Cervicogenic Headache is Rare – You Have Got to be Kidding (?)

October 7, 2009 by dean · Leave a Comment 

In a study coming out of Norway the incidence of cervicogenic (neck) headache was found to be rare – only 0.17% of the population.

It is interesting to note that the diagnosis was made based only on the features of headache. It is widely accepted that features of headache alone are not sensitive enough to differentiate cervicogenic headache from migraine and from tension headache.

To diagnose cervicogenic headache, a thorough and skilled examination of the upper neck needs to be performed for temporary reproduction (and resolution) of familiar headache.

A physical examination was performed on only those headache sufferers selected on the basis of their headache features (and did include the above!). If it had it would have confirmed cervicogenic headache. However this is not the point, the physical examination was performed on only a select few!

Similarly, greater occipital nerve (GON) blocks blocks were performed only on those selected from their headache features – the blocks were effective in over 90% – I am not surprised. As with the physical examination, the blocks needed to be performed before a diagnosis of cervicogenic headache was made.

I have written before of the numerous studies demonstrating that headaches with a diagnosis of migraine are relieved by blocking the GON (greater occipital nerve) – who knows how many of the headache sufferers were excluded based on features and who had cervicogenic headache (?)

Previous research has shown that cervicogenic (neck) headache is as common as migraine.



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Nilsson N. The prevalence of cervicogenic headache in a random population sample of 20-59 year olds. Spine 1995;20:1884-1888

Rozen T. Cessation of hemiplegic migraine auras with greater occipital nerve blockade. Headache 2007;47:917-928

Takmaz, S. et al Greater occipital nerve block in migraine headache: Preliminary results of 10 patients. Agri 2008 Jan;20(1):47-50

Yi X et al Cervicogenic headache in patients with presumed migraine: missed diagnosis or misdiagnosis? J Pain. 2005 Oct;6(10):700-3

Young WB, Marmura M, Ashkenazi A, Evans RW. Expert opinion: Greater occipital nerve and other anesthetic injections for primary headache disorders. Headache. 2008;48:1122-1125

Young et al. The first 5 minutes after greater occipital nerve block. Headache 2008;48:1126-1139)

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About dean
Consultant Headache & Migraine Physiotherapist; International Teacher; Director, The Headache Clinic & Watson Headache Institute; PhD Candidate Murdoch University, Western Australia; Adjunct Lecturer, Masters Program, Physiotherapy School, University of South Australia; MAppSc(Res) GradDipAdvManipTher Experienced health practitioners trained in the Watson Headache Approach perform the examination and treatment techniques developed by Dean Watson. These techniques are based on his extensive experience of 7000 headache patients (21,000 hours) over 21 years and are now taught internationally. For your nearest practitioner who has completed training in the ‘Watson Headache Approach’ please refer to the ‘Practitioner Directory’.

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