Invited Review
Cervicogenic Headache: Bad Referral or Appropriate for Your Spine Clinic?
Kristina Barber, MD
University of Colorado School of Medicine Aurora, CO, USA
Jason Friedrich, MD
University of Colorado School of Medicine Aurora, CO, USA
Jason Friedrich, MD, previews this article on the trend of cervicogenic headaches being referred to spine care providers.
Introduction
Headache is one of the most common reasons for medical evaluation in the world and spine clinics frequently receive referrals for cervicogenic headache. Cervicogenic headache is a precise diagnosis, as described in the International Classification of Headache Disorders (ICHD). However, this particular diagnosis may be trending into a more generic term for any patient experiencing both neck pain and headache. This trend is problematic due to inappropriate referrals to spine clinics without initial evaluation and management of more common primary headache disorders. In this article, we will briefly review headache classification and epidemiology, define cervicogenic headaches, and provide a reasonable approach for triaging these referrals, diagnosing true cervicogenic headache, and managing this disorder after the diagnosis is confirmed.
Background and Epidemiology
Lifetime prevalence for headache is 96%, with a peak in females between the age of 25 and 55 years.1 The International Classification of Headache Disorders (ICHD) provides a systematic approach to classification and diagnosis. Primary headaches account for 90% of headaches, do not have an apparent cause, and include tension type, migraine, and cluster. Tension type headaches are the most prevalent, but migraine is the most common among patients who seek medical care.2,3 Many of these patients report neck pain associated with their primary headaches.
Secondary headaches, including cervicogenic, account for the remaining 10% of headaches. There are multiple subcategories of secondary headaches with classifications for over 300 different causes.2 (Figure 1)
Cervicogenic headache was initially described in 1983 and established as a secondary headache disorder by The International Headache Society (IHS) in 2004. Google searches for cervicogenic headache have been steadily rising since that time.4 Cervicogenic headache is defined as a headache “caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.”5 Most commonly, this refers to anatomic abnormalities at C1-C3 known to cause cranial nociception.