Neck (Cervical)
Cervicogenic Headache
경추성 두통
Secondary headache originating from upper cervical spine pathology
- How common
- Common (15–20% of chronic headaches)
- Typical age
- Ages 30–60
What is it?
Upper cervical (C1-C3) afferents converge with trigeminal fibers in the trigemino-cervical nucleus, referring pain to the head.
Commonly affected: C2-3 facet, suboccipital muscles, C1-2 atlantoaxial joint
How it develops
- Cervical DysfunctionDysfunction of C1–C3 joints, muscles, or ligaments
- Nerve IrritationUpper cervical nerve roots (C1–C3) become irritated
- Trigemino-cervical ConvergenceCervical signals converge with trigeminal nucleus
- Referred HeadacheBrain perceives neck pain as head pain
Symptoms
- Unilateral HeadacheAlways the same side (side-locked)
- Occipital OnsetBegins at occiput, radiates to frontal region
- Neck-Induced PainTriggered by neck rotation/flexion
- Neck StiffnessRestricted cervical rotation
- Ipsilateral Shoulder PainPain extending to same-side shoulder
How it is examined
- Flexion-Rotation TestPositive if rotation <30° to affected side
- Occipital TendernessTenderness over greater occipital nerve
- Cervical Facet TendernessC2-3 facet palpation reproduces headache
- Diagnostic BlockPain relief with occipital or C2-3 block confirms diagnosis
Imaging
Lateral and open-mouth X-ray evaluate upper cervical instability and degeneration.
- C1-2 instability
- C2-3 facet degeneration
- Atlantoaxial asymmetry
MRI evaluates upper cervical soft tissues and cord status.
- C2-3 facet inflammation
- Muscle hypertonicity
- Exclude structural causes
Non-surgical care
- Posture + StretchingCorrect forward-head posture, hourly neck stretches
- NSAIDs + Muscle RelaxantsShort-term NSAIDs and muscle relaxants
- PT / Manual TherapyUpper cervical mobilization, deep neck flexor strengthening
- Occipital Nerve BlockGreater occipital nerve injection with local anesthetic + steroid
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed 6-month conservative care with confirmed structural cause
Procedures that may be discussed
- Cervical facet radiofrequency ablation
- Occipital nerve stimulation
- C2-3 facet fusion (rare)
Outlook
70–80% improve with posture correction and physical therapy.