All About Cervicogenic Headaches in Dentistry

 

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Kopfschmerzen

Specific symptoms of the cervicogenic headache are a unilateral headache that does not change sides.

It is triggered by certain movements of the cervical vertebra or by the application of pressure to specific trigger points (e.g., the starting point of the greater occipital nerve or the transverse processes of the cervical vertebra). It presents itself almost exclusively as a continuous, permanent pain fluctuating in intensity, and may be superimposed by attacks with durations lasting from several hours to several days.

Pain levels are from moderate to severe intensity and are characterized by a dull or dragging-piercing quality. It typically radiates from the neck to the forehead/temple or the eye. Sometimes, attendant symptoms such as nausea and vomiting, unspecified dizziness, isolated sensitivity to sound and light, and swallowing disturbances (only rarely) are observed. The cervicogenic headache is differentiated from the migraine.

Epidemiology

The majority of studies were performed in headache centers, where the incidence rate varied between 1-15 %. There is a frequent combination (up to 17 %) with other headache forms, such as, e.g., migraine or tension headaches. Almost all study authors stated that women suffer from cervicogenic headaches more than men by a ratio of 3:2.

Cause (Etiology)

Peripheral nerve fibers reach into the spinal cord from the back of the head and the neck, where they mix with spinal cord fibers. This morphologic and functional mixing of peripheral nerves and spinal cord fibers in the sense of a “relay” is responsible for the transmission of pain impulses from the neck to the forehead.

Known causes, such as basilar impression, transitional anomalies, rheumatoid arthritis, cervical myelopathy, bony tumors, neurinomas at the height of C1-C2, venous plexus, arterial vascular loops, arteriovenous malformations, a dissection of the vertebral artery and in rare cases of the internal carotid artery as well, or unilateral retropharyngeal tendinitis must be differentiated from unknown causes through precise clinical studies.

Treatment

In case of known causes, corresponding therapy should be implemented. In case of unknown causes, one has to rely on different approaches. Nerve or root blockages (the paracervical block according to Moore and the C2 ganglion block according to Bogduk) probably only have a diagnostic value.

Blockages of the greater occipital nerve are technically easier to perform, have fewer side effects, and constitute an alternative to C2 blockages. Furthermore, transcutane electrical nerve stimulation (TENS), physical measures such as massages, hydrotherapy, or electrotherapy, as well as therapy approaches combined with physiotherapeutic and cognitive-behavioral therapeutic measures are applied.

There are no systematic studies that allow for classification according to evidence-based medicine. The importance of manual therapy is not conclusively clarified. Such therapies are often overrated.

Surgical Interventions

In case of pain in the back of the head/neck/cervical vertebra, different techniques are often employed. These can only be compared to a limited degree. The examined patient population is inhomogeneous, not clearly defined, and contains some patients with unilateral discomforts and others suffering from bilateral complaints as well.

The natural histories are obviously underestimated in the evaluation of therapy results. In cases of clinically unambiguous diagnoses, neurolyses of the greater occipital nerve only showed a lasting effect over more than 16 months in 8 % of patients. In a differentiated application of the ganglionectomy, as well as ventrally and dorsally decompressing surgeries, success rates of 80 % were described in an overview including 102 patients.

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