Neoplasm should always be considered as a potential cause in new onset headache that does not fit the classic clinical presentations of migraine, cluster headache, and other well-defined headache syndromes. Headaches from neoplasm are nonspecific and can present with a variety of symptoms. Classic symptoms from an intracranial mass include subacute to chronic progressive pain minimally relieved with medications, pain worse with Valsalva maneuvers or laying down, and neurological deficits including vision changes and paresthesias that are more chronic than those occurring with aura. An MRI with and without contrast is sufficient to make the diagnosis.

Cervicogenic Headache

Cervicogenic headache is a headache caused by the cervical spine and its components including fascia, muscles, and nerves [2]. Headache that starts in the back of the head or is associated with neck pain may suggest cervicogenic headache.

The confluence of upper cervical afferent somatosensory neurons synapse in the spinal nucleus of the trigeminal nerve meaning that sensory input from the cervical region terminates in the trigeminal spinal nucleus as well as input from the trigeminal nerve itself [3, 10]. This synapse explains how pain from the cervical region may refer to the face [3, 10]. Cervicogenic headache will be further discussed in this chapter (Box 1.7).

Box 1.7: Cervicogenic Headache [2]

A. Any headache fulfilling criterion C

B. Clinical, laboratory, and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache

C. Evidence of causation demonstrated by at least two of the following:

  • 1. Headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
  • 2. Headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
  • 3. Cervical range of motion is reduced and headache is made significantly worse by provocative maneuvers
  • 4. Headache is abolished following diagnostic blockade of a cervical structure or its nerve supply

D. Not better accounted for by another ICHD-3 diagnosis

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