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European Spine Journal

, Volume 16, Issue 7, pp 953–959 | Cite as

Headache in patients with cervical radiculopathy: a prospective study with selective nerve root blocks in 275 patients

  • Liselott C. G. PerssonEmail author
  • Jane Y. Carlsson
  • Leif Anderberg
Original Article

Abstract

Since many years we routinely use diagnostic selective nerve root blocks (SNRB) at our department when evaluating patients with cervical radiculopathy. Frequently patients who also presented with headache reported that the headache disappeared when the nerve root responsible for the radicular pain was blocked with local anaesthetics. Headache has been described as a companioning symptom related to cervical radiculopathy but has never before been evaluated with SNRB performed in the lower cervical spine. For this reason we added to our routine an evaluation of the response from the SNRB on headache in patients with cervical radiculopathy. The aim was to describe the frequency of headache in patients with cervical radiculopathy and its response to a selective nerve root block of the nerve root/roots responsible for the radiculopathy. Can nerve root compression in the lower cervical spine produce headache? In this consecutive series of 275 patients with cervical radiculopathy, 161 patients reported that they also suffered from daily or recurrent headache located most often unilaterally on the same side as the radiculopathy. All patients underwent a careful clinical examination by a neurosurgeon and a MRI of the cervical spine. The significantly compressed root/roots, according to the MRI, underwent SNRB with a local anaesthetic. The effect of the nerve root block on the radiculopathy and the headache was carefully noted and evaluated by a physiotherapist using visual analogue scales (VAS) before and after the SNRB. All patients with headache had tender points in the neck/shoulder region on the affected side. Patients with headache graded significantly more limitations in daily activities and higher pain intensity in the neck/shoulder/arm than patients without headache. After selective nerve root block, 59% of the patients with headache reported 50% or more reduction of headache and of these 69% reported total relief. A significant correlation was seen between reduced headache intensity and reduced pain in the neck, shoulder and arm. The result indicates that cervical root compression from degenerative disease in the lower cervical spine producing radiculopathy might also induce headache.

Keywords

Cervical spine Cervicogenic headache Cervical radiculopathy Selective nerve root block International Headache Society classification 

Notes

Acknowledgment

The study was supported by grants from the Region Skane, Medical Faculty, University in Lund, and the Department of Neurosurgery, University Hospital of Lund, Sweden.

References

  1. 1.
    Ackelman BH, Lindgren U (2002) Validity and reliability of a modified version of the neck disability index. J Rehabil Med 34(6):284–287PubMedCrossRefGoogle Scholar
  2. 2.
    Anderberg L, Annertz M, Brandt L, Säveland H (2004) Selective diagnostic nerve root blocks: correlation with clinical symptoms and MRI-pathology. Acta Neurochir 146(6):559–565CrossRefGoogle Scholar
  3. 3.
    Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H (2006) Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J 15(6):794–798PubMedCrossRefGoogle Scholar
  4. 4.
    Biondi DM (2005) Cervicogenic headache: a review of diagnostic and treatment strategies. JADA (suppl. 2);05(4):6–22Google Scholar
  5. 5.
    Bogduk N (1987) The clinical anatomy of the cervical dorsal rami. Spine 4:319–330Google Scholar
  6. 6.
    Bogduk N (2001) Cervicogenic headache: anatomic basis and pathophysiologic mechanism. Curr Pain and Headache Rep 5(4):382–386CrossRefGoogle Scholar
  7. 7.
    Bogduk N (2004) The neck and headaches. Neurol Clin 22(1):151–171PubMedCrossRefGoogle Scholar
  8. 8.
    Bogduk N (2005) Distinguishing primary headache disorders from cervicogenic headache: clinical and therapeutic implications. Headache Currents 2:27–36CrossRefGoogle Scholar
  9. 9.
    Bogduk N, Marsland A (1988) The cervical zygapophyseal joints as source of neck pain. Spine 13(6):610–617PubMedCrossRefGoogle Scholar
  10. 10.
    Bogduk N, Windsor M, Inglis A (1988) The innervation of the cervical intervertebral discs. Spine 13(1):2–8PubMedCrossRefGoogle Scholar
  11. 11.
    Carette Fehling MG (2005) Clinical practice. Cervical radiculopathy. N Engl J Med 28 353(4):392–399Google Scholar
  12. 12.
    Carlsson AM (1983) Assessment of chronic pain: aspects of the reliability and validity of the visual analoque scale. Pain 16:87–101PubMedCrossRefGoogle Scholar
  13. 13.
    Davidoff RA (1998) Trigger points and myofascial pain: toward understanding how they affect headaches. Cephalalgia 18(7):436–448PubMedCrossRefGoogle Scholar
  14. 14.
    Espersen JO, Buhl EF, Fode K, Lindeberg KH, Madsen CB, Strange P, Wohlert L (1984) Treatment of cervical disc disease using Cloward technique. General results, effect of different operative methods and complications in 1106 patients. Acta Neurochir 70:97–114CrossRefGoogle Scholar
  15. 15.
    Fredriksen TA, Salvesen R, Stolt-Nielsen A, Sjaastad O (1999) Cervicogen headache: long-term postoperative follow-up. Cephalagia 39:21–27Google Scholar
  16. 16.
    Haldeman S, Dagenais S (2001) Cervicogenic headaches; a critical review. Spine J 1(1):31–46PubMedCrossRefGoogle Scholar
  17. 17.
    Hoving JL, O´Leary EF, Niere KR, Green S, Buchbinder R (2003) Validity of the neck disability index, Northwick park neck pain questionnaire and problem elicitation technique for measuring disability associated with whiplash-associated disorders. Pain 102:273–281PubMedCrossRefGoogle Scholar
  18. 18.
    International Classification of headache disorders (2004). Headache classification subcommittee of the International Headache Sociality, 2nd edn. Cephalalgia, 24 (suppl 1)Google Scholar
  19. 19.
    Jaeger B (1989) Are cervicogenic headache due to myofascial pain and cervical spine dysfunction? Cephalalgia 9:157–164PubMedCrossRefGoogle Scholar
  20. 20.
    Jensen R (2003) Peripheral and central mechanism in tension-type headache: an update. Cephalalgia 23(suppl.1):49–52PubMedCrossRefGoogle Scholar
  21. 21.
    Jensen S (2005) Neck related causes of headache. Aust fam Phys 34(8):635–639Google Scholar
  22. 22.
    Kikuchi S, Macnab P, Moreu P (1981) Localization of the level of symptomatic cervical disc degeneration. J Bone Joint Surg 2:272–277Google Scholar
  23. 23.
    Langemark M, Olesen J (1987) Pericranial tenderness in tension headache. A blind controlled study. Cephalalgia 7:249–255PubMedCrossRefGoogle Scholar
  24. 24.
    Letchuman R, Gay RE, Shelerud RA, VanOstrand LA (2005) Are tender points associated with cervical radiculopathy? Arch Phys Med Rehabil 86(7):1333–1337PubMedCrossRefGoogle Scholar
  25. 25.
    Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 1: treatment of lateral disc herniation in 253 cases. J Neurosurg 53(1):1–11PubMedCrossRefGoogle Scholar
  26. 26.
    Marcus D, Scharff L, Mercer MA, Turk DC (1999) Musculoskeletal abnormalities in chronic headache; a controlled comparison of headache diagnostic groups. Headache 39:21–27PubMedCrossRefGoogle Scholar
  27. 27.
    Michler RP, Bovim G, Sjaastad O (1991) Disorders in the lower cervical spine. A cause of unilateral headache. Headache 31:550–551PubMedCrossRefGoogle Scholar
  28. 28.
    O`Leary S, Falla D, Jull G (2003) Recent advances in therapeutic exercise for the neck; implications for patients with head and neck pain. Aust Endod J 239(3) 138–142Google Scholar
  29. 29.
    Persson L, Moritz U (1994) Pain-drawing: a quantitative and qualitative model for pain assessment in cervico-brachial pain syndrome. 1993 The pain clinic 1:13–22Google Scholar
  30. 30.
    Persson LC, Carlsson JY (1999) Headache in patients with neck–shoulder–arm pain of cervical radicular origin. Headache 39(3):218–224PubMedCrossRefGoogle Scholar
  31. 31.
    Persson LCG, Carlsson CA, Carlsson JY (1997) Long lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine 22:751–758PubMedCrossRefGoogle Scholar
  32. 32.
    Pfaffenrath V, Dankekar R, Pöllmann W (1987) Cervicogenic headache. The clinical picture, radiological findings and hypothesese on its pathophysiology. Headache 27:495–499PubMedCrossRefGoogle Scholar
  33. 33.
    Sjaastad O, Saunte C, Hovdahl H, Breivik H, Grønbæk E (1983) “Cervicogenic” headache. An hypothesis. Cephalalgia 3:249–256PubMedCrossRefGoogle Scholar
  34. 34.
    Sjaastad O, Fredriksen TA, Pfaffenrath V (1998) Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 38:442–445PubMedCrossRefGoogle Scholar
  35. 35.
    Tan JC, Nordin M (1992) Role of physical therapy in the treatment of cervical disk disease. Orthop Clin North Am 23(3):435–449PubMedGoogle Scholar
  36. 36.
    Torbjorn AF, Stolt-Nielsen A, Skaanes KO, Sjaastad O (2003) Headache and the lower cervical spine: long-term postoperative follow up after decompressive neck surgery. Funct Neurol 18(1):17–28PubMedGoogle Scholar
  37. 37.
    Travell JG, Simons DG (1983) Myofascial pain and dysfunction. Trigger point manual, 1st edn. Willams and Wilkins, BaltimoreGoogle Scholar
  38. 38.
    Vernon H, Mior S (1991) The neck disability index: a study of validity and reliability. J Manipulative Physiol Ther 14:409–415PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Liselott C. G. Persson
    • 1
    Email author
  • Jane Y. Carlsson
    • 2
  • Leif Anderberg
    • 1
  1. 1.Neurosurgery DepartmentClinNeuroscience, University HospitalLundSweden
  2. 2.Neuroscience and PhysiologyThe Sahlgrenska AcademyGothenburgSweden

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