Current Pain and Headache Reports

, Volume 14, Issue 6, pp 418–423 | Cite as

Cervical Facet Arthropathy and Occipital Neuralgia: Headache Culprits

  • J. D. HoppenfeldEmail author


Cervicogenic headache (CH) is pain referred from the neck. Two common causes are cervical facet arthropathy and occipital neuralgia. Clinical diagnosis is difficult because of the overlying features between primary headaches such as migraine, tension-type headache, and CH. Interventional pain physicians have focused on supporting the clinical diagnosis of CH with confirmatory blocks. The treatment of cervical facet arthropathy as the source of CH is best approached with a multidimensional plan focusing on physical therapy and/or manual therapy. The effective management of occipital neuralgia remains challenging, but both injections and neuromodulation are promising options.


Cervicogenic headache Occipital neuralgia Cervical facet arthropathy Occipital nerve stimulation Occipital nerve block 



No conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Haldeman S, Dagenais S: Cervicogenic headaches: a critical review. Spine J 2001, 1:31–46.CrossRefPubMedGoogle Scholar
  2. 2.
    Lynch MC, Taylor JF: Facet joint injection for low back pain: a clinical study. J Bone Joint Surg Br 1986, 68:138–141.PubMedGoogle Scholar
  3. 3.
    Lord SM, Barnley L, Wallis BJ, Bogduk N: Chronic cervical zygapophyseal joint pain after whiplash. A placebo-controlled prevalence study. Spine (Phila Pa 1976) 1996, 21:1737–1744.Google Scholar
  4. 4.
    Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns: a study in normal volunteers. Spine (Phila Pa 1976) 1990, 15:453–457.Google Scholar
  5. 5.
    Bogduk N, Bartsch T: Cervicogenic headache. In Wolff’s Headache, edn 8. Edited by Silberstein SD, Lipton RB, Dodick DW. New York: Oxford University Press; 2008:551–570.Google Scholar
  6. 6.
    Bogduk N: Cervicogenic headache: anatomic basis and pathophysiologic mechanisms. Curr Pain Headache Rep 2001, 5:382–386.CrossRefPubMedGoogle Scholar
  7. 7.
    Bartsch T, Goadsby PJ: Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002, 125:1496–1509.CrossRefPubMedGoogle Scholar
  8. 8.
    Bartsch T, Goadsby PJ: Increased responses in trigeminocervical nociceptive neurons to cervical input after stimulation of the dura mater. Brain 2003, 126:1801–1813.CrossRefPubMedGoogle Scholar
  9. 9.
    Goadsby PJ, Bartsch T: On the functional neuroanatomy of neck pain. Cephalalgia 2008, 28(Suppl 1):1–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Kerr FW: Structural relationship of the trigeminal spinal tract to upper cervical roots in the solitary nucleus in the cat. Exp Neurol 1961, 4:134–148.CrossRefPubMedGoogle Scholar
  11. 11.
    Blau JN, MacGregor EA: Migraine and the neck. Headache 1994, 34:88–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Headache Classification Committee of the International Headache Society: e International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24(Suppl 1):1–160.Google Scholar
  13. 13.
    van Suijlekom JA, de Vet HC, van den Berg SG, Weber WE: Interobserver reliability of diagnostic criteria for cervicogenic headache. Cephalalgia 1999, 19:817–823.CrossRefPubMedGoogle Scholar
  14. 14.
    Van Suijlekom HA, De Vet HC, Van Den Berg SG, Weber WE: Interobserver reliability in physical examination of the cervical spine in patients with headache. Headache 2000, 40:581–586.CrossRefPubMedGoogle Scholar
  15. 15.
    Sjaastad O, Fredriksen TA, Pfaffenrath V: Cervicogenic headache: diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 1998, 38:442–445.CrossRefPubMedGoogle Scholar
  16. 16.
    Coskun O, Ucler S, Karakurum B, et al.: Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia 2003, 23:842–845.CrossRefPubMedGoogle Scholar
  17. 17.
    Halla JT, Hardin JG Jr: Atlantoaxial (C1–C2) facet joint osteoarthritis: a distinct clinical syndrome. Arthritis Rheum 1987, 30:577–582.CrossRefPubMedGoogle Scholar
  18. 18.
    Bogduk N: Lateral Atlanto-Axial Joint Blocks. In Practice Guidelines for Spinal Diagnostic and Treatment Procedures, edn 1. San Francisco: International Spine Intervention Society (ISIS); 2004:138–143.Google Scholar
  19. 19.
    Jull G, Trott P, Potter H, et al.: A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002, 27:1835–1843.Google Scholar
  20. 20.
    Freund B, Schwartz M: Treatment of chronic cervical-associated headache with botulinum toxin A: A pilot study. Headache 2000, 40:231–236.CrossRefPubMedGoogle Scholar
  21. 21.
    Joseph B, Kumar B: Gallie’s fusion for atlantoaxial arthrosis with occipital neuralgia. Spine (Phila Pa 1976) 1994, 19:454–455.Google Scholar
  22. 22.
    Ghanayem AJ, Leventhal M, Bohlman HH: Osteoarthrosis of the atlanto-axial joints. Long-term follow-up after treatment with arthrodesis. J Bone Joint Surg Am 1996, 78:1300–1307.PubMedGoogle Scholar
  23. 23.
    Roberts AH, Sternbach RA, Polich J: Behavioral management of chronic pain and excess disability: long-term follow-up of an outpatient program. Clin J Pain 1993, 9:41–48.CrossRefPubMedGoogle Scholar
  24. 24.
    Anthony M: Cervicogenic headache: prevalence and response to local steroid therapy. Clin Exp Rheumatol 2000, 18(2 Suppl 19):S59–S64.PubMedGoogle Scholar
  25. 25.
    Pikus HJ, Phillips JM: Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second cervical root. Headache 1995, 35:621–629.CrossRefPubMedGoogle Scholar
  26. 26.
    •• Matharu MS, Bartsch T, Ward N, et al.: Central neuromodulation in chronic migraine patients with sub occipital stimulation: a PET study. Brain 2004, 127:220–230. In this article, positron emission tomography studies of eight patients with chronic migraine undergoing neuromodulation by suboccipital stimulation were analyzed. Significant changes in rate of cerebral blood flow in the dorsal rostral pons that correlated to the level of stimulation were seen.CrossRefPubMedGoogle Scholar
  27. 27.
    • Burns B, Watkins L, Goadsby PJ: Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet 2007, 369:1099–1106. In this study, eight patients with medically intractable chronic cluster headache were implanted with bilaterally placed electrodes for occipital nerve stimulation. Patients reported a decrease of both frequency and severity of attacks.CrossRefPubMedGoogle Scholar
  28. 28.
    Weiner RL, Reed KL: Peripheral neurostimulation for control of intractable occipital neuralgia, Neuromodulation 1999, 2:217–221.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Southeast Pain Care at Morehead Medical PlazaCharlotteUSA

Personalised recommendations