What are cervicogenic headaches?
Cervicogenic headaches are those which result from problems in the neck, such as disc degeneration or prolapse, or facet joint arthritis.

‘Cervico-’ means neck, and ‘-genic’ means origin.

Headaches arising from the cervical spine are relatively common and under-recognised.

What may cause cervicogenic headaches?
Cervicogenic headaches may occur as a consequence of degenerative cervical spine disease (arthritis), a disc prolapse in the neck, or following a whiplash-type injury to the neck. Any type of neck condition can result in these types of headaches.

What are the symptoms of cervicogenic headaches?
Cervicogenic headaches cause pain typically at the back of the head. This pain may radiate (spread) to the top of the skull and sometimes to the forehead or temple. It may also be associated with pain or discomfort behind the eye.

There is often, but not always, associated neck pain or discomfort, and sometimes the neck pain and headaches become more or less severe at the same time.

Nausea, poor concentration and irritability are frequent accompanying symptoms.

What are the other possible diagnoses?
Cervicogenic headaches may resemble true occipital neuralgia, a condition causing localised pain and neurological abnormalities in the distribution of the occipital nerves at the back of the head. Migraines may also be confused with cervicogenic headaches. An opinion from a neurologist is frequently sought to be more certain of the diagnosis.

How are cervicogenic headaches treated?
It is important to attempt to determine the anatomical basis of these headaches, in other words “exactly which structures in the neck are causing the headaches?”. Once this has been done, the appropriate treatment may be prescribed.

Initially, cervicogenic headaches are treated with pain medications and physiotherapy. Avoidance of aggravating activities is important.

Unremitting cervicogenic headaches arising from the facet joints may respond to percutaneous radiofrequency denervation (where the nerves over the joints are damaged by controlled heating through a needle in the back of the neck). A facet joint block with local anaeasthetic (and often steroids) is usually performed first to confirm the diagnosis.

C2 radiofrequency pulse ganglionotomy is another percutaneous technique which may benefit some patients, particularly if C2 nerve root compression is thought to be involved in the production of the headaches.

Cervicogenic headaches secondary to cervical disc prolapse or nerve root compression often (but not reliably) improve with microsurgical discectomy and fusion.

More recently, peripheral nerve stimulation of the greater and lesser occipital nerves has emerged as an effective technique in patients with cervicogenic headaches resistant to all conventional therapies. It appears that upwards of 70% of patients may benefit from this surgical technique.