Diagnosis and Treatment of Cervicogenic Headaches

Cervicogenic headaches are headaches associated with neck movement or neck positions. The International Headache Society established the criteria for diagnosing cervicogenic headaches in 1990. The diagnostic criteria is as follows:  

1. Pain localized to the neck and back of the head. The pain my radiate to the forehead, temples, eyes, top of the head or the ears. 

2. Pain is brought on by or aggravated by special neck movements or sustained neck posture.

3. One or more of the following findings is found on examination. Resistance to or limitation of movement of the neck when assisted by the doctor. Changes in neck muscles in response to active or passive stretching or muscle contraction. Abnormal tenderness of neck muscles. 

4. X-rays of the cervical spine reveal at least one of the following findings: Abnormal flexion/extension movements. Abnormal posture such a s straightened or reversed neck curvature. Congenital abnormalities, bone tumors, fractures, rheumatoid arthritis or other significant distinct pathological changes. Bone spurs or osteophytes are  not considered  to be significant. 

What causes cervicogenic headaches or headaches originating from the neck? Cervicogenic headaches are thought to be caused by irritation of the C1 to C3 spinal nerves in the upper neck. Excessive stress to the neck due to neck trauma, whiplash injuries or prolonged holding of the neck in the same position can contribute to cervicogenic headaches. Osteoarthritis and degenerative disc disease of the cervical spine can contribute to cervical spinal nerve irritation. Muscle and other soft tissue scaring limits neck motion and contribute to neck pain and headaches. Enlargement of the cervical joints, called facet hypertrophy, is also thought to contribute to the development of cervicogenic headaches. Rare but serious and even life threatening conditions can mimic cervicogenic headaches. They include spinal cord tumors,  brain tumors, meningitis, and vertebral or internal carotid artery dissections. 

Cervicogenic headaches are due to abnormal movement of the neck. Improving this abnormal movement can only be achieved by improving joint movement and relaxing cervical muscles. Chiropractic spinal adjustments, mobilization of soft tissues and active exercises are the best treatment methods to decrease the frequency and severity of cervicogenic headaches. Massage therapy and acupuncture are also effective tools in the treatment of headaches originating from the neck. For severe intractable cervicogenic headaches, a pain specialist may inject an analgesic medication near the upper cervical nerves as both a treatment and a diagnostic procedure. If this makes a dramatic difference in the headaches, the pain specialist doctor may opt to burn the upper cervical nerves with a procedure called radio-frequency neurotomy. Your doctor of chiropractic has extensive training in the diagnosis and treatment of cervicogenic headaches. He or she will work with you and other medical professionals to ensure you receive the best possible treatment


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