• Cervicogenic headaches are a syndrome of chronic, hemicranial pain that is referred to the head from bony structures or soft tissue of the neck.
• Adequate treatment of these headaches is often difficult to achieve, particularly from the emergency department, as a multi-faceted approach including pharmacologic, physical, anesthetic nerve block, psychological and sometimes surgical therapy, is often required.
• The emergency physician may prescribe simple agents such as acetaminophen and ibuprofen, with or without muscle relaxants to treat cervicogenic headaches.
• When close follow up is ensured, low doses of tricyclic anti-depressants or anti-epileptics such as gabapentin, divalproex sodium, carbamazepine, and topiramate may be utilized; while these are not FDA approved for the treatment of cervicogenic headaches, they have been shown to be effective for some headache types and neurogenic pain syndromes.

References

• Biondi, DM.  Cervicogenic Headaches:  A Review of Diagnostic and Treatment Strategies.  JAOA. Volume 105. No. 4. Suppl; 16-22.  April 2005.