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Cervicogenic Headache

Cervicogenic headache is a bit unusual in that the pain isn’t actually in the head. It’s referred pain perceived in the head from a source in the neck. Referred pain is pain felt at a location other than the location of the cause of the pain.

Cervicogenic headache is a secondary headache disorder, which means that it’s caused by another illness or physical issue. With cervicogenic, the cause is a neck disorder or lesion.

Information and diagnostic criteria for cervicogenic headache from the International Headache Society’s International Classification of Headache Disorders, 2nd Edition (ICHD-II)1:

11.2 Headache attributed to disorder of the neck
11.2.1 Cervicogenic headache

Previously used term:
Cervical headache

Coded elsewhere:
Headache causally associated with cervical myofascial tender spots is coded as 2.1.1 Infrequent episodic tension-type headache associated with pericranial tenderness, 2.2.1 Frequent episodic tension-type headache associated with pericranial tenderness or 2.3.1 Chronic tension-type headache associated with pericranial tenderness.

Diagnostic criteria:

  1. Pain, referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfilling criteria C and D
  2. Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of headache1
  3. Evidence that the pain can be attributed to the neck disorder or lesion based on at least one of the following:
    1. demonstration of clinical signs that implicate a source of pain in the neck2
    2. abolition of headache following diagnostic blockade of a cervical structure or its nerve supply using placebo- or other adequate controls3
  4. Pain resolves within 3 months after successful treatment of the causative disorder or lesion

Notes:

  1. Tumours, fractures, infections and rheumatoid arthritis of the upper cervical spine have not been validated formally as causes of headache, but are nevertheless accepted as valid causes when demonstrated to be so in individual cases. Cervical spondylosis and osteochondritis are NOT accepted as valid causes fulfilling criterion B. When myofascial tender spots are the cause, the headache should be coded under 2. Tension-type headache.
  2. Clinical signs acceptable for criterion C1 must have demonstrated reliability and validity. The future task is the identification of such reliable and valid operational tests. Clinical features such as neck pain, focal neck tenderness, history of neck trauma, mechanical exacerbation of pain, unilaterality, coexisting shoulder pain, reduced range of motion in the neck, nuchal onset, nausea, vomiting, photophobia etc are not unique to cervicogenic headache. These may be features of cervicogenic headache, but they do not define the relationship between the disorder and the source of the headache.
  3. Abolition of headache means complete relief of headache, indicated by a score of zero on a visual analogue scale (VAS). Nevertheless, acceptable as fulfilling criterion C2 is equal to or more than 90% reduction in pain to a level of less than 5 on a 100-point VAS.

Diagnosis:

To diagnose cervicogenic headache, doctors search out the source of the pain. Nerve blocks are often employed for this purpose. By using nerve blocks, doctors can determine which nerve is causing the pain. To confirm a diagnosis of cervicogenic headache, the headache must be relieved by nerve blocks.

Treatment:

Appropriate treatment for cervicogenic treatment should target the cause of the pain (in the neck). As with other headache treatments, it will vary depending on what works well for the individual patient. Potential treatments include:

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

1. International Headache Society. “International Classification of Headache Disorders, 2nd Edition” (ICHD-II), First Revision. May, 2005.2. Silberstein, Stephen D.; Lipton, Richard B.; Dodick, David W. Wolff’s Headache and Other Head Pain. New York. Oxford Press. 2008.

Comments

  • Star71
    3 years ago

    Teri,
    I’ve been checked and this told this is not my case…
    I was just curious if anyone who has Spina Bifida Occulta has migraines as well. It seems as though the two would go hand in hand seeing as though the spine is involved.

  • Julie
    7 years ago

    If a person has had neck surgeries I can understand the reluctance or aversion to Chiropractic care, but for those of us who have had no such surgeries I see no harm that is why you tell or ask you doctor before you seek out such treatment as one is suppose to do. My neck actually feels better after gentle, repeating, gentle manupliation and my neck, head and shoulder felt better after deep tissue massage from my massage therapist and alternated w/cupping which felt pretty strange at first. I had no serious injury to my neck or shoulder that indicated surgery so therefore no surgery was performed. When traditional medicine has failed I have gone to alternative and holistic and heck I’ve combined all of them and I believe cupping is chinese medicine as is accupuncturein which involves Moxibustion which I’ve tried before as well as pressure point therapy where they focus on the Yin and the Yang-powers in Balance, and the 5 basic substances: Qi-Life Engergy, Xie-Blood, Shen-Spirit, Jing-Strenght of Life, Jinye-Body Fluids. Then they go into the 8 key principles, the Yin-Yang Key Principle, the Inside-Outside Key Principle, The Emptiness-Fullness Key Principle, The Coldness-Heat Key Principle. Then they go into a very intense exam of the person. That is why it is key to find a qualified massage therapist who is trained into the Acupressure Therapy. It’s a Deep Tissue Massage Therapy and it gets to all your pressure points and releases the body toxins. They are pretty hard to find in this area and I really wish the one I had did not retire because she was spectacular. A lot of people think Chinese Medicine is a bunch of bunk but do you see a lot of overweight and disease ridden Chinese people in China? Nope. I totally beleive in alternative therapies but I do not agree with aromatherapy as I am too sensative to smells and cannot tolerate anything with scent at all. That is where I draw the line. But I am and do remain open to anything and everything as I have been through the years. To be close-minded is to cut short any possibilities I may have to find something out there that may help me. So yes I will try anything at least once or even twice if need be to help alleviate some of the pain. If others are not willing to be so open to experiment than that is for them to decide on their own but I decide for myself and no one else decides for me but ME.

  • ruskimo63
    7 years ago

    To a point I can relate to singnsk8ngrama…I have had 5 cervical posterior and anterior surgeries levels 5-7 and have Migraines everyday. I rate a pain scale of 4-5 on my left side occipital nerve on a daily basis, with and without auras. I will have 2-3 and 8-9 pain scale migraines in a week, this has ruined my life. I have asked about these Cerviogenic headaches and asked if this is what they could be with no real answer. I have had all the treatments, medications that are out there with little relief. Singsk8ngrama as for the “electric shock” feeling, look up Arachnoiditis…this might help you with this feeling…I have it and it is weird. It is a condition associated with damage to the spinal chord. I am currantly undergoing Ketamine treatments for pain, …I was out of pain for 4 whole days, I have also had a lumbar fusion as well, but it did not help with the “Migraine” I am trying the Ketamine again…will discuss this type of headache one more time with the doctor and see what he says…good luck to you all! p.s. if you have serious spine problems…please stay away from Chiropractors…just my personal opinion…get a soft tissue massage!

  • Vicki
    7 years ago

    If I understand all this, this describes mine as well. I have migraines and I consider these to be my ‘tension headaches’. Sometimes, a tension headache can escalate into a migraine.
    I have always had a hard time relaxing. And the muscles in the shoulders and neck are ALWAYS tight. For years, I have been aware of the tender spots at the base of my skull….if I continue to massage them, sometimes I can get relief. Is this the pericranial tenderness?? The last time I got a massage, I asked her, why are these spots always tender? She said, “because the muscles in your shoulders and neck are always tight!”

  • Teri-Robert author
    7 years ago

    Vicki,
    I also have tension-type headaches that will trigger a Migraine if I don’t get them stopped in time. I don’t know if it would work or be appropriate for you or not, but something you might as your doctor about is a TENS unit that you could use on your shoulders when one of those tension-type headaches is starting. They can’t be used on the head or upper neck, but I have one that I use on my shoulders and lower neck, and it often stops the tension-type headaches without medications.
    Teri

  • Julie
    7 years ago

    I think it’s all related. I just recently got a book from Amazon.com: The Acupressure Atlas. It’s a huge book and goes into detail about activating body and life energies naturally by using preventive approaches using Chinese Medicine using Acupressure. I think if I or anyone could find a really good massage therapist or Chiropractor that uses this tecnique and go there on a regular basis and not rob the bank it would be helpful. I had a massage therapist who helped me out but she retired so to speak to work w/Hospice and then full time as a grandmother to babysit her new grandbaby. She was quit affordable but our insurance doesn’t cover that and hardly covers chiropractic care and it does not cover acupuncture which is very expensive. But even if you could get the book and have your partner learn how to do some of the pressure points at home is helpful. My husband learned how to work on my pressure points on my head w/this book. It helps. It’s by Bernard C Kolster M.D and Astrid Waskowiak MD. But nothing beats the actual “hands on” of a professional massage therapist and most of the ones around here charge $60.00 for 30 min. On SSD I cannot afford that and w/it not being covered and to get really good benefits at 1st you need to go 2x a week for the 1st few weeks to be able to cut down to 1x a week. I was a skeptic at 1st when my best friend turned me onto this but boy oh boy did I become a believer fast. But the back and front of shoulder, back and side of neck, base of and complete skull area, temple, brow bone, under eye, all along your jawbone to your ears even-it’s all connected once you find those pressure points. They can press on a point at the base of the back of your skull and you can feel it shoot to an area above your eye. It’s amazing how all the nerves in those areas are all connected. And when you have daily migraines and tension headaches those areas will be sore and tender to the touch. I got several of those mens solid white sports tube socks, filled them with long grain white rice and filled each sock about 3/4 ways full. Sewed the top of the sock up. When I get really tense and sore in the shoulder and neck I take one of two of those and put it in the microwave for 1 to 1 1/2 min (try 1 min at 1st) and lay it on the tense and sore spot. Those things last forever as long as you don’t get them wet. I never buy the store bought ones. I will have 1 wrapped around my neck and 1 slung over my shoulder or sometimes 2 slung over my shoulder. If heat works for your migraines there you go. But ice works on mine. So I have rice packs on my neck and shoulder and ice on my head most of the time. Just an idea to pass along for a cheap fix for the tension in the neck and shoulder. Not long term but the heat is moist and it’s cheap. My massage therapist taught me that one. You can take an old kitchen towel, sew 2 sides together, leave a pocket open, fill it over 3/4 full and sew the open end tight by hand and you have a larger rice pack than the sock one if you want to cover a bigger area. Forgot to add that one, sorry. Just don’t ever get them wet or they will be ruined.

  • Vicki
    7 years ago

    Clarification….I have migraines AND tension headaches.

  • Julie
    7 years ago

    Can pain in the neck and shoulder related from an older whiplash injury(early 80’s) lead to chronic migraines later (late 80’s that over time got progressively worse) be related? Pain on 1 side of the head/face & behind the eye (all LH side), but stiff & sore neckv(ery tender at base of skull) that curves in reverse of what it should & tender to touch and the LH shoulder very sore. I have tried to tell doctors this but they look at me like I’m nuts or just fell out of the tree. Maybe I have…………………. But it hurts worse during and after a migraine attack and just achey and stiff before one happens. Maybe it’s just something else altogether different. Just thought I’d run it past you and see what you thought…….. Maybe pressure point or tension related??? I don’t know-just confused anymore it seems about this nagging neck/shoulder pain that nothing seems to touch and where is it coming from and why won’t it go away. So very frustrating and when you can’t get any one of the countless doctors I’ve been to to really stop, listen and take it seriously to even check it out. Is it or is it not adding to my migraines-is it connected or not.

  • Teri-Robert author
    7 years ago

    Julie,

    I’m sorry your doctors haven’t been more responsive. That stinks! Neck and shoulder pain can be a symptom of Migraine, BUT given your history, I’d want to be sure you’re not also having some kind of post-traumatic headache or cervicogenic headache as well. It’s not uncommon to have more than one headache disorder. It’s also possible for another headache to trigger a Migraine. Sounds like it’s time to find yourself a good Migraine and Headache specialist. Take a look at http://migraine.com/blog/is-it-time-for-a-new-migraine-doctor/

    Keep me posted?
    Teri

  • singnsk8ngrama
    7 years ago

    This sounds EXACTLY like my headaches. I have had 3 neck surgeries, one of which gave me a paralyzed vocal cord. Since the neck surgeries I have had 5 what were ORIGINALLY diagnosed as mini-strokes or TIAs, but more recently re-diagnosed as SOME of them possibly being Hemiplegic Migraines. Personally, I think they were from my neck, ALL felt different from what I hear of as symptoms of stroke OR HM, in that there was an initial feeling of something like an electrical shock. My first neck surgery involved 4 vertabrae, and the plate was coming out at the bottom, the dr. re-did it and went UP one more vertabrae.. That one ALSO was coming out at the bottom, so the plate was removed. ALL of the episodes have happened SINCE then. Even tho I have had Auras with NO associated headaches, this is why I believe the HM diagnosis was made. I AM taking small dose of Depakote (250 mg a day) and the Auras have stopped, but I get headaches like you would not believe and my neck HURTS like you would not believe. In fact, today I notice a VERY TENDER spot in my neck just to the right of the spine and at the base of my skill, when I touch it. TWO Ultram will not even TOUCH the pain when it hits, nor will ice nor heat…NOTHING relieves it. I have recently had 2 steroid injections in my neck, the first one did help a LOT, the second has hardly helped at all. Wish I could find out more about this Cervicogenic Headache.

  • Teri-Robert author
    7 years ago

    singnsk8ngrama,
    It’s also possible to have both cervicogenic headaches and Migraines. If your doctor doesn’t know about cervicogenic headaches, please do yourself the favor of finding a good specialist who does. That can make all the difference in the world. I didn’t make any progress at all with my own Migraines and headaches until I got to a real specialist. At the time, my husband and I drove eight hours to get to one, but it really was worth it. Please take a look at this on doctors – http://migraine.com/blog/is-it-time-for-a-new-migraine-doctor/

    Teri

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