Cervicogenic headache

Cervicogenic headache is a term used by Sjaastad (1983) to define an intermittent, unilateral headache with associated symptoms typical to migraine often precipitated or aggravated by certain neck movements. Cervicogenic headache arises typically from sublaxation or facet joint disease of the C2-C3 vertebrae. Typically, cervicogenic headache presents in: suboccipital, hemicranial, and supraorbital distribution. Cervicogenic headache is four times more common in women than men, and up to 66% present with whiplash-associated disorder

Many investigators in the past such as Cyriax (1938), Kellgren (1939), and Kerr (1961) reported via human neurophysiological experiments that stimulation of facet joint, periosteum, ligaments, and paravertebral muscles are capable of generating pain that is different in characterization and topography than the classical nerve root dermatomal pain. All of the past spinal structures are supplied by the “Dorsal rami” of the cervical spinal nerves, which are the source of cervicogenic headache due to their myofascial and subcutaneous neural supply

Myodural fibrous bridge tension

The dura matter in the posterior suboccipital region is attached to the “Rectus capitis posterior minor (RCPM) muscle” by a fibrous band / bridge that is normally (13.6 mm) in length and (1.1 mm) in width according to the cadaveric dissections. In cases of cervical vertebral sublaxation, myofascial trigger point develops within the RCPM muscle, which will exert traction force on the pain-sensitive dura, causing dural inflammatory thickening and suboccipital pain (Suboccipital headache)

Other myodural bridges are detected between C1 and C2 vertebrae with the rectus capitis posterior major and obliquus capitis inferior muscles. The ventral dura is supplied by a sensory (nociceptive) nerve plexus that is derived from the “Sinuvertebral nerve” and “The nerve plexus of the posterior longitudinal ligament”. The dorsal dura is innervated from ventral dural plexi. The sinuvertebral nerve originates exclusively in the rami communicantes and has a sympathetic component

Dural tension at any of these points is capable of generating symptoms due to the pain-sensitive nature of the dura. For example, an occipito-atlanto-axial sublaxation can create a cervical dural tension that radiate to the sacral region causing sciatica-like pain (Sciatica brachialis), while a sacroiliac instability can create a dural tension that radiate upward to the craniocervical region generating suboccipital headache  


Selected references

1. Eriksen K. Upper Cervical subluxation complex: a review of the chiropractic and medical literature. 2003; Lippincott William & Wilkins; 1 edition


2. Sjaastad O et al. “Cervicogenic” headache. An hypothesis. Cephalalgia 1983; 3(4): 249-256

3. Sjaastad O et al. Cervicogenic headache, C2 rhizopathy, and occipital neuralgia: a common connection? Cephalalgia 1986; 6(4): 189-195