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Cervicogenic headache is mainly characterized by unilateral or bilateral headache symptoms which arise from the neck and radiating to the side & upper part of the skull and upper part of the eyes also.
 
 
SYMPTOMS
 
  • Headache is nagging and non-pulsating in nature.
  • Symptoms which the involvement of the cervical spinal column are essential, such as limited movement of neck, provocation of the neck / headache symptoms with mechanical stimuli.
  • One-sided neck, shoulder or arm pain non-radicular in nature can be present. Migraine like symptoms like nausea, vomiting and photophobia can be present in milder form.
 
 
DIAGNOSIS
 
Physical examination of the neck and back of the skull encompasses several elements:
  • Movement of cervical spinal column will be restricted or painful
  • External pressure points on occipital or higher cervical region are painful
  • Pressure pain on the Trapezius muscle border are painful




  • Usually migraine can shift from one side to other side whereas cervicogenic headache usually doesn’t.
  • Cervicogenic headache begins in the neck while migraine begins in the front or side of the skull.
  • Cervicogenic headache can be provoked by mechanical pressure in the upper and side of the cervical spine, on the symptomatic side, and / or with continuous backward tilting of the head; whereas this usually doesn’t happen in migraine. In cervigogenic headache there is often a limitation of movement in the neck, which is not charecteristic of migraine.
  • A non-radicular, unilateral diffuse shoulder / arm pain sometimes occur in cervicogenic headache but not in migraine.
So, it is now clear that cervicogenic headache is arising from the structures of cervical spinal column like Facet joint, Intervertebral disc, Muscles and Ligaments which are supplied by spinal nerve root C1, C2 and C3 / C4.

 
TREATMENT
 
Conservative therapy:
  • Medications
  • Exercise
  • Physiotherapy
  • Trans-cutaneous Electrical Nerve Stimulation (TENS)
 
 
INTERVENTIONAL MANAGEMENT :
 
  • Greater or Lesser Occipital nerve block with Local Anesthetics and Steroid
  • Injection into Atlanto-axial joint with Local Anesthetics and Steroid and Steroid
  • Cervical facet Joint Intra-articular block with Local Anesthetics and Steroid
  • Diagnostic blocking of nerve supple of Facet Joint (Median Branch Block)
  • Long term therapy by Radio-frequency ablation (Median Branch)
 

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