09/12/2022
Determining if the Upper Neck is Relevant in Cervicogenic and Primary Headache
Head pain occurs when normal signals from structures within the head and abnormal signals from the upper neck merge in the top part of the spinal cord. Together the normal and abnormal information then travels to the brain. The brain incorrectly interprets the abnormal information (which came from the neck) as coming from inside the head, and head pain is produced. (1)
One of the confusing phenomena about Cervicogenic Headache is that its symptoms can present as Migraine, Tension Headache or even Cluster Headache. (2-6)
So even though your headache may have been diagnosed as Migraine, Tension Headache, Cluster Headache etc., it may actually be a ‘Cervicogenic Headache’... and there is one feature, which confirms that the upper neck is responsible for headache, and that is the behaviour of head pain.
If a headache is a one-sided headache, which, for example occurs on the left, and the next episode on the right, that is, it swaps sides between episodes (or within the same episode) or similarly, a headache on both sides of the head at the same time, but is stronger on the left and other times on the right, this confirms that the neck is responsible for headache. (2,5)
Ironically though, even if headache does not have any of these features it still could be Cervicogenic Headache. In this case, a physical examination by a practitioner specifically (post-graduate) trained in examination of the upper cervical spine is required to confirm or rule out a neck disorder as the cause of headache or migraine. (3,5)
References:
1. Bogduk N. Headaches and the cervical spine. Cephalalgia. Mar 1984;4(1):7-8.
2. Rothbart P. The cervicogenic headache: A pain in the neck. Can J Diagnos 1996; 13: 64–71.
3. Watson DH, Drummond PD. Head pain referral during examination of the neck in migraine and tension-type headache. Headache 2102 52; 8:1226 - 1235.
4. Gallagher R, Cervicogenic Headache; A special report. Expert Rev. Neurotherapeutics 2007;7(10) 1279-83
5. Watson DH, Drummond PD Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex. Headache 2014;54:1035-1045)
6. Goadsby PJ, Bartsch T. Anatomy and physiology of pain referral patterns in primary and cervicogenic headache disorders. Headache Currents 2005;10:42-48.
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