Cervicogenic Headache. Cervicogenic Headache is currently not considered an independent disease but rather a symptom complex, etiologically and pathogenetically associated with dysfunction in the cervical region of the spine. Thus, the concept of cervicogenic headache encompasses various mechanisms of headache development related to diseases and pathological conditions of the cervical spine and other neck structures.

The prevalence of cervicogenic headaches is attributed to the close anatomical and physiological interrelationships between osseous, muscular, fibrous, and vascular structures of the cervical region, as well as the complex functional interactions between intervertebral segments, muscles, fibrous tissues, and vascular formations at the cervical level.

Anatomical and Pathophysiological Basis of Cervicogenic Headache Development

The development of cervicogenic headaches involves upper cervical synovial joints, upper cervical muscles, the C2-C3 disc, vertebrae, internal vertebral venous plexuses, and the dura mater of the upper spinal cord, which is innervated by the C1 - C3 spinal nerve structures.

Cervicogenic headaches often arise due to changes in the cervical spine of a degenerative-dystrophic nature (e.g., disc degeneration, cervical instability, uncovertebral arthrosis, etc.), which cause compression of nerve roots, sympathetic paravertebral chains, and muscles in the occipital region, potentially serving as a source of pain. The manifestation of pain syndrome involves both peripheral and central mechanisms, specifically the altered activity of limbic-reticular complex structures and dysfunction in antinociceptive control systems. Common pain sources include intervertebral discs, particularly facet joints (zygapophyseal joints), and associated neural structures (such as the Luschka nerve). The priority role of facet joints in cervicogenic headaches is emphasized when disc function is insufficient.

In the overall manifestation of the pain syndrome in the cervico-occipital region, the leading musculoskeletal component is the trigemino-cervical mechanism. Within the trigeminal system, the trigemino-vascular and trigemino-cervical subsystems are distinguished, both of which play a crucial role in the occurrence and progression of pain syndromes in the head and facial regions. The trigemino-vascular system transmits sensory information from the dura mater and blood vessels of the middle and anterior cerebral arteries, contributing to the development of neurovascular pain syndromes (such as migraines or periodic migraine neuralgia). Meanwhile, the trigemino-cervical system conducts signals from sensory zones innervated by the first and second cervical roots of the spinal cord.

Our clinical studies confirm that the primary mechanisms of cervicogenic headache involve myofascial pain dysfunction (MPD) and reflexive muscle-tonic syndromes, with the formation of localized muscle spasms in the cervico-scapular region.

Treatment in our clinic encompasses a comprehensive approach that includes pharmacological therapy, physiotherapy, manual therapy, reflexology, and the use of dry needling techniques.