Distinguishing Primary Headache Disorders from Cervicogenic Headache: Clinical and Therapeutic Implications

Abstract

The objectives of this article are to encapsulate the literature on the clinical aspects of cervicogenic headache, in order to help readers understand how cervicogenic headache can be distinguished from other primary headaches, and how it might be treated. Cervicogenic headache has evolved as a contentious and controversial entity. Tensions have developed concerning how it should be diagnosed, and if it at all exists as an entity. The literature is summarized and appraised in the form of a narrative review. Two conflicting approaches have been used to define cervicogenic headache. One has pursued the definition according to clinical features, but the validity of this approach has not been established. The other approach ignores clinical features and seeks instead to establish the diagnosis by demonstrating a cervical source of pain in the head. For that purpose diagnostic blocks have been used to pinpoint sources of pain in the upper cervical joints. Few treatments have been tested and validated for this condition. In conclusion, cervicogenic headache can be suspected but not diagnosed on the basis of clinical features. The diagnosis ultimately requires diagnostic blocks. Intra-articular steroids may be a useful treatment. Complete relief of headache can be achieved by radiofreqeuncy neurotomy in patients whose headache stems from the C2–3 zygapophysial joint.