What is cervicogenic headache?

  Ms. Tai is 40 years old, she has been working as a clerk after graduating from university, due to the nature of her work, she often works long hours in a desk job. 10 years ago, she started to have headache, initially she had headache on the right side, it was light and heavy at times, she didn’t pay much attention to it at that time, but later the headache became more and more severe, and sometimes she had throbbing headache, especially after working in a desk job, the headache worsened, accompanied by stiffness of the neck, soreness and swelling of the scapula, and in the last three years, the headache became more severe. She knew that migraine was very difficult to treat and would last a lifetime. She went to many big hospitals and had several head CT examinations, but no abnormalities were found. The rash gradually ulcerated and formed an ulcer, which remained painful after healing. The patient had anxiety, irritability, insomnia and weight loss due to unrelieved headache. By chance, the patient learned through a friend that there was a pain department at the Hebei University Hospital, so she came to the pain clinic with the attitude of giving it a try. The results of the examination came out in a short time and showed that the cervical 3-4 and cervical 6-7 intervertebral discs were herniated, especially the cervical 3-4 discs were herniated the most, and the cervical multi-intervertebral discs were degenerated. Combining the patient’s clinical symptoms and MRI findings, Director Yao diagnosed the patient with cervicogenic headache. The patient underwent inpatient pain intervention, which finally cured the headache for many years, and the stiffness and swelling of the neck and shoulder disappeared.  Patients like Ms. Tai are very common, and the phenomenon of patients with headache and doctors with headache occurred because there was less awareness of this disease. With the in-depth research on the pathogenesis of pain, the concept of cervicogenic headache was first introduced by American doctor Sjaastad in 1983. However, this concept is not yet universally recognized by clinicians. The vast majority of these patients are still diagnosed as neurovascular headache, migraine, tension headache, occipital neuralgia, etc. Their treatments are also very limited, and the treatment effect still has not improved significantly.  The origin of cervicogenic headache is in the cervical spine and the symptoms are manifested in the head. Based on the relationship between the innervation of the head and the cervical nerves, it is not difficult to understand the anatomical basis of cervicogenic headache. The pathogenesis of cervicogenic headache is mostly due to the direct compression of cervical nerves by herniated, bulging and degenerated intervertebral discs caused by exudation and protrusion of disc material. The causes include prolonged head-down work, trauma to the cervical spine, degeneration of the intervertebral discs with age, etc. These factors can lead to instability of the vertebral body, intervertebral joint disorders, etc., and over time will cause small joint capsule hyperplasia, intervertebral disc degeneration, relaxation of the annulus fibrosus, leakage of disc material, disc bulge, protrusion, etc., the disc material leakage into the spinal canal can cause direct stimulation of the nerves in the spinal canal, coupled with the protrusion or bulge of the intervertebral disc to compress and stimulate the nerve roots in the spinal canal, resulting in intractable pain and numbness in the area innervated by the stimulated nerves. Pain, numbness, etc. If the motor nerve is involved, muscle strength and muscle atrophy may occur. The concept of cervicogenic headache has laid the theoretical foundation for the treatment of this type of headache. Based on many years of clinical experience, Director Yao Jun of the Affiliated Hospital of Hebei University has been the first to implement interventional treatment for cervicogenic headache in China, which has resulted in better treatment of this type of headache and greatly improved the cure rate. For patients with mild symptoms, cervical paravertebral nerve root injection treatment can be performed in the outpatient clinic, while patients with no obvious effect of cervical nerve root injection treatment need to be hospitalized for pain interventional treatment.