Cervicogenic Headaches: A Pain in the Neck

Headaches are an extremely common pain disorder affecting 66% of the general population, and causing widespread changes to quality of life and work productivity⁽¹⁾. A list of fourteen different headache forms has been documented by The International Headache Society⁽²⁾. In particular, its classification of headache disorders can be extremely useful when diagnosing a cause of headache (see Box 1).

Box 1: IHS classification of headache disorders (2013)

Since each form of headache has a different pathological basis and because an incorrect differential diagnosis will often lead to treatment failure, it is critical to correctly diagnose the type of headache. This is of particular importance for manual therapy interventions, as otherwise, they are unlikely to be effective for the majority of headache forms⁽²⁾. When considering the best clinical approach to athletes complaining of headache, there is a helpful tool, which can be used when contemplating the appropriate management pathway (see Figure 1).

The role of trigeminocervical nucleus (TCN)

The most common form of headache is TTH with a global prevalence of 38%; this compares with migraine, which has a prevalence of 10%, chronic daily headache 3%, and CGH 2.5-4.1%⁽¹⁾. CGH arises primarily from a musculoskeletal dysfunction in the upper three cervical segments. The prevalence is as high as 53% in patients or athletes with headache after whiplash-type trauma⁽³⁾.

The mechanism underlying the pain involves convergence between cervical and trigeminal afferents in the TCN, which descends in the spinal cord to the level of C3/4 (see Figure 2)^{(3, 4)}.