Cervicogenic Headaches

Potential sources of cervicogenic headache include, but are not necessarily limited to, upper cervical (C2-3 and C3-4) facet joints, C2-3 intervertebral disc, atlantoaxial (C1-2) joint, atlanto-occipital (C0-1) joint, and a variety of muscles that surround and support the cervical spine (suboccipital, sternocleidomastoid, trapezius, semispinalis, splenius, multifidus).

A diagnosis of cervicogenic headache is primarily based on a patient’s symptoms and physical examination findings. Typical symptoms and signs of cervicogenic headache include pain at the occipital (back of the head), temporoparietal (side of head), frontal (forehead), and/or ocular (around the eye) regions with or without neck pain. Physical examination may reveal provocation or reproduction of pain with certain cervical spine ranges of motion or sustained positions as well as tenderness at certain aspects of the cervical spine or head. Imaging such as x-ray, magnetic resonance imaging (MRI), or computed tomography (CT) may be useful to evaluate for other potential sources of neck pain, rule out more serious issues such as fractures, tumors, or infections, and help plan procedural approaches if injections are pursued. Finally, diagnostic injections, such as medial branch blocks, can be considered to more precisely identify certain sources of cervicogenic headache.

Treatment options for cervicogenic headache typically include medications, physical therapy, chiropractic, kinesiology, and a variety of injection or procedural options. Most commonly, the more conservative treatment options will be pursued first before consideration of the interventional options. Interventional spine options will vary depending on the type of cervicogenic headache and may include trigger point injections, cervical medial branch radiofrequency ablation, cervical facet joint injections with corticosteroid, cervical facet joint injections with platelet rich plasma (PRP) injections, and atlanto-axial joint injections.