Treatment of Cervicogenic Headache

This post is for educational purposes only and may contain errors. Please talk to your neurologist. 

The treatment of cervicogenic headache should involve the patient, allowing them to be an active participant in the decision-making process.

First-line treatment

Physical therapy

• Spinal joint manipulation and/or mobilization
• Soft tissue manipulation focusing on the myofascial trigger points of the sternocleidomastoid muscle
• Muscle endurance and strength training focusing on deep cervical flexor muscles
• Do NOT perform high-velocity low amplitude manipulation therapy (neck cracking) due to risk of stroke

There may be discomfort immediately post therapy.

Pharmacological options

• Pregabalin (https://pubmed.ncbi.nlm.nih.gov/25373811/)
• Duloxetine (not studied for cervicogenic headache)
• Gabapentin (not studied for cervicogenic headache)
• Tricyclic antidepressants (not studied for cervicogenic headache)

Procedures

• Anesthetic blockade of the lateral atlanto-axial joint, the C2-3 zygapophyseal joint (and the overlying third occipital nerve), and/or the C3-4 zygapophyseal joint. This may also allow patients to be able to handle physical therapy better. Moreover, an occipital nerve block may also be done, but the logic isn’t sound because cervicogenic headache is referred pain from the neck.
• Radiofrequency ablation of C2 dorsal root ganglion and/or third occipital nerve.
• Coblation (https://pubmed.ncbi.nlm.nih.gov/30561695/)
• Glucocorticoid injections. Options include atlantoaxial joint injection, C2-C3 zygapophyseal joint injection, and cervical spinal nerve root block (in patients with cervical spondylotic radiculopathy).
• Neuromodulation (https://pubmed.ncbi.nlm.nih.gov/29178511/)
• Surgery (only if there is an obvious reason on imaging that necessitates it)

Other:

Alternative medicine: dry needling