Cervicogenic headache refers to headaches that occur because of abnormalities in the neck or cervical spine. The upper three cervical nerves segments (C1-3) and the trigeminal nerve segments (V1-3) innervates the face and head and form the trigeminocervical complex.

Pain that originates from the joints in the upper neck can refer pain to the head, which is called cervicogenic headache. It is usually on one side but can be on both sides. The headache can be in the back, side or front of the head.

Common sources of Cervicogenic Headaches include

• The Atlantoaxial joint (between C1 and C2)
• The Zygapophyseal (facet) joint between C2 and C3 – This is the most common source of cervicogenic headaches after whiplash.
• Occipital Neuralgia

Atlantoaxial joint (C1-2) accounts for 16% of cervicogenic headaches.

• the headache is usually in the occipital region (back of the head).
• focal tenderness over the suboccipital area
• restricted, painful rotation of the head (C1 on C2)
• pain on passive rotation of C1 with neck flexed

Causes of Atlantoaxial joint pain and cervicogenic headaches include;

1. degenerative (osteoarthritis)
2. Traumatic – due to whiplash injuries.

Diagnosis is made by injecting the joint with local anesthetic (diagnostic block)

Treatment:

1. Intra-articular steroid injection
2. Radiofrequency ablation (rhizotomy)
3. Prolotherapy with platelet rich plasma (PRP) and/or stem cells.
4. Surgical fusion of the C1-2 joint.