Cervicogenic headache (CGH) occurs when pain is referred from a specific source in the neck up to the head. This pain is commonly a steady ache or dull feeling, but sometimes the pain intensity can worsen. Cervicogenic Headache are usually side-locked, which means they occur on one side of the neck, head, and/or face.
CGH is a secondary headache that occurs because of a physical or neurologic condition that started first. CGH may be caused by trauma, such as fracture, dislocation, or whiplash injury, or an underlying medical condition such as rheumatoid arthritis, cancer, or infection. While the pain source is located in the cervical spine, CGH can be difficult to diagnose because pain is not always felt in the neck. CGH symptoms can also mimic primary headaches, such as migraine and tension-type headache.
CGH usually starts as an intermittent pain and may progress to become a continuous pain. The common features of CGH include:
- Pain originating at the back of the neck and radiating along the forehead, area around the eye, temple, and ear
- Pain along the shoulder and arm on the same side
- Reduced flexibility of the neck
- Eye swelling and blurriness of vision may occur on the affected side in some cases
- Pain almost always affects the same side of the neck and head, but in uncommon cases both sides may be affected
CGH pain is mainly triggered by abnormal movements or postures of the neck, pressing the back of the neck, or sudden movements from coughing or sneezing.
The long-term outlook for CGH depends on the underlying cause of the headache. CGH is generally chronic and may continue for months or years. However, once diagnosed the condition can be well managed with treatment.
In the upper cervical spine region, the trigeminocervical nucleus is an area of convergence of sensory nerve fibers originating from both the trigeminal nerve and the upper spinal nerves. The trigeminal nerve is responsible for pain sensation in the face including the top of the head, forehead, eye, and temple area. When a pain sensation from a cause of CGH is sensed by the upper spinal nerves, it gets transferred to the trigeminal nerve fibers in the trigeminocervical nucleus. This results in pain being felt in different regions of the head.
Several factors can transmit pain from the neck to the head, such as:
- An injury to the atlanto-occipital joint (joint between the base of the skull and the first cervical vertebra)
- Injury to a component of the cervical spine, such as a vertebra, facet joint, or disc
- Cervical radiculopathy resulting from pinched nerve in the upper spinal region
- Injury to neck muscles
- Tumors in the cervical region
A common cause for CGH is whiplash injury resulting in pain shortly after the injury. CGH originating from whiplash may resolve in a few days, or may last for years.
In some cases, CGH may be caused by dangerous underlying conditions such as tumor, hemorrhage, fracture, or arteriovenous malformation (abnormal connection between arteries and veins) in the head or neck region. In such cases, one or more of the following symptoms may also be present:
- A change in the type of headache pain, such as severe headache that is intolerable
- Nausea and vomiting
- Confusion and disorientation
- Headaches triggered by coughing or Valsalva maneuver (an attempt to expel air with the mouth shut and nostrils pinched tight)
- Neck stiffness and swelling
- Numbness in the arms
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