Diagnosing cervicogenic headache

Since the first cases of cervicogenic headache (CEH) were identified [1], considerable progress has been made. Particularly in the last decade, there have been advances in therapeutic approach and in defining the clinical picture and diagnostic criteria. As repeatedly stated, CEH is a syndrome, not a disease or an entity sui generis. It consti-tutes a “final common pathway ” for pain stemming from several neck disorders. These may involve such structures as nerves, nerve root ganglia, uncovertebral joints, inter-vertebral disks, facet joints, ligaments, muscles and so on [2, 3]. Pain may accordingly originate at different levels, including the lower part of the cervical spine [4]. CEH comprises all headaches stemming from the neck with the possible exception of specific headache entities (e.g., a subgroup of chronic paroxysmal hemicrania (CPH) with mechanical precipitation of attacks) [3]. CEH has been defined, in principle, as a unilateral headache without sideshift. In the upgrading of the CEH diagnostic criteria [5], the strict unilaterality criterion ha