Dvorak J, Walchli B
Neurologische Abteilung, Schulthess-Klinik, Zurich
Headache is a common symptom in patients suffering from cervical spine disorders. The percentage of headaches in association with degenerative changes of the cervical spine ranges from 13 to 79% and that in association with indirect trauma of the cervical spine from 48 to 82%. Based on neuroanatomical and neurophysiological studies, the relationship of the upper cervical spine and the trigeminal nuclei has been demonstrated and serves as an explanation for perceived head pain in cervical spine disorders. As a source of pain, tension in the suboccipital muscles, irritation of the third occipital nerve, and degenerative changes of the C2/C3 joints have been discussed. Bogduk, in his studies, asserts a direct causative role of mechanical derangement of the cervical spine in the pathogenesis of cervicogenic headaches.
In 1983, Sjaastad et al. postulated the concept of ‘cervicogenic headaches’: a migraine-like headache due to certain disorders of the cervical spine, strictly located unilaterally, its manifestations being in the temporal, frontal, and ocular areas, with associated symptoms such as slight lacrimation, conjunctival injections, tinnitus, runny nose, and erythema in the forehead ipsilaterally. As arguments in favour of a cervical origin, Sjaastad mentioned the following features: precipitation of the headaches either by neck movements or by pressure against certain tender spots on the neck, the possibility of homolateral shoulder or arm pain, stiffness and pain of the neck, and reduced mobility of the cervical spine. In 1988, the Headache Classification Committee of the International Headache Society set strict criteria for ‘headaches’ to be classified as to be of cervical origin.