Curr Pain Headache Rep (2010) 14:238–243

DOI 10.1007/s11916-010-0114-x

Cervicogenic Headache: A Review Comparison

with Migraine, Tension-Type Headache, and Whiplash
Maurice B. Vincent

Published online: 29 April 2010

# Springer Science+Business Media, LLC 2010

Abstract Cervicogenic headache (CEH) is a well- 1860. Some relevant developments include the Barré-Liéou
recognized syndrome. Proposed diagnostic criteria differ- syndrome (“syndrome sympathique cervicale postérieur”)
entiate CEH from migraine and tension-type headache [2], the sensory cervical roots and greater occipital nerve
(TTH) in most of the cases. The best differentiating factors section approach proposed by Hunter and Mayfield [3], the
include side-locked unilateral pain irradiating from the back Bärtschi-Rochaix “migraine cervicale” [4], and the “cervi-
and evidence of neck involvement—attacks may be cal headache” of Robert Maigne [5]. Sjaastad et al. [6]
precipitated by digital pressure over trigger spots in the regenerated the discussion and popularized the cervicogenic
cervical/nuchal areas or sustained awkward neck positions. headache (CEH) syndrome concept, which they believe is a
Migrainous traits may be present in some cases. Cervical well-defined reaction pattern. Their first attempt to set
lesions are not necessarily seen, and most common cervical down diagnostic criteria [7] was followed by a revised
lesions do not produce CEH. Whiplash may occasionally proposal 8 years latter—the Cervicogenic Headache Inter-
induce headaches. This is suspected when the pain onset national Study Group (CHISG) criteria [8]. In the present
and the whiplash trauma are close in time. Whiplash-related edition of the headache disorders diagnostic criteria, the
headaches tend to be short-lasting, admitting mostly a TTH International Headache Society (IHS) considers CEH as a
or a CEH-like phenotype. Neuroimaging abnormalities are secondary headache in which a demonstrable underlying
not necessarily expected in CEH. Whiplash patients must lesion must be found [9].
undergo cervical imaging mostly in connection with the Few areas in neurology have accumulated as much
trauma, as no abnormalities are pathognomonic in chronic controversy as CEH and whiplash, as illustrated by the
cases. following statement: “Although cervical disk disease and
trauma to the cervical spine are often regarded as causing
Keywords Cervicogenic headache . Whiplash . Migraine . headache, the relationship is unproven and often dubious.
Tension-type headache Still other syndromes, as third occipital headache, the
posterior cervical sympathetic syndrome, and cervical
migraine may not exist. CEH requires much more substan-
Introduction tial evidence before it can be accepted as a separate entity”
[10]. Whiplash is not any less controversial. As Harold
Neck-related headaches have occupied the vision of several Crowe [11] wrote himself, “in 1928, presenting a report on
authors for many years. Pearce [1] cited Hilton’s observa- eight cases of neck injuries resulting from traffic accidents
tions on headache related to neck abnormalities as early as before the Western Orthopaedic Association in San Fran-
cisco, I used the unfortunate term whiplash. This expression
M. B. Vincent (*) was intended to be a description of motion, but it has been
Hospital Universitário Clementino Fraga Filho, accepted by physicians, patients, and attorneys as the name
Universidade Federal do Rio de Janeiro,
of a disease.”
Av das Américas, 1155 room 504,
CEP 22631-000 Rio de Janeiro, Brazil The reasons for dissensions concerning neck-related
e-mail: [email protected] pain and headache include the lack of diagnostic
Curr Pain Headache Rep (2010) 14:238–243 239

biomarkers and experimental models; the possible influ- from stimulus to pain, either by digital pressure or neck
ence of external factors such as stress, psychological movement, ranges from seconds to 30 min [18]. If the
components, and accident compensation claims; and the headache starts right after waking up and improves
methodologic constrains restricting reliable treatment progressively afterward, this may indicate possible
efficacy assessments. Some of these difficulties have position-triggered attacks.
slowed down progress in primary headache research too. Pain duration may vary from short lasting to a
For the practicing physician, the greatest difficulty is to continuous, fluctuating pattern [18]. Some patients have
precisely identify CEH and distinguish it from similar long intervals between different series of attacks. In a pain-
disorders that may even coexist in the same patient. This free patient, a trauma such as a car collision from behind
short review focuses on the clinical presentation of CEH would sometimes restart an otherwise latent syndrome.
and whiplash, and throws some light on the differenti- Interictally, a slight soreness may occur.
ation between such disorders and the most frequent
primary headaches.
The Borderland Between CEH, Migraine, and TTH

Clinical Picture of CEH In practice, CEH and the most frequent primary headache
clinical pictures intermingle. Nothing precludes the coexis-
The CEH syndrome may be distinguished from other tence of CEH and other headache disorders. Therefore, the
headache disorders based on available clinical criteria differential diagnosis in less typical cases will require
[12–15••]. CEH prevalence may reach 4.1% [16]. The attentiveness, cautiousness, and suspicion (Fig. 1).
female preponderance once believed to be marked [17–19] The differentiation between CEH and migraine is
may not be too relevant [20]. CEH starts early or late in life, particularly important because of clinical similarities and
frequently following migraine or tension-type headache the lack of objective biomarkers (Table 1). Nausea,
(TTH). vomiting, photophobia, and phonophobia may also occur
Although the physical examination may be relatively in CEH to a comparatively lesser extent [1, 23–25]. The
more important in CEH compared with other headache CHISG criteria [8] are able to differentiate most CEHs from
disorders, it may rarely change the diagnostic impression migraines and TTHs with some overlap. In a series of 114
that the clinician had already built up during the patient patients presenting with 1) unilateral headache without side
interview. Contrary to migraine, in typical CEH the pain is shift and/or 2) pain starting in the neck and spreading to the
side-locked, although bilaterality may occur [7]. Contralat- fronto-ocular area, 17% fulfilled diagnostic criteria for both
eral trigeminal dysesthesias secondary to a C2 compression migraine and CEH, indicating that migrainous traits such as
[21] and pain on the opposite side during strong attacks nausea, vomiting, and photophobia/phonophobia may occur
[18] have been reported.
The pain is located at the first trigeminal branch area. In
many cases, it tends to start at the posterior part of the head
and/or neck in a subject who presents reduced range of
motion of the neck, and spreads to the front following the
scalp, over or around the ear, or through the upper part of
the mandible and/or the zygomatic area. An ipsilateral,
nonradicular feeling of numbness at the ipsilateral shoulder
and arm may occur, although radicular pain may also be
present [7]. A nonthrobbing [8, 22], mild pain [18] is
expected in CEH, but some pulsating quality may arise
[17].
Digital pressure over trigger points at the occipital-
nuchal area, including the greater occipital nerve (2 cm to
3 cm laterally and inferiorly to the occipital protuberance)
or the transverse process of the upper vertebrae, may
generate attacks similar to the naturally occurring episodes
[18]. Pressure over the same trigger spots in the contralat- Fig. 1 Proposed work-up for the differential diagnosis of long-lasting
unilateral headache attacks. Asterisk indicates pain induced by digital
eral side does not induce pain in the forehead. Triggering pressure over cervical triggering areas or sustained triggering
factors, involving positioning or moving the head in certain positions, reduced cervical range of motion, and pain radiation to the
ways, vary largely and come from daily living. The latency ipsilateral shoulder and possibly the arm
240 Curr Pain Headache Rep (2010) 14:238–243

in CEH [26]. Among the CHISG criteria, we found that the be even less frequent [40]. Cervical radiculopathy, affecting
two best differentiating ones are pain with varying duration 85 out of 100,000 people annually [41], is mostly due to a
or fluctuating continuous pain, and pain of a similar nature disk herniation. In a radiculopathy series, headaches were
triggered by neck movement and/or sustained awkward present in only 9.7% of the patients, much less than arm
head positioning. CEH patients fulfilled 10.51±2.14 out of pain (99.4%), sensory deficits (85.2%), neck pain (79.7%),
19 criteria, contrary to 3.85±0.94 fulfilled by migraineurs reflex (71.2%) and motor (68%) deficits [42].
(P=0.0001, analysis of variance). Likewise, no CEH The facet joints, considered as a possible target for CEH
subject in our series fulfilled all ISH criteria for migraine. treatment [43], induce pain with a prevalence varying from
Among those, the best differentiating criteria were at least 25% to 63% [44], often located in the neck, sometimes
five attacks fulfilling B to D; moderate or severe pain; and radiating to the shoulders or midback, without headache in
unilaterality—required in migraine as nonlocked [17]. In most of the cases [45]. Taken together, data show that the
addition, CHISG diagnostic criteria for CEH were shown to majority of the CEH patients have no demonstrable lesion
be similar in terms of interobserver reliability to IHS in the neck; some cervical lesions do lead to the CEH
criteria from migraine and TTH [27]. picture, but most of the patients suffering from cervical
Although the IHS requires the presence of a lesion for spondylosis, disc pathologies, radiculopathies, and facet
the CEH diagnosis, in most patients such a lesion will never joint disorders do not present with pain in the trigeminal
be documented, at least based on present diagnostic areas. This indicates that neck-related headaches may not
technology. Neuroimaging does not serve as a reliable be just the result of neck lesions, but rather the result of a
method for CEH diagnosis. MRI abnormalities in CEH do cervical abnormality occurring in a person with a suscep-
not differ from controls [28]. There is no biomarker for the tible brain. This justifies the occurrence of some distinct
diagnosis of CEH [29], although a lack in calcitonin gene- pictures observed in practice:
related peptide increase in CEH, pointing to a fundamental
1. CEH without migrainous traits, if a cervical lesion
difference in migraine, has been suggested [30]. This
produces headache in a person not prone to develop
contradicts the idea of trigeminal activation by upper
migrainous pain and with no past history of migraine;
cervical stimuli being the pathophysiologic centerpiece in
2. “Cervicogenic migraine,” if a cervical pathology
CEH, based on a putative anatomic cervico-trigeminal
induces CEH in a patient who presents with a
convergence [31].
susceptible brain favorable to migraine development.
Usually, CEH occurs without any demonstrable abnor-
In this case, there is probably activation of the
mality in cervical or brain imaging. X-rays, cervical and
trigeminovascular system;
cerebral CT scans, cerebral angiography, and cervical
3. CEH concomitant with migraine, if a patient suffering
myelography failed to show a common pathology in
from migraine presents with a cervical pathology
CEH, although mild disk protrusions, reduced disks
capable of producing CEH on top of the previous
heights, and degenerative abnormalities were detected in
migraine picture.
some individuals [32]. Cervical herniated disks may
underlie CEH, sometimes at lower levels [33]. A causal Few studies have specifically addressed the TTH versus
relationship cannot be established unless in the case of CEH differential diagnosis. However, TTH much less
surgical healing. commonly will present as a differential challenge to the
Most cervical lesions do not induce CEH [34]. physician because the pain here tends to be bilateral and the
Spondylosis, a rather frequent condition, produces poste- symptoms and signs of neck involvement are lacking. CEH
rior disk protrusion, decreases in signal intensity at traits are typically not present in TTH [46]. In our series,
intervertebral discs, and anterior compression of the dura out of the 19 CEH CHISG criteria, TTH patients fulfilled
and the spinal cord in as much as 70% of the subjects [35]. 4.89±1.57 (CH patients: 10.51±2.14, P=0.0001). The
Up to 50% to 80% of spondylotic patients may have at number of CEH-fulfilled criteria was not different between
least one episode of neck pain annually, with or without migraine and TTH patients [17]
radicular pain [36], but very few complain of headache.
Also, CEH starting earlier in life is probably not caused by
cervical spondylosis, as spondylotic myelopathy is the Whiplash and Headache
most common cause of spinal dysfunction in the elderly
[37]. There has been debate on the role of trauma as a
Headache stemming from cervical discs has been pathophysiologic cornerstone in CEH. Some patients
observed, and procedures such as discectomy proposed have a trauma history, but this is far from being a rule.
[38]. However, the prevalence of cervical discogenic pain Whiplash-like disorders may induce headaches [18, 47],
was found to be only 16% to 20% [39], and headache may but the exact extent of this condition remains obscure [48].
Curr Pain Headache Rep (2010) 14:238–243 241

Table 1 Differential diagnosis between migraine, tension-type headache, and cervicogenic headache

Migraine Tension-type headache Cervicogenic headache

Female preponderance +++ ++ +/−

Unilaterality +++ (side shifting) − +++ (side-locked)
Radiation from the back to the front −(+) − +++
Radiation to the ipsilateral shoulder and arm − − ++
Nausea, vomiting, photophobia, and phonophobia +++ −(+) +
Pulsating pain quality +++ − +/−
Pain intensity +++ + ++
Attack provocation by digital pressure − − +++
Attack provocation by posture and movement − − +++
Temporal pattern Paroxysmal, 4–72 h Varies in duration/continuous Varies in duration/continuous

+ Less marked, ++ marked, +++ very marked, +/− possibly present, − not present, −(+) present in a few cases

Theoretically, 12 headache scenarios are possible Whiplash-associated disorders (WADs) may be assciated
following a whiplash injury. As depicted in Fig. 2, in with various symptoms. They have been clinically graded
scenarios A to D, no previous headache is present before according to related symptomatology, and have been
trauma, as opposed to possibilities E to L. In scenarios I to recently reviewed in terms of course and prognosis [50]:
L, the new headache following whiplash would coexist
1. Grade 0: no neck complaints and no physical signs.
with the previous headache, whereas in scenarios E to H,
the new headache replaces—or modifies—the pre-existing
pain. In scenarios A, C, E, G, I, and K, the post-whiplash
headache would occur close in time with the trauma,
suggesting a causal relationship, as opposed to situations
B, D, F, H, J, and L, in which the new headache pattern
would occur much after the whiplash. This suggests a
causal relationship to be less likely. Among the headaches
occurring right after the whiplash scenarios, possibilities
C, G, and K represent the occurrence of long-lasting
headache. In these cases, either a previous headache
predisposition was necessarily present beforehand and
the trauma just precipitates its clinical manifestation, or
the whiplash produces a permanent cervical lesion that
would perpetuate a new headache-producing mechanism.
Conversely, the short-lasting whiplash-related pain seen in
scenarios E and I suggests either a lack of headache
predisposition or the absence of irreversible, pain-
perpetuating cervical lesions.
As a corollary of these interpretations, it is concluded
that 1) relatively few cervical whiplash traumas lead to
chronic headache; 2) not all headaches following whip-
lash are caused by this sort of trauma and may be the
expression of previous pain; 3) the headache type
following whiplash perhaps depends on an individual’s
previous headache pictures and/or genetic predisposition
to headache. The likelihood of whiplash-induced head-
ache may depend on anxiety, depression, lack of
confidence for complete recovery, and pre-existing facial
pain [49]. Fig. 2 Possible headache scenarios following whiplash trauma
242 Curr Pain Headache Rep (2010) 14:238–243

2. Grade I: injuries involving complaints of neck pain, ities alone do not necessarily lead to pain in trigeminal
stiffness, or tenderness, but no physical signs. areas. Whiplash may sometimes induce headache, mostly
3. Grade II: neck complaints accompanied by decreased CEH or TTH-like pain, which tends to occur close in time
range of motion and point tenderness (musculoskeletal with the whiplash trauma and tends to be short lasting.
signs).
4. Grade III: neck complaints accompanied by neurologic
signs such as decreased or absent deep tendon reflexes, Disclosure Dr. Maurice B. Vincent is a member of an Allergan
weakness, and/or sensory deficits. international advisory board. Honoraria are given in connection to this
5. Grade IV: injuries in which neck complaints are work.
accompanied by fracture or dislocation.
6. Other symptoms such as deafness, dizziness, tinnitus,
headache, memory loss, dysphagia, and temporoman- References
dibular joint pain can be present in all grades.
Papers of particular interest, published recently, have been
Concerning headache, among WAD headache pictures
highlighted as:
[51], CEH is a possibility. In a whiplash series, CEH was
• Of importance
present in 8% and 3% after 6 weeks and 1 year, respectively
•• Of major importance
[52]. The authors concluded that CEH might be present
after whiplash injury, particularly in the early phase. Such
1. Pearce JM: Cervicogenic headache: an early description. J Neurol
headache syndrome, however, may be not identical to non- Neurosurg Psychiatry 1995, 58:698.
whiplash CEH. The possibility of bias induced by interests 2. Barré N: Sur une syndrome sympathique cervicale posterieur et sa
connected with litigation related to whiplash trauma must cause frequante: L’arthrite cervicale. Rev Neurol 1926, 33:1246–
always be considered [53, 54]. CEH and/or TTH-like 1248.
3. Hunter CR, Mayfield FH: Role of the upper cervical roots in the
(mostly in the back of the head) pain occurs as a result of production of pain in the head. Am J Surg 1949, 78:749–751.
whiplash [55•]. 4. Bärtschi-Rochaix W: Headaches of cervical origin. In Handbook
Although as much as half of the patients complain of of Clinical Neurology, vol 5. Edited by Vinken PJ, Bruyn GW.
headache immediately following a whiplash injury [53], Amsterdam: North Holland Publishing Co.; 1968:192–203.
5. Maigne R: Un signe évocateur et inattendu de céphalée cervicale:
there is evidence suggesting that whiplash-induced head-
“La douleur au pincé-roulé du sourcil”. Ann Med Phys (Lille)
aches are short lasting and will disappear before 3 months 1976, 14:416–434.
[49]. According to a recent critical review, as much as 6. Sjaastad O, Saunte C, Hovdahl H, et al.: “Cervicogenic”
50% of the subjects may report pain 1 year after a headache. An hypothesis. Cephalalgia 1983, 3:249–256.
7. Sjaastad O, Fredriksen TA, Pfaffenrath V: Cervicogenic headache:
whiplash injury [50]. In this report, a poorer prognosis
diagnostic criteria. Headache 1990, 30:725–726.
was related to greater initial symptom severity. Analysing 8. Sjaastad O, Fredriksen TA, Pfaffenrath V: Cervicogenic headache:
210 rear-end car collisions, whiplash-related headaches diagnostic criteria. The Cervicogenic Headache International
were found to be few, short lasting, and dependent on pre- Study Group. Headache 1998, 38:442–445.
9. Headache Classification Subcommittee of the International Head-
existing primary headaches [56•]. Imaging plays an
ache Society: The International Classification of Headache Disor-
obvious role in whiplash patients acutely, as fractures ders: 2nd edition. Cephalalgia 2004, 24(Suppl 1):9–160.
and other trauma-related lesions must be ruled out. When 10. Edmeads J: The cervical spine and headache. Neurology 1988,
the pain becomes chronic in the few instances, neuro- 38:1874–1878.
imaging not useful in practice [57]. 11. Crowe HL: A new diagnostic sign in neck injuries. Calif Med
1964, 100:12–13.
12. Haldeman S, Dagenais S: Cervicogenic headaches: a critical
review. Spine J 2001, 1:31–46.
13. Antonaci F, Fredriksen TA, Sjaastad O: Cervicogenic headache:
Conclusions clinical presentation, diagnostic criteria, and differential diagnosis.
Curr Pain Headache Rep 2001, 5:387–392.
CEH is a syndrome clinically distinguishable from migraine 14. Biondi DM: Cervicogenic headache: a review of diagnostic and
and TTH, although some cases may represent a diagnostic treatment strategies. J Am Osteopath Assoc 2005, 105(4 Suppl
2):16S–22S.
challenge. In addition, these entities may coexist in the 15. •• Bogduk N, Govind J: Cervicogenic headache: an assessment of
same patient. Migraine is comparatively closer to CEH than the evidence on clinical diagnosis, invasive tests, and treatment.
TTH. In CEH, demonstrable lesions are not obligatory. Lancet Neurol 2009, 8:959–968. This is a comprehensive review
Conversely, most frequent cervical diseases are not accom- on the diagnosis and approach to CEH. Pathophysiologic aspects
are also discussed.
panied by headache. This suggests that not only the cervical
16. Sjaastad O, Bakketeig LS: Prevalence of cervicogenic headache:
component is required in CEH, but also a concomitant Vågå study of headache epidemiology. Acta Neurol Scand 2008,
cerebral predisposition to headache, as cervical abnormal- 117:173–180.
Curr Pain Headache Rep (2010) 14:238–243 243

17. Vincent MB, Luna RA: Cervicogenic headache—a comparison 40. Grubb SA, Kelly CK: Cervical discography: clinical implications
with migraine and tension-type headache. Cephalalgia 1999, 19 from 12 years of experience. Spine (Phila Pa 1976) 2000,
(Suppl 25):11–16. 25:1382–1389.
18. Fredriksen TA, Hovdal H, Sjaastad O: “Cervicogenic headache”: 41. Abbed KM, Coumans JV: Cervical radiculopathy: pathophysiol-
clinical manifestation. Cephalalgia 1987, 7:147–160. ogy, presentation, and clinical evaluation. Neurosurgery 2007, 60
19. van Suijlekom HA, van Kleef M, Barendse GA, et al.: Radio- (1 Supp1 1):S28–S34.
frequency cervical zygapophyseal joint neurotomy for cervico- 42. Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG:
genic headache: a prospective study in 15 patients. Funct Neurol Posterior-lateral foraminotomy as an exclusive operative tech-
1998, 13:297–303. nique for cervical radiculopathy: a review of 846 consecutively
20. Sjaastad O, Bakketeig LS: Migraine without aura: comparison operated cases. Neurosurgery 1983, 13:504–512.
with cervicogenic headache. Vågå study of headache epidemiol- 43. Bovim G, Berg R, Dale LG: Cervicogenic headache: anesthetic
ogy. Acta Neurol Scand 2008, 117:377–383. blockades of cervical nerves (C2-C5) and facet joint (C2/C3). Pain
21. Rosenberg WS, Swearingen B, Poletti CE: Contralateral trigem- 1992, 49:315–320.
inal dysaesthesias associated with second cervical nerve compres- 44. Aprill C, Bogduk N: The prevalence of cervical zygapophyseal
sion: a case report. Cephalalgia 1990, 10:259–262. joint pain. A first approximation. Spine (Phila Pa 1976) 1992,
22. Fredriksen TA: Studies on cervicogenic headache. Clinical 17:744–747.
manifestation and differentiation from other unilateral headache 45. Kirpalani D, Mitra R: Cervical facet joint dysfunction: a review.
forms [PhD Thesis]. Trondheim: Tapir; 1989. Arch Phys Med Rehabil 2008, 89:770–774.
23. Sjaastad O, Bovim G: Cervicogenic headache. The differentiation 46. Sjaastad O, Bakketeig L: Tension-type headache: comparison
from common migraine. An overview. Funct Neurol 1991, 6:93–100. with migraine without aura and cervicogenic headache. The
24. Pfaffenrath V, Dandekar R, Pöllmann W: Cervicogenic headache— Vågå study of headache epidemiology. Funct Neurol 2008,
the clinical picture, radiological findings and hypothesis on its 23:71–76.
pathophysiology. Headache 1987, 27:495–499. 47. Balla J, Karnaghan J: Whiplash headache. Clin Exp Neurol 1987,
25. Pikus HJ, Phillips JM: Characteristics of patients successfully 23:179–182.
treated for cervicogenic headache by surgical decompression of 48. Stovner LJ: Whiplash headache: does the diagnosis make more harm
the second cervical root. Headache 1995, 35:621–629. than the whiplash? Cephalalgia 2009 Sep 9 (Epub ahead of print).
26. Antonaci F, Ghirmai S, Bono G, et al.: Cervicogenic headache: 49. Spitzer WO, Skovron ML, Salmi LR, et al.: Scientific monograph
evaluation of the original diagnostic criteria. Cephalalgia 2001, of the Quebec Task Force on Whiplash-Associated Disorders:
21:573–583. redefining "whiplash" and its management. Spine (Phila Pa 1976)
27. van Suijlekom JA, de Vet HC, van den Berg SG, Weber WE: 1995, 20(8 Suppl):1S–73S. (Published erratum appears in Spine
Interobserver reliability of diagnostic criteria for cervicogenic 1995, 20:2372.).
headache. Cephalalgia 1999, 19:817–823. 50. •• Carroll LJ, Holm LW, Hogg-Johnson S, et al.: Course and
28. Coskun O, Ucler S, Karakurum B, et al.: Magnetic resonance prognostic factors for neck pain in whiplash-associated disorders
imaging of patients with cervicogenic headache. Cephalalgia (WAD): results of the Bone and Joint Decade 2000–2010 Task
2003, 23:842–845. Force on Neck Pain and Its Associated Disorders. J Manipulative
29. Frese A, Evers S: Biological markers of cervicogenic headache. Physiol Ther 2009, 32(2 Suppl):S97–S107. This is a critical
Cephalalgia 2008, 28(Suppl 1):21–23. review on the clinical aspects of whiplash-associated disorders.
30. Frese A, Schilgen M, Edvinsson L, et al.: Calcitonin gene- The relevant literature on the clinical course and prognosis
related peptide in cervicogenic headache. Cephalalgia 2005, factors are analyzed.
25:700–703. 51. Drottning M, Staff PH, Sjaastad O: Cervicogenic headache (CEH)
31. Goadsby PJ, Bartsch T: On the functional neuroanatomy of neck after whiplash injury. Cephalalgia 2002, 22:165–171.
pain. Cephalalgia 2008, 28(Suppl 1):1–7. 52. Schrader H, Obelieniene D, Bovim G, et al.: Natural evolution of
32. Fredriksen TA, Fougner R, Tangerud Å, Sjaastad O: Cervicogenic late whiplash syndrome outside the medicolegal context. Lancet
headache. Radiological investigations concerning head/neck. 1996, 347:1207–1211.
Cephalalgia 1989, 9:139–146. 53. Awerbuch MS: Whiplash in Australia: illness or injury? Med J
33. Michler RP, Bovim G, Sjaastad O: Disorders in the lower cervical Aust 1992, 157:193–196.
spine. A cause of unilateral headache? A case report. Headache 54. Vincent MB: Is a de novo whiplash-associated pain most
1991, 31:550–551. commonly cervicogenic headache? Cephalalgia 2008, 28(Suppl
34. Vincent MB: Cervicogenic Headache: The Neck Is a Generator: 1):32–34.
Con. Headache 2010, 50:706-709 55. • Obermann M, Nebel K, Riegel A, et al.: Incidence and predictors
35. Okada E, Matsumoto M, Ichihara D, et al.: Aging of the cervical of chronic headache attributed to whiplash injury. Cephalalgia
spine in healthy volunteers: a 10-year longitudinal magnetic 2009 Aug 10 (Epub ahead of print). Predictors for the
resonance imaging study. Spine (Phila Pa 1976) 2009, 34:706–712. development of chronic headache were estimated. Pre-facial pain
36. Harrop JS, Hanna A, Silva MT, Sharan A: Neurological and medication overuse, depression, and anxiety among other
manifestations of cervical spondylosis: an overview of signs, factors, may increase the likelihood of chronic headache
symptoms, and pathophysiology. Neurosurgery 2007, 60(1 Supp1 following whiplash.
1):S14–S20. 56. • Stovner LJ, Obelieniene D: Whiplash headache is transitory
37. Baron EM, Young WF: Cervical spondylotic myelopathy: a brief worsening of a pre-existing primary headache. Cephalalgia 2008,
review of its pathophysiology, clinical course, and diagnosis. 28(Suppl 1):28–31. This article shows that pre-accidental
Neurosurgery 2007, 60(1 Suppl 1):S35–S41. headache increases significantly the risk (6–10 times increased,
38. Schofferman J, Garges K, Goldthwaite N, et al.: Upper cervical depending on the frequency of the pre-accidental headache) of
anterior diskectomy and fusion improves discogenic cervical chronic pain following whiplash. This indicates that a central
headaches. Spine (Phila Pa 1976) 2002, 27:2240–2244. predisposition plays an important role in neck pain-induced
39. Buenaventura RM, Shah RV, Patel V, et al.: Systematic review of headaches.
discography as a diagnostic test for spinal pain: an update. Pain 57. Hol PK: Imaging in whiplash. Cephalalgia 2008, 28(Suppl 1):25–
Physician 2007, 10:147–164. 27.