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INTRODUCTION

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Neck pain and cervical muscle tightness are common and prominent symptoms of primary headache disorders such as tension-type headache (TTH) and migraine.1 Conversely, head pain referred from bony structures or soft tissues of the neck is a condition that is commonly called cervicogenic headache.2 Cervicogenic headache can be a perplexing pain disorder that is often refractory to common headache treatments when it is not recognized. The successful treatment of cervicogenic headache usually requires a multifaceted approach using pharmacologic, nonpharmacologic, anesthetic, and occasionally surgical interventions.

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CERVICOGENIC HEADACHE

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Cervicogenic headache can be generally defined as a recurring or persistent pain that is referred to the head from bony structures or soft tissues of the neck. Although the condition's pathophysiology and source of pain have been debated,3-5 pain is believed to be referred to the head or face from one or more muscular, neurogenic, osseous, articular, and vascular structures in the neck through a functional convergence of cervical spinal and trigeminal sensory pathways in the upper cervical spinal cord.6 It is often a sequela of head or neck injury but may also occur in the absence of recognized injury. The clinical features of cervicogenic headache may mimic those commonly associated with primary headache disorders such as TTH, migraine, or hemicrania continua, and as a result, distinguishing the etiology of chronic head pain from among these headache types by medical history alone can be difficult.

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DIAGNOSTIC CRITERIA

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The Cervicogenic Headache International Study Group developed diagnostic criteria that have provided a detailed, clinically useful description of the condition7 (Table 31-1).

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TABLE 31-1

The Cervicogenic Headache International Study Group Diagnostic Criteria

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