muscles have been shown to be equally effective to manipulative therapy in short and long-term reduction of cervicogenic headache (Jull et al 2002). Muscle endurance and strength training has recently been demonstrated to provide a greater reduction in headache symptoms than stretching alone (Ylinen et al 2010).
Sound postural/ergonomic/activity education is also crucial in ongoing management/reoccurrence of chronic headache.