◔
Cervicogenic Headache: Difference between revisions
From WikiMSK
No edit summary |
No edit summary |
||
| Line 50: | Line 50: | ||
A. Any headache fulfilling criterion C | A. Any headache fulfilling criterion C | ||
B. Clinical and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache | B. Clinical and/or imaging evidence<ref group="Notes">Imaging findings in the upper cervical spine are common in patients without headache; they are suggestive but not firm evidence of causation.</ref> of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache<ref group="Notes">Tumours, fractures, infections and rheumatoid arthritis of the upper cervical spine have not been formally validated as causes of headache, but are accepted to fulfil criterion B in individual cases. Cervical spondylosis and osteochondritis may or may not be valid causes fulfilling criterion B, again depending on the individual case.</ref> | ||
C. Evidence of causation demonstrated by at least two of the following: | C. Evidence of causation demonstrated by at least two of the following: | ||
| Line 58: | Line 58: | ||
:4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply | :4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply | ||
D. Not better accounted for by another ICHD-3 diagnosis. | D. Not better accounted for by another ICHD-3 diagnosis.<ref group="Notes">When cervical myofascial pain is the cause, the headache should probably be coded under 2. Tension-type headache; however, awaiting further evidence, an alternative diagnosis of A11.2.5 Headache attributed to cervical myofascial pain is in the Appendix.</ref><ref group="Notes">Headache caused by upper cervical radiculopathy has been postulated and, considering the now well-understood convergence between upper cervical and trigeminal nociception, this is a logical cause of headache. Pending further evidence, this diagnosis is in the Appendix as A11.2.4 Headache attributed to upper cervical radiculopathy.</ref><ref group="Notes">Features that tend to distinguish 11.2.1 Cervicogenic headache from 1. Migraine and 2. Tension-type headache include side-locked pain, provocation of typical headache by digital pressure on neck muscles and by head movement, and posterior-to-anterior radiation of pain. However, while these may be features of 11.2.1 Cervicogenic headache, they are not unique to it and they do not necessarily define causal relationships. Migrainous features such as nausea, vomiting and photo/phonophobia may be present with 11.2.1 Cervicogenic headache, although to a generally lesser degree than in 1. Migraine, and may differentiate some cases from 2. Tension-type headache.</ref> | ||
==Resources== | ==Resources== | ||
[[File:Cervicogenic Headache - Lancet Bogduk 2009.pdf]] | [[File:Cervicogenic Headache - Lancet Bogduk 2009.pdf]] | ||
==Notes== | |||
<references group="Notes"/> | |||
==References== | ==References== | ||
Revision as of 12:33, 23 May 2021
This article is a stub.
| Cervicogenic Headache | |
|---|---|
| Definition | Pain that is perceived in the head but whose source is actually in the cervical spine or which is innervated by cervical nerves (a form of cervical referred pain) |
Cervicogenic headache is headache arising from the cervical region. It is treated by four main groups of health professionals: neurologists, headache specialists, pain medicine, and manual therapists. Each group has their own view.
Mechanism
There are sensory axons in C1, C2, and C2 spinal nerves that converse on dorsal horn neurons that also receive trigeminal afferents largely from the ophthalmic division. The convergence allows pain mediated in the C1, C2, or C3 nerves to be perceived in regions innervated by the trigeminal nerve (cervical - trigeminal referral). Can also have cervical - cervical referral.
Aetiology
| C1 Nerve Root | C2 Nerve Root | C3 Nerve Root | |
|---|---|---|---|
| Joints | Median C1-2 C0-C1 |
Lateral C1-2 | C2-3 ZA joint C2-3 disc |
| Ligaments | Transverse C1-2 Alar |
||
| Muscles | Prevertebral Sternocleidomastoid Trapezius Suboccipital |
Semispinalis Splenius |
Multifidus Semispinalis |
| Dura | Upper spinal cord Posterior cranial fossa |
||
| Arteries | Vertebral Internal carotid |
Diagnosis
Diagnostic criteria ICHD-3(2018)[1]
A. Any headache fulfilling criterion C
B. Clinical and/or imaging evidence[Notes 1] of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache[Notes 2]
C. Evidence of causation demonstrated by at least two of the following:
- 1. headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
- 2. headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
- 3. cervical range of motion is reduced and headache is made significantly worse by provocative manลuvres
- 4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply
D. Not better accounted for by another ICHD-3 diagnosis.[Notes 3][Notes 4][Notes 5]
Resources
File:Cervicogenic Headache - Lancet Bogduk 2009.pdf
Notes
- โ Imaging findings in the upper cervical spine are common in patients without headache; they are suggestive but not firm evidence of causation.
- โ Tumours, fractures, infections and rheumatoid arthritis of the upper cervical spine have not been formally validated as causes of headache, but are accepted to fulfil criterion B in individual cases. Cervical spondylosis and osteochondritis may or may not be valid causes fulfilling criterion B, again depending on the individual case.
- โ When cervical myofascial pain is the cause, the headache should probably be coded under 2. Tension-type headache; however, awaiting further evidence, an alternative diagnosis of A11.2.5 Headache attributed to cervical myofascial pain is in the Appendix.
- โ Headache caused by upper cervical radiculopathy has been postulated and, considering the now well-understood convergence between upper cervical and trigeminal nociception, this is a logical cause of headache. Pending further evidence, this diagnosis is in the Appendix as A11.2.4 Headache attributed to upper cervical radiculopathy.
- โ Features that tend to distinguish 11.2.1 Cervicogenic headache from 1. Migraine and 2. Tension-type headache include side-locked pain, provocation of typical headache by digital pressure on neck muscles and by head movement, and posterior-to-anterior radiation of pain. However, while these may be features of 11.2.1 Cervicogenic headache, they are not unique to it and they do not necessarily define causal relationships. Migrainous features such as nausea, vomiting and photo/phonophobia may be present with 11.2.1 Cervicogenic headache, although to a generally lesser degree than in 1. Migraine, and may differentiate some cases from 2. Tension-type headache.
References
Literature Review
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,
