Chapter 16 – Cervicogenic Headache

Cervicogenic headache is an unrecognized yet relatively common chronic headache disorder that is often misdiagnosed as migraine or tension-type headache. Cervicogenic headache typically presents as an occipital headache with pain radiating to one side of the head. Physical examination may show restricted range of motion to the affected side, and focal tenderness to cervical facets or other structures. Diagnostic imaging is commonly normal or non-specific, but may identify areas of clinical concern such as C2/3 or C3/4 facet hypertrophy. Physiotherapy may be an effective treatment. Although there are no FDA approved medications for cervicogenic headache, medications such as gabapentin, topiramate, or duloxetine may have a clinical role. Interventional treatments, such as occipital nerve anesthetic blockade or cervical neurotomy, may be considered. Early diagnosis and management can significantly decrease the duration, cost, and disability of this often challenging pain disorder.