Cervicogenic headache: Josey's cases revisited

Abstract

-Before Sjaastad coined the term cervicogenic headache (CH) 15 years ago, neck-related headaches have been considered by different authors for many years. Even after the publication of diagnostic criteria, dispute on the clinical picture, differential diagnosis, pathophysiology and treatment of CH still persists. A paper published in 1949 by Josey reports on 6 "illustrative" cases of cervical-related headaches. Indeed, looked from a more recent perspective, those cases could eventually correspond to CH. Important topics such as the relatively high frequency, fixed unilaterality of the pain, relation to previous trauma, irradiation from the back to the forehead, normal or slightly abnormal roentgenograms, and the mechanical precipitation of attacks are some of the topics considered by Josey. The female gender was not prevalent in Josey's series. Traction and analgesics were basically the recommended treatment. CH is probably a common disorder, an idea already considered by a clinician in 1949. This syndrome was not adequately described before Sjaastad's group papers in the 80's.KEY WORDS: cervicogenic headache, differential diagnosis. Cefaléia cervicogênica: revisão dos casos de JoseyRESUMO -Muitos autores escreveram sobre cefaléias relacionadas ao pescoço antes da descrição da cefaléia cervicogênica (CH) por Sjaastad e col. Mesmo após a publicação de critérios diagnósticos, há controvérsias em relação ao quadro clínico, diagnóstico diferencial, fisiopatologia e tratamento da CH. Um artigo publicado em 1949 por Josey relata 6 casos "ilustrativos" de cefaléia relacionada ao pescoço, cujo quadro pode corresponder ao que hoje consideramos ser CH. Aspectos importantes como sua frequência relativamente elevada, unilateralidade fixa, relação a traumas prévios, irradiação póstero-anterior, normalidade de exames radiológicos e os mecanismos de precipitação foram considerados por Josey. O sexo feminino não foi predominante na sua casuística. Tração e analgésicos foram os tratamentos recomendados. CH é provavelmente uma desordem comum, o que já havia sido considerado neste estudo de 1949. A síndrome, entretanto, não foi completa e adequadamente descrita antes de Sjaastad. PALAVRAS-CHAVE: cefaléia cervicogênica, diagnóstico diferencial.By discribing cervicogenic headache (CH), Sjaastad and co-authors renovated the discussion on neck-generated headaches, which they believe are a well-defined reaction pattern 38,41 . Cornerstone features according to these authors are strict unilateral pain that typically starts at the occipitalnuchal area and spreads to the ipsilateral forehead, and attack induction by neck movements and/or digital pressure over trigger points such as the greater occipital nerve (GON) or the C2 area. Additionally, there may be diffuse, vague ipsilateral arm pain or discomfort. Females tend to be more affected than males, and a trauma may precede the onset of the symptoms.

Headache Research and Medical Practice in Brazil: An Historical Overview

“…In Rio de Janeiro, São Paulo, Paraná, Santa Catarina, and Rio Grande do Sul, there are several centers dealing with headache disorders and an excellent scientific production has been made by a number of headache specialists, mentioning Abouch Krymchantowski, Carla da Cunha Jevoux, Maurice Vincent, Pedro Ferreira Moreira Filho, Jano Alves de Souza, Maria Eduarda Nobre in Rio de Janeiro; Celia P. Roesler, Deusvenir de Souza Carvalho, Eliova Zukerman, Mario Fernando Prieto Peres,…”

“…A number of the early articles on headache disorders were published by Farias da Silva and coworkers in the scientific journal Neurobiologia (Recife), which is one of the oldest journals in the area of neurology in Latin America, founded in 1943 by Ulysses Pernambucano. Another important journal containing articles on headache written by Brazilians is Arquivos de Neuropsiquiatria , which was founded in 1945 …”

Inflammatory mechanisms in cervicogenic headache: An integrative view

“…The problem of pain originating in the neck region and its nonexisting relationship to degenerative situations of the cervical column was first raised by Hunter and Mayfield in 1949 [8]. However, a paper published by Josey in 1949 reported on six "illustrative" cases of cervical-related headache, which could correspond to CEH if it is considered from a more recent perspective [9]. It has been hypothesized recently that one could define a new and distinct clinical entity, which Sjaastad et al [10] termed "cervicogenic headache" in 1983.…”