Headaches can sometimes be caused by the neck known as “cervicogenic headaches.” Cervicogenic headaches are sometimes misdiagnosed as either migraine headaches or cluster headaches, both of which originate in the head.
The roots of the upper 3 cervical spinal nerves located at C1, C2, and C3 share a pain nucleus which routes pain signals to the brain with the trigeminal nerve. The trigeminal nerve is the main sensory nerve that carries messages from your face to your brain. Because of the shared nerve tracts, pain is misunderstood and thus “felt” by the brain as being located in the head.
Determining the origin of the headache is one of the most controversial and difficult procedures to perform. Almost all types of headaches share common symptoms of throbbing pain, nausea, sensitivity to light, and sensitivity to noise. The signs and symptoms that could point towards cervicogenic type include tenderness at the base of the skull and possible exacerbation of symptoms with head and neck movement.
A proper diagnosis should include:
- A medical history and a physical examination
- A series of plain cervical spine x-rays, including flexion/extension views of the joints in the upper three cervical spinal segments
- An open-mouth view of the skull and a lateral skull x-ray may be necessary
- One or more diagnostic nerve blocks in the neck will need to be performed. Doing one diagnostic block at a time to see whether it reduces the pain will help narrow down the origin of the headache within the cervical spine. Frequently, it will take several diagnostic blocks, carefully performed and evaluated, to arrive at the understanding of the precise source of the cervicogenic headache.
- Although not mandatory, a CT or MRI may be of interest
The type of treatment a patient receives should be dependent on the type of headache they have to ensure the utmost success in relieving the headache without prolonging the pain and extra cost of erroneous treatment. As a general rule, treatment begins once the diagnosis of cervicogenic headache has been made. Pain medications may be considered, including non-steroidal anti-inflammatory drugs (NSAIDs), anti-seizure agents such as gabapentin, tricyclic anti-depressants, and/or migraine prescriptions. If pain medications prove unsuccessful, then injections may be considered, including occipital nerve blocks, atlantoaxial joint block administered at C1-C2, and/or facet joint blocks administered at C2-C3.
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