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Revista de la Sociedad Española del Dolor

versión impresa ISSN 1134-8046


O'MULLONY, I.; LAFUENTE, A.  y  PAREJA, J. A.. Cervicogenic headache: Differential diagnosis and general therapeutic principles. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.1, pp.24-32. ISSN 1134-8046.

Cervicogenic headache is either a syndrome, a common final route or a reaction pattern against nociceptive stimulus caused by lesions in one or several anatomical neck structures innervated by cervical nerves. This concept allows different potential etiologies and multi-factorial mechanisms. Cervicogenic headache is frequent and preferably hits middle-aged women. Pain is strictly unilateral, predominates at the occipital region, but also appears in the frontal area. Headache is generally moderate, non-pulsed and can be accompanied by nausea, vomiting and photoaudiophobia, but it is much less severe than in the migraine. It has a remitting or chronic pattern over time. The signs and symptoms associated to cervical affectation are always the same: previous history of direct or indirect cervical trauma, limitation of cervical motility towards the symptomatic side, hypersensitivity or pain triggered by pressure applied on certain occipital or cervical areas, and complete (although transitory) relief after local anesthesia of the major occipital nerve and/or the ipsilateral C2 root. Occasionally, anesthesia of the lowest roots or anesthetic cervical joint blockades are required. Episodic forms can be symptomatically treated with short cycles of NSAIDs or local infiltration of anesthetics and corticoids in the hypersensitive area. Chronic forms require preventive treatment with amitryptiline or antineuralgic drugs. Several invasive procedures, mainly based on radiofrequency, can be required in order to relief pain. Prior to their use, the therapeutic target must be identified and the response to local anesthetic blockades has to be estimated.

Palabras clave : Cervicogenic headache; Unilateral headache; Neck-origin headache; Anesthetic blockade; Radiofrequency treatment.

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