Cervicogenic Headache Caused by Cervical C3-C4 Intervertebral Disc Herniation : A case report

ABSTRACT

Cervicogenic headache is a syndrome characterized by chronic hemicranial pain referred to the head from either bony structures or soft tissues of the neck. Although the pathophysiology and source of pain in this condition have been debated, the pain is believed to be referred from one or more muscles, occipital nerves, facet joints, intervertebral discs, or vascular structures. Among the various possible pain sources, cervicogenic headache from discogenic origin (disc herniation or damaged annulus fibrosus) has been called "discogenic cervical headache". We report a case of cervicogenic headache caused by C3-C4 intervertebral disc herniation. A 33-year-old man presented with headache and posterior neck and right shoulder pain. These symptoms did not improve after therapy with medication, trigger point injection, intramuscular stimulation, greater occipital nerve block, third occipital nerve block, or cervical medial branch block. However, after diagnostic cervical epidural block, the patient's symptoms improved dramatically. Diagnostic magnetic resonance imaging findings confirmed C3-C4 intervertebral disc herniation.