Cervicogenic and Tension-Type Headaches Care Pathway

8. Diagnostic Criteria for Cervicogenic and Tension-type Headaches

 

Diagnosis requires a thorough understanding of the patient's condition. It integrates patient stories; clinical findings; risk factor evaluations; and physical, psychological, social, and environmental aspects of pain.

 

A. Cervicogenic Headache

• Definition: Headache secondary to disorders of the cervical spine or soft tissues, provoked by mechanical provocation of those cervical disorders.

• Prevalence: The one-year prevalence of cervicogenic headache is estimated at 2%. Cervicogenic headaches account for 15% - 20% of all chronic recurrent headaches. Prevalence increases with age.

• Risk Factors: Include sociodemographic factors (e.g., female sex), having sustained an injury that limits neck movement, unemployed job status.

• Prognostic Factors for Delayed Recovery: Passive coping strategies, higher initial pain levels, poor recovery expectations, mental health issues, younger age, persistent symptoms, arm pain, work-related factors, previous neck pain, functional limitations.

• Pain Location: Often with a characteristic unilateral distribution that starts from the nuchal area posteriorly and extends anteriorly to the oculofrontal area.

• Duration: Episodes may vary in duration; may be fluctuating or continuous pain.

• Signs/Symptoms: Moderate-intensity, non-throbbing, episodic pain.

• Physical and Neurological Examination: Reproduction of headache during cervical spine range of motion and tests (cervical flexion-rotation, manual posterior-to-anterior intervertebral movements of cervical spine, myofascial trigger points in paraspinal muscles). Additional tests for cervical spine disorders include cervical Kemp's, cervical compression, and Spurling's tests. Normal upper extremity and cranial nerve neurological tests.

• Other Diagnostic Studies: Relief of headache with a diagnostic greater occipital nerve anesthetic pain block.

 

 

 

B. Tension-Type Headache (TTH)

• Definition: A primary headache not attributable to a pathology requiring medical attention (e.g., infection, tumor, osteoporosis, disc herniation).

• Prevalence: The most prevalent primary headache, estimated at 26% globally. Peak prevalence at ages 35-39.

• Risk Factors: Include psychosocial factors (e.g., stress, sleep disturbance), sociodemographic factors (e.g., female sex), and comorbid conditions (e.g., anxiety, depression).

• Prognostic Factors for Delayed Recovery: Passive coping strategies, higher initial pain levels, poor recovery expectations, mental health issues, younger age, persistent symptoms, work-related factors, functional limitations.

• Pain Location: Bilateral pressing, non-throbbing quality, described as a tight band around the head.

• Duration:

  • Episodic:

    • Infrequent Episodic: At least 10 episodes per year, occurring on <1 day per month on average (<12 days per year). Episodes last from 30 minutes to 7 days.

    • Frequent Episodic: At least 10 episodes of headache occurring on 1-14 days per month on average for >3 months (≥12 and <180 days per year). Episodes last from 30 minutes to 7 days.

  • Chronic: Occur ≥15 days/month for >3 months (≥180 days per year). Episodes last hours or may be continuous.

• Signs/Symptoms:

  • Varies in intensity from mild to moderate.

  • May include no more than one of photophobia, phonophobia, or mild nausea.

  • Not associated with moderate or severe nausea or vomiting.

  • May be associated with scalp or neck muscle tenderness.

  • Does not worsen with routine activity.

• Physical and Neurological Examination: Normal upper extremity and cranial nerve neurological tests.