Cervicogenic Headaches.

Cervicogenic headache is a well-recognized syndrome that can be differentiated from migraines and tension-type headaches clinically for being a side-locked unilateral pain, radiating from the back of the neck with evidence of neck involvement—attacks may be precipitated by digital pressure over trigger spots in the cervical/nuchal areas or sustained awkward neck positions.

Migrainous features may be present in some cases and lesions of the cervical spine are not necessarily seen on the imaging methods currently available.

Whiplash and head trauma (any kind of head trauma is transmitted to the cervical spine) may induce headaches. This is suspected when the pain onset and the whiplash and/or concussion are close in time.

Whiplash-related headaches tend to be short-lasting.

Whiplash and concussed patients must undergo cervical imaging to rule out structural lesions of the cervical spine.

The pathophysiology revolves around the anatomy and physiology of upper cervical segment nociceptive afferents, and their projections to second order neurons. In experimental animals, the cervical and ophthalmic divisions of trigeminal neurons clearly synapse on common second-order neurons in the trigeminocervical complex. The basic data are supported by clinical observations, such as referred pain from cervical muscles and the C2–3 zygapophysial joint.

Clinical data suggest that the caudal limit of cranial referral in the neck is at the level of the C3 afferents.

Caudal pressure on the head with lateral rotation is a very sensitive marker of upper cervical pathology.

Treatment consists basically on anticonvulsants (Pregabalin or Gabapentin), muscle relaxants, physical therapy, occipital nerve blocks and in refractory cases cervical medial branch block followed by Radiofrequency ablation of the medial branches.