Cervicogenic Headaches: A Critical Review
Spine J 2001 (Jan); 1 (1): 3146
Despite a growing body of literature on CGH and an increasing acceptance that headaches can originate from the cervical spine, there remains considerable controversy and confusion concerning all aspects of this topic. However, a number of comments on CGH appear quite reasonable. The concept that headaches can originate from the neck is not new. The pain appears to be generated by irritation of nociceptors from structures in the cervical spine and may accompany injury and pathology in the neck. These headaches are difficult to differentiate from MH and TTH, although they possess the distinguishing characteristics of being triggered by neck movements, pain spreading to the occipital region, tenderness in the suboccipital tissues, decreased cervical range of motion, and unresponsiveness to typical headache medication.
The significance of radiological findings and advanced diagnostic testing is unclear. Evidence to support treatment with surgery and injections consists mainly of case series without controls or standardized follow-up. The only treatment approach supported by a reasonable body of controlled trials is cervical manipulation, but this is by no means conclusive.
Until additional research and improved consensus on the topic of CGH becomes available, it is essential that any clinician maintain an open, cautious, and critical approach to the literature. At this point, the clinician must be wary of enthusiastic and dogmatic claims concerning CGH. As the literature on this topic grows in volume and quality, the debate will intensify and hopefully result in the clarification of the cause, diagnosis, and treatment of CGH.