Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Neck pain in different cephalalgias

Full Text:


The paper reviews the literature related to the investigations of neck pain (cervicalgia) in patients with headache (cephalalgia). Neck pain is second to lower back pain as a reason for considerable socioeconomic damage to society. The prevalence of cervicalgia in the population ranges from 5.9 to 38%; the annual incidence is 10.4–21.3%; 14.2 to 71% of people report to have neck pain at some time in their lifetime. Neck pain is concurrent with cephalalgia in 70% of cases. In patients with cervicalgia, the prevalence of headache is 20–40% higher than in those with musculoskeletal pain at another site. Neck pain is as a major risk factor for migraine and tension headache (TH). Neck pain in TH progresses with the increased intensity, frequency, and strength of headache. There is a direct relationship of the quality of life worsening associated with
cervicalgia to the frequency of migraine attacks and the risk of its chronization. Neck pain is noted in cervicogenic headache belonging to secondary headaches. The identification of mixed headache in a patient with cervicalgia allows the prescription of a treatment option that may be effective in relieving both headache and neck pain. The paper discusses the causes and pathogenesis of cervicalgia in patients with headache, examination methods, and main approaches to drug and nondrug therapies in relation to the leading pathophysiological mechanism, as well as new possibilities for the effective and safe relief of pain syndrome in this category of patients. Nonsteroidal anti-inflammatory drugs, myorelaxants,
and their combination are observed to be effective in treating patients with cervicalgia and cephalalgia.

About the Authors

E. A. Chechet
Department of Nervous System Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021
Russian Federation

G. R. Tabeeva
Department of Nervous System Diseases and Neurosurgery, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia 11, Rossolimo St., Moscow 119021
Russian Federation


1. Табеева ГР. Цервикалгии, цервикокраниалгии и цервикогенные головные боли. Неврология, нейропсихиатрия, психосоматика. 2014;(2):90–6. [Tabeeva GR. Cervicalgia, cervicocranialgia, and cervicogenic headache. Nevrologiya, neiiopsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;(2):90–6. (In Russ.)]. DOI:

2. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15:834–48. DOI:

3. Carroll LJ, Hogg-Johnson S, van der Velde G. Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):87–96. DOI: 10.1016/j.jmpt.2008.11.013.

4. Hoy DG, Protani M, De R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):783–92. DOI: 10.1016/j.berh.2011.01.019.

5. Croft PR, Lewis M, Papageorgiou AC, et al. Risk factors for neck pain: a longitudinal study in the general population. Pain. 2001;93:317–25.

6. Binder AI. Neck pain. Clin Evid (Online). 2008 Aug 4;2008:pii:1103.

7. Подчуфарова ЕВ, Яхно НН. Боль в спине. Москва: ГЭОТАР-Медиа, 2010; 368 с. [Podchufarova EV, Yakhno NN. Bol' v spine [Back pain]. Moscow: GEOTAR-Media, 2010; 368 p.]

8. Яхно НН, Кукушкин МЛ. Боль (практическое руководство для врачей). Москва: Изд-во РАМН; 2012. 512 c. [Yakhno NN, Kukushkin ML. Bol' (prakticheskoe rukovodstvo dlya vrachei) [Pain (practical guidance for doctors)]. Moscow: Izd-vo RAMN; 2012. 512 p.]

9. Leone M, D'Amigo D, Grazzi L, et al. Cervicogenic headache: a critical review of current diagnostic criteria. Pain. 1998;78(1):1–5. DOI:

10. Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20–59 year olds. Spine (Phila Pa 1976). 1995;20(17):1884–8.DOI:

11. Hagen K, Einarsen C, Zwart J, et al.The co-occurance of headache and musculoskeletal symptoms among 51050 adults in Norway. Eur J Neurol. 2002;9(5):527–33.DOI:

12. Albers L, Milde-Busch A, Bayer O. Prevention of headache in adolescents: population- attributable risk fraction for risk factors amenable to intervention. Neuropediatrics. 2013 Feb;44(1):40–5. DOI:

13. Осипова ВВ. Дисфункция перикраниальных мышц при первичной головной боли и ее коррекция. Неврология, нейропсихиатрия, психосоматика. 2010;(4):29–36. [Osipova VV. Pericranial muscle dysfunction in primary headache and its correction. Nevrologiya, neiiopsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(4):29–36. (In Russ.)]. DOI:

14. Осипова ВВ, Вознесенская ТГ. Коморбидность мигрени: обзор литературы и подходы к изучению. Журнал неврологии и психиатрии им. С.С. Корсакова. 2007;107(3):64–73. [Osipova VV, Voznesenskaya TG. Comorbidity in migraine: the literature review and approaches to study. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2007;107(3):64–73. (In Russ.)]

15. Осипова ВВ, Табеева ГР. Первичные головные боли: диагностика, клиника, терапия. Практическое руководство. Москва: Издательство «Медицинское информационное агентство»; 2014. 336 с. [Osipova VV, Tabeeva GR. Pervichnye golovnye boli: diagnostika, klinika, terapiya. Prakticheskoe rukovodstvo [Primary headaches: diagnostics, clinic, therapy. Practical guidance]. Moscow: Izdatel'stvo «Meditsinskoe informatsionnoe agentstvo»; 2014. 336 p.]

16. Calhoun AH, Ford S, Millen C, et al. Prevalence of neck pain in migraine. Headache. 2010 Sep;50(8):1273–7. DOI: 4610.2009.01608.x.

17. Blau JN, MacGregor EA. Migraine and the neck. Headache. 1994;34:88–90. DOI:

18. Carvalho GF, Chaves TC, Goncalves MC. Comparison between neck pain disability and cervical range of motion in patients with episodic and chronic migraine: a cross-sectional study. J Manipulative Physiol Ther. 2014 Oct 2; DOI: 10.1016/j.jmpt.2014.09.002.

19. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. 3rd ed. (beta version). Cephalalgia. 2013;33(9):629–808. DOI: 10.1177/0333102413485658.

20. Табеева ГР, Сергеев АВ. Цервикогенная головная боль: патофизиология, клиника, подходы к терапии. Неврология, нейропсихиатрия, психосоматика. 2010;(2):19–26. [Tabeeva GR, Sergeev AV. Cervicogenic headache: pathophysiology, clinical picture, approaches to therapy. Nevrologiya, neiiopsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(2):19–26. (In Russ.)]. DOI:,

21. Баринов АН. Сегментарные механизмы формирования мышечного спазма, спастичности и хронизации боли. Врач. 2012;(5):17–23. [Barinov AN. Segmental mechanisms of muscle spasm, spasticity, and pain chronification. Vrach. 2012;(5):17–23. (In Russ.)]

22. Shulman EA, Levin M, Lake AE, et al. Refractory migraine. Mechanisms and management. New York: Oxford University Press; 2010. 474 p.

23. Silberstein SD, Lipton RB, Goadsby PJ. Headache in clinical practice. 2nd ed. London: Martin Dunit; 2002.

24. Баринов АН. Диагностика и лечение цервикогенной головной боли. Неврология, нейропсихиатрия, психосоматика. 2010;(1):58–61. [Barinov AN. Cervicogenic headache: diagnosis and treatment. Nevrologiya, neiiopsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics.

25. ;(1):58–61. (In Russ.)]. DOI:

26. Bartsch T, Goadsby P. Increased responses in in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain. 2003;126(Pt 8):1801–13. DOI:

27. Исайкин АИ. Боль в шейном отделе позвоночника. Трудный пациент. 2012;10(7):36–44. [Isaikin AI. Pain in the cervical spine area. Trudnyi patsient. 2012;10(7):36–44. (In Russ.)]

28. Douglass АB, Bope ET. Evaluation and treatment of posterior neck pain in family practice. J Am Board Fam Med. 2004;17(1):13–22.

29. Victor L, Richeimer SM. Psychosocial therapies for neck pain. Phys Med Rehabil Clin N Am. 2003;14(3):643–57. DOI: 10.1097/00007632-200101150-00015.

30. Kay TM, Gross A, Goldsmith CH. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2012 Aug 15;8:CD004250. DOI: 10.1002/14651858. CD004250.pub4.

31. Steiner TJ, Paemeleire K, Jensen R, et al. European principles of management of common headache disorders in primary care. J Headache Pain. 2007 Oct;8(1):3–47.

32. Shrestha M, Singh R, Moreden J, et al. Ketorolac vs chlorpromazine in the treatment of acute migraine without aura: a prospective, randomized, double-blind trial. Arch Intern Med. 1996;156:1725–8. DOI: 1996.00440140163017.

33. Meredith JT, Wait S, Brewer KL. A prospective double-blind study of nasal sumatriptan versus IV ketorolac in migraine. Am J Emerg Med. 2003;21:173–5. DOI:

34. Ashkenazi A, Blumenfeld A. On a botulinum toxin A for the treatment of headache. Headache. 2013 Sep;53(2):54–61. DOI:

35. Persaud R, Garas G, Silva S. An evidencebased review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions.JRSM Short Rep. 2013 Feb;4(2):10. DOI:

36. Peloso PMJ, Gross A, Haines T, et al. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2007 Jul 18;(3):CD000319. DOI: 10.1002/14651858.CD000319.pub4

37. Hurwitz EL, Carragee EJ, van der Velde G. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther. 2009 Feb;32(2):141–75. DOI: 10.1016/j.jmpt.2008.11.017.

38. Kongsted A, Qerama E, Kasch H, et al. Neck collar, «act-asusual» or active mobilization for whiplash injury? A randomized parallelgroup trial. Spine. 2007;32:618–26. DOI:

39. Veenema KR, Leahey N, Schneider S. Ketorolac versus meperidine: ED treatment of severe musculoskeletal low back pain. Am J Emerg Med. 2000 Jul;18(4):404–7. DOI:

40. Каратеев АЕ. Нимесулид: мифы и реальность. Справочник поликлинического врача. 2013;(4):56–61. [Karateev AE. Nimesulid: myths and reality. Spravochnik poliklinicheskogo vracha. 2013;(4):56–61. (In Russ.)]

41. Coruzzi G, Coppelli G, Spaggiari S, et al. Gastroprotective effects of amtolmetin guacyl: a new nonsteroidal antiinflammatory drug that activates inducible aastric nitric oxide svnthase. Dig Liver Dis. 2002;34(6):403–10. DOI: 8658(02)80037-8.

42. Malanga GA, Gwynn MW, Smith R, et al. Tizanidine is effective in the treatment of myofascial pain syndrome. Pain Physician. 2002;5(4):422–32

43. Mojica JAP, Mancao BD, Perez MLP, et al. A dose-finding therapeutic trial on tizanidine in Filipinos with acute muscle spasm. Philipp J Intern Med. 1994;32:141–5.

44. Tsakitzidis G, Remmen R, Dankaerts W, et al. Non-specific neck pain and evidence-based practice. European Scientific Journal 2013 Jan; 9(3):1857–81.

45. Khan M, Soomro RR, Ali SS. The effectiveness of isometric exercises as compared to general exercises in the management of chronic non-specificneck pain. Pak J Pharm Sci. 2014 Sep;27(5):1719–22.

46. Brison RJ, Hartling L, Dostaler S, et al. A randomized controlled trial of an educational intervention to prevent the chronic pain of whiplash associated disorders following rearend motor vehicle collisions. Spine. 2005;30:1799–807. DOI: 10.1097/01.brs.0000174115.58954.17.

47. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004249. DOI: 10.1002/14651858.CD004249.pub3.

48. Smania N, Corato E, Fiaschi A, et al. Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol. 2005;252:307–14. DOI:

49. Witt CM, Jena S, Brinkhaus B, et al. Acupuncture for patients with chronic neck pain. Pain. 2006;125:98–106. DOI:

50. Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil. 2000;79(1):48–52. DOI:

51. Парфенов ВА, Бойко АН, Костенко ЕВ. Неспецифическая боль в нижней части спины (дифференциальная диагностика и комплексное лечение). Методические рекомендации №11. Москва: Департамент здравоохранения Правительсва Москвы; 2014.32 с. [Parfenov VA, Boiko AN, Kostenko EV. Nespetsificheskaya bol' v nizhnei chasti spiny (differentsial'naya diagnostika i kompleksnoe lechenie). Metodicheskie rekomendatsii №11 [Nonspecific lower back pain (differential diagnostics and complex treatment). Methodical recommendations No. 11.]. Moscow: Departament zdravookhraneniya Pravitel'sva Moskvy; 2014.32 p.]

52. Stanton WR, Jull GA. Cervicogenic headache: locus of control and success of treatment. Headache. 2003;43:956–61. DOI: 4610.2003.03187.x.

For citation:

Chechet E.A., Tabeeva G.R. Neck pain in different cephalalgias. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):87-93. (In Russ.)

Views: 642

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)