Cervicogenic Headache: Evidence That the Neck is a Pain Generator

Headache: The Journal of Head and Face Pain

Volume 50 Issue 4, Pages 699 - 705

Published Online: 13 Apr 2010

CURRENT REVIEW: CLINICAL SCIENCE

Werner J. Becker, MD

From the University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.

Correspondence to  W.J. Becker, Division of Neurology, Foothills Hospital, 1403 29th St NW, Calgary, AB, Canada T2N 2T9.

  Conflict of Interest: None

Copyright Copyright © 2010 American Headache Society

ABSTRACT

This review was developed as part of a debate, and takes the "pro" stance that abnormalities of structures in the neck can be a significant source of headache. The argument for this is developed from a review of the medical literature, and is made in 5 steps.

It is clear that the cervical region contains many pain-sensitive structures, and that these are prone to injury. The anatomical and physiological mechanisms are in place to allow referral of pain to the head including frontal head regions and even the orbit in patients with pain originating from many of these neck structures. 

Clinical studies have shown that pain from cervical spine structures can in fact be referred to the head. 

Finally, clinical treatment trials involving patients with proven painful disorders of upper cervical zygapophysial joints have shown significant headache relief with treatment directed at cervical pain generators. 

In conclusion, painful disorders of the neck can give rise to headache, and the challenge is to identify these patients and treat them successfully.

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DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1526-4610.2010.01648.x About DOI

Whiplash-Associated Disorders

EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders 
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl 

ABSTRACT

Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.

In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.

Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).

Reduced head steadiness in whiplash compared with non-traumatic neck pain

Journal of Rehabilitation MedicineVol. 42/2010 > Iss. 1/January > pp. 35-41
Astrid Woodhouse, Pål Liljebäck, Ottar Vasseljen.
Original report
Abstract:
Objective: While sensorimotor alterations have been observed in patients with neck pain, it is uncertain whether such changes distinguish whiplash-associated disorders from chronic neck pain without trauma. The aim of this study was to investigate head steadiness during isometric neck flexion in subjects with chronic whiplash-associated disorders (WAD), those with chronic non-traumatic neck pain and healthy subjects. Associations with fatigue and effects of pain and dizziness were also investigated.
Methods: Head steadiness in terms of head motion velocity was compared in subjects with whiplash (n = 59), non-traumatic neck pain (n = 57) and healthy controls (n = 57) during 2 40-s isometric neck flexion tests; a high load test and a low load test. Increased velocity was expected to reflect decreased head steadiness.
Results: The whiplash group showed significantly decreased head steadiness in the low load task compared with the other 2 groups. The difference was explained largely by severe levels of neck pain and dizziness. No group differences in head steadiness were found in the high load task.

Conclusion: Reduced head steadiness during an isometric holding test was observed in a group of patients with whiplash-associated disorders. Decreased head steadiness was related to severe pain and dizziness.