Cervicogenic Headache - a common cause of pain in the side of the head

About 4% of adults may experience this type of headache in any given year.

What does Cervicogenic Headache Feel Like?

It occurs on the same side as the worn neck joint. After migraine, cervicogenic headache is probably the next most common cause of a unilateral headache (pain on one side of the head only).

The pain can feel like a sharp pain, dull ache or even a shooting pain.

It can be worse after lying down - many patients will report that the headache in the back of the head is awful when they waken in the morning.

People with headache coming from the neck do not normally feel nauseated or feel annoyed by light or noise (where as people with migraine usually do).

Rarely, the pain will come on quite suddenly, and persist for days at a time. If this happens the person may require diagnostic tests to rule out other causes, such as a Vertebral Artery Dissection.

There have been a small number of cases in which vertebral dissection has been mis-diagnosed as cervicogenic headache.

If care is taken to properly evaluate the patient (a history and physical examination as a minimum) the risk should not be great.

Any case where there is a doubt about diagnosis should see a doctor urgently. Tests such as MRI may be required to rule out the very rare cases where the pain is not from joints in the neck, but from a torn artery instead.

What is the Treatment?

Clinical trials of physiotherapy have shown positive results, with moderate relief of headache sustained up to 12 months after strength and endurance exercises for neck muscles.

In more severe cases, occipital nerve block or facet joint neurolysis can be performed - often to very good effect.

One carefully conducted study, with a carefully selected group of people with cervicogenic headache saw 88% of people with a good level of headache relief for almost 300 days after the procedure.

Occipital nerve block, as a treatment for neck-related headache, is usually a temporary measure lasting only a matter of week at a time - but can be very effective for short periods of time.

I often use an occipital nerve block to give temporary relief for people who have presented with a very severe pain that has not been relieved by ordinary painkillers.

How does a neck problem cause headaches?

These joints are called facet joints or zygapophysial joints, and include a joint called the lateral atlanto-axial joint.

Nerves from these joints travel into the brain where they join up, or merge, with nerves from the main nerve to the head and face, called the trigeminal nerve.

Because the nerves from the upper part of the neck join up with nerves from the head and face, you brain cannot tell the difference between pain in the neck and pain in the head.

This means that arthritic-type problems in the upper part of neck can produce a symptom of pain in the back of head, side of the head or even pain above one eye.

This is called referred pain.

Studies of joints of the upper spine have proven that pain in the forehead, side of head and back of head can all be caused by disease of the facet joints.



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