Therapeutic options for cervicogenic headache

Abstract

The term cervicogenic headache (CeH) describes a syndrome originating from the cervical spine. There are a variety of therapeutic approaches used for the management of CeH, but scientific evidence of their effectiveness is scarce. No medication drug has proven to be effective. The evidence for greater occipital nerve blocks, cervical nerve blockades, facet joint injections and surgical procedures is limited. Several physical therapy interventions are proposed for CeH, with spinal manipulation and soft tissue interventions being the most commonly used. However, the lack of solid evidence of positive effects and risks of serious complications for spinal manipulation should be considered in favor of other physical therapy interventions associated with less risk. The inconsistent results in the literature can be related to the fact that maybe not all therapeutic interventions are appropriate for all patients with CeH or maybe not all patients with CeH will benefit from particular interventions.

Keywords::

• cervicogenic headache
• headache
• manual therapy
• neck
• nerve blocks
• physical therapy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Many treatments have been proposed for cervicogenic headache (CeH), but only few of them have been tested in randomized controlled trials and even fewer have proven effective.

• No drugs are effective for CeH.

• Local injections of anesthetics or nerve blocks have been used as diagnosis and treatment tools in patients with CeH, but the evidence for their effectiveness is limited.

• Surgical interventions for CeH are not sufficiently validated.

• The presence of several musculoskeletal impairments of the cervical spine in patients with CeH justifies the application of physical therapy interventions.

• There are several physical therapy interventions proposed for CeH (manipulation, massage, stretching, connective tissue, dry needling or spinal joint mobilization), but no solid evidence supports their effectiveness at this moment.

• The lack of solid evidence of positive effects and risks of serious complications for spinal manipulation should be considered in favor of other physical therapy options.

• It seems that certain subgroups of individuals with CeH could respond positively to specific interventions.

Notes

† The International Classification of Headache Disorders, 3rd Edition (beta version) [5].