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Cervicogenic headache: pathophysiology, clinical picture, approaches to therapy

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Cervicogenic headache (CH) is a common form of cephalgias. Despite the progress in understanding the mechanisms of CH, the clinical diagnosis and effective therapy of this condition present considerable difficulties. The prevalence of CH in the population is as high as 20%. Pathological changes in the upper cervical spinal segments form the basis of the neuroanatomy of CH. Its diagnosis is based on the diagnostic criteria of the Cervicogenic Headache International Study Group and on the criteria of the International Classification of Headache Disorders, 2nd Edition (2004). Effective therapy for CGP is possible when a comprehensive approach and combined use of drug and nondrug treatments, including local anesthetic blocks, are employed.

About the Authors

G. R. Tabeeva
I.M. Sechenov Moscow Medical Academy
Russian Federation

A. V. Sergeev
I.M. Sechenov Moscow Medical Academy
Russian Federation


1. <div><p>Яхно Н.Н., Парфенов В.А., Алексеев В.В. Головная боль. М.: Р-ВРАЧ, 2000.</p><p>Вейн А.М. (ред.). Болевые синдромы в неврологической практике. М.: МЕДпресс- информ, 2001.</p><p>Матхаликов Р.А. Функциональное состояние тригеминальной системы при цервикогенных головных болях. Дис.... канд. мед. наук. М., 2006; 97 с.</p><p>Martelletti P., van Suijlekom H. Cervicogenic headache: practical approaches to therapy. CNS Drugs 2004; 18(12): 793-805.</p><p>Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20- 59 year olds. Spine 1995; 20: 1884-8.</p><p>Haldeman S., Dagenais S. Cervicogenic headaches: a critical review. Spine J 2001; 1(1): 31-46.</p><p>Van Suijlekom H.A., Lame I., Stompvan den Berg S.G. et al. Quality of life of patients with cervicogenic headache: a comparison with control subjects and patients with migraine or tension-type headache. Headache 2003; 43: 1034-41.</p><p>Vincent M., Luna R.A. Cervicogenic headache. Josey's cases revisited. Arquivos de Neuro-Psiquiatria 1997; 55: 841-8.</p><p>Sjaastad O., Saunte C., Hovdahl H. et al. «Cervicogenic» headache. An hypothesis. Cephalalgia 1983; 3: 249-56.</p><p>Alix M.E., Bates D.K. A proposed etiology of cervicogenic headache: The neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther 1999; 22: 534-9.</p><p>Anthony M. Headache and the greater occipital nerve. Clin Neurol Neurosurg 1992; 94: 297-301.</p><p>Bogduk N., Corrigan B., Kelly P et al. Cervical headache. Med J Aust 1985; 143: 202, 206-7.</p><p>Bogduk N. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther 1992; 15: 67-70.</p><p>Bogduk N., Marsland A. On the concept of third occipital headache. J Neurol Neurosurg Psychiatry 1986; 49: 775-80.</p><p>Bogduk N. Headaches and the cervical spine. Cephalalgia 1984; 4: 7-8.</p><p>Bogduk N. The anatomy of occipital neuralgia. Clin Exp Neurol 1981; 17: 167-84.</p><p>Goadsby P., Knight Y., Hoskin K. Stimulation of the greater occipital nerve increases metabolic activity in the trigeminal nucleus caudalis and cervical dorsal horn of the cat. Pain 1997; 73(1): 23-8.</p><p>Bartsch T. H., Goadsby P.J. Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002; 125: 149-50.</p><p>Kerr F.W.L. Structural relation of the trigeminal tract to the upper cervical roots and the solitary nucleus of the cat. Exp Neurol 1961; 4: 134-48.</p><p>Kerr F.W.L. A mechanism to account for frontal headache in cases of posterior fossa tumors. J Neurosurg 1961; 18: 605-9.</p><p>Pöllmann W., Keidel M., Pfaffenrath V. Headache and the cervical spine. A critical review. Cephalalgia 1997; 17: 801-16.</p><p>Lucas G.D.A., Laudanna A., Chopard R.P., Rafaelli Jr E. Anatomy of the lesser occipital nerve in relation to cervicogenic headache. Clin Anat 1994; 7: 90-6.</p><p>Pikus H.J., Philips J.M. Characteristics of patients successfully treated for cervicogenic hedache by surgical decompression of the second cervical root. Headache 1995; 35: 621-9.</p><p>Матхаликов Р.А., Алексеев В.В. Мигательный рефлекс при односторонних головных болях (мигрень, цервикогенная головная боль, пучковая головная боль). Боль 2007; 1: 26-32.</p><p>Andersen N.B., Vingen J.V., Westgard R., Sand T. Pathophysiology of cervicogenic headache: a review. In: O. Sjaastad et al. (eds). Cervicogenic Headache: Basic concepts 2003. Smith-Gordon and Co Ltd., 2003; 19-30.</p><p>Bansevicius D., Pareja J.A. The skin roll test: a diagnostic tool for cervicogenic headache? Funct Neurol 1998; 13: 125-33.</p><p>Bovim G. Cervicogenic headache, migraine, and tension-type headache pressure-pain threshold measurements. Pain 1992; 51: 169-73.</p><p>Crowe H.E. Injuries to the cervical spine. Proc West Orthop Assoc 1928.</p><p>Evans R.W. Some observations on whiplash injuries. Neurol Clin 1992; 10: 975-97.</p><p>Obelieniene D., Schrader H., Bovim G. et al. Pain after whiplash: A prospective controlled inception cohort study. J Neurol Neurosurg Psychiatry 1999; 66: 279-83.</p><p>Barnsley L., Lord S.M., Wallis B.J. et al. The prevalence of chronic cervical zygapophyseal joint pain after whiplash. Spine 1995; 20: 20-6.</p><p>Landy P.J. Neurological sequelae of minor head and neck injuries. Injury 1998; 29: 199-206.</p><p>Pfaffenrath V., Dandekar R., Mayer E.T. et al. Cervicogenic headache: results of computer-based measurements of cervical spine mobility in 15 patients. Cephalalgia 1988; 8: 45-8.</p><p>Meloche J.P., Bergeron Y., Bellavance A. et al. Painful intervertebral dysfunction: Robert Maigne's original contribution to headache of cervical origin. The Quebec Headache Study Group. Headache 1993; 33: 328-34.</p><p>Jull G. Manual diagnosis of C2-3 headache. Cephalgia 1993; 5: 308-9.</p><p>Jensen O.K., Justesen T., Nielsen F.F. et al. Functional radiographic examination of the cervical spine in patients with post-traumatic headache. Cephalalgia 1990; 10: 295-303.</p><p>Bovim G., Bonamico L., Fredriksen T.A. et al. Topographic variations in the peripheral course of the greater occipital nerve. Autopsy study with clinical correlations. Spine 1991; 16: 475-8.</p><p>Hammond S.R., Danta G. Occipital neuralgia. Clin Exper Neurol 1978; 15: 258-70.</p><p>Dwyer A., Aprill C., Bogduk N. Cervical zygapophyseal joint pain patterns I: A study of normal volunteers. Spine 1990; 15: 453-7.</p><p>Dreyfuss P., Michaelsen M., Fletcher D. Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994; 19: 125-32.</p><p>Blau J.N., MacGregor E.A. Migraine and the neck. Headache 1994; 34: 88-90.</p><p>Kaniecki R.G. Migraine and tension-type headache: an assessment of challenges in diagnosis. Neurology 2002; 58(9 Suppl. 16): S15-S20.</p><p>Алексеев В.В., Подчуфарова Е.В., Матхаликов Р.А., Черненко О.А. Цервикогенная головная боль. Неврол. журн. 2005; 4: 44-8.</p><p>Алексеев В.В., Яхно Н.Н., Кисель С.А. и др. Цервикогенная головная боль: сравнение с мигренью и головной болью напряжения. Боль 2004; 3(4).</p><p>Sjaastad O., Fredriksen T., Pfaffenrath V. Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 1998; 38(6): 442-5.</p><p>Göbel H. et al. Headache or facial pain attributed to disorders of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures. The International classification of headache disorders. 2nd ed. Cephalalgia 2004; 24(1): 115-6.</p><p>The international classification of headache disorder. 2-nd ed. Cephalalgia 2004; 24(Suppl. 1).</p><p>Biondi D.M. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc 2005; 105(4 Suppl. 2): 16S-22S.</p><p>Hall T., Robinson K. The flexion-rotation test and active cervical mobility - a comparative measurement study in cervicogenic headache. Man Ther 2004; 9: 197-202.</p><p>Coskun O., Ucler S., Karakurum B. et al. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia 2003; 23: 842-5.</p><p>Delfini R., Salvati R., Passacantilli E., Pacciani E. Symptomatic cervicogenic headache. Clin Exp Rheumatol 2000; 18(Suppl. 19): S29-S32.</p><p>Окнин В.Ю. Дифференциально-диагностические аспекты цервикогенной боли. РМЖ 2003; 11(10): 10-3.</p><p>Van Suijlekom J.A., Weber W.E., van Kleef M. Cervicogenic headache: Techniques of diagnostic nerve blocks. Clin Exper Rheumatol 2000; 18(2 Suppl. 19): S39-S44.</p><p>Bono G., Antonaci F., Dario A. et al. Unilateral headaches and their relationship with cervicogenic headache. Clin Exper Rheumatol 2000; 18(2 Suppl. 19): S11-S15.</p><p>Bovim G., Berg R., Dale L.G. Cervicogenic headache: Anesthetic blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain 1992; 49: 315-20.</p><p>Martelletti P., van Suijlekom H. Cervicogenic headache-practical approaches to therapy. CNS. Drugs 2004; 18: 793-805.</p><p>Forrest J.B. et al. Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery. Br J Anaesth 2002; 88(2): 227-33.</p><p>Jelinek G.A. Ketorolac versus morphine for severe pain. Ketorolac is more effective, cheaper, and has fewer side effects. Br Med J 2000; 321(7271): 1236-7.</p><p>Верткин А.Л., Тополянский А.В., Вовк Е.И., Наумов А.В. Место кеторолака в терапии острых болевых синдромов на догоспитальном этапе. Consilium Medicum 2006; 8(2).</p><p>Bovim G., Sjaastad O. Cervicogenic headache: responses to nitroglycerin, oxygen, ergotamine, and morphine. Headache 1993; 33: 249-52.</p><p>Hobson D.E., Gladish D.F. Botulinum toxin injection for cervicogenic headache. Headache 1997; 37: 253-5.</p><p>Wheeler A.H. Botulinum toxin A: adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache 1998; 38: 468-71.</p><p>Jull G.A., Stanton W.R. Predictors of responsiveness to physiotherapy management of cervicogenic headache. Cephalalgia 2005; 25: 101-8.</p><p>Jull G., Trott P., Potter H. et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27: 1835-43.</p><p>Biondi D. Physical treatments for headache: a structured review. Headache 2005; 45: 1-9.</p><p>Anthony M. Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol 2000; 18(Suppl. 19): S59-S64.</p><p>Inan N., Ceyhan A., Inan L. et al. C2C3 nerve blocks and greater occipital nerve block in cervicogenic headache treatment. Funct Neurol 2001; 16: 239-43.</p><p>Popeney C.A., Alo K.M. Peripheral neurostimulation for the treatment of chronic, disabling transformed migraine. Headache 2003; 43: 369-75.</p></div><br />

For citation:

Tabeeva G.R., Sergeev A.V. Cervicogenic headache: pathophysiology, clinical picture, approaches to therapy. Neurology, Neuropsychiatry, Psychosomatics. 2010;2(2):19-26. (In Russ.)

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