Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment

The Lancet Neurology, Volume 8, Issue 10, Pages 959 - 968, October 2009

Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment
Original Text Nikolai Bogduk MD a b , Jayantilal Govind MBChB c d ‡

Summary

Cervicogenic headache is characterised by pain referred to the head from the cervical spine. Although the International Headache Society recognises this type of headache as a distinct disorder, some clinicians remain sceptical. Laboratory and clinical studies have shown that pain from upper cervical joints and muscles can be referred to the head. Clinical diagnostic criteria have not proved valid, but a cervical source of pain can be established by use of fluoroscopically guided, controlled, diagnostic nerve blocks. In this Review, we outline the basic science and clinical evidence for cervicogenic headache and indicate how opposing approaches to its definition and diagnosis affect the evidence for its clinical management. We provide recommendations that enable a pragmatic approach to the diagnosis and management of probable cervicogenic headache, as well as a rigorous approach to the diagnosis and management of definite cervical headache.

a Newcastle Bone and Joint Institute, Royal Newcastle Centre, Newcastle, New South Wales, Australia
b Faculty of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
c Pain Management Unit, Canberra Hospital, Woden, Australian Capital Territory, Australia
d School of Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
Correspondence to: Nikolai Bogduk, Newcastle Bone and Joint Institute, Royal Newcastle Centre, PO Box 664J, Newcastle, New South Wales 2300, Australia
‡ Dr Govind died on June 16, 2009