Cervicogenic Headache

Pain Practice
Volume 10 Issue 2, Pages 124 - 130 Published Online: 23 Feb 2010Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
Hans van Suijlekom, MD, PhD*; Jan Van Zundert, MD, PhD, FIPP †‡ ; Samer Narouze, MD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ‡ ; Nagy Mekhail, MD, PhD, FIPP §
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands, † Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg Genk, Belgium, ‡ Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands, § Pain Management Department, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Correspondence to M. van Kleef, MD, PhD, Maastricht University Medical Centre, Department of Anesthesiology and Pain Management, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: maarten.van.kleef@mumc.nl 

ABSTRACT

Cervicogenic headache is mainly characterized by unilateral headache symptoms which arise from the neck radiating to the fronto-temporal and possibly to the supra-orbital region. Physical examination to find evidence of a disorder known to be a valid cause of headache encompasses movement tests of the cervical spinal column and segmental palpation of the cervical facet joints and soft tissues of the neck.

Injection of the nervus occipitalis major is recommended after unsatisfactory results with conservative treatments (1 B+). In the case of an unsatisfactory outcome after injection of the nervus occipitalis major, radiofrequency treatment of the ramus medialis (medial branch) of the cervical ramus dorsalis can be considered (2 B±).

If the result is unsatisfactory pulsed radiofrequency treatment of the ganglion spinale (dorsal root ganglion) of C2 and/or C3 can be considered in a study context (O).