Document Type
Article
Publication Date
12-2025
Publisher
Springer
Source Publication
Current Pain and Headache Reports
Source ISSN
1531-3433
Abstract
Purpose of Review Intervention trials for cervicogenic headache (CGH) often yield equivocal results with marked treatment effect heterogeneity, possibly reflecting variations in underlying pain mechanisms throughout the CGH population. Pain phenotyping or classifying patients into subgroups based on their predominant pain mechanism may facilitate more precise CGH treatment. This review aims to explore the role of pain phenotyping in CGH management.
Recent Findings Clinical evidence suggests two predominant pain mechanisms in the CGH population: nociceptive and nociplastic. Arguably, treatments for nociceptive pain should address the source of peripheral nociception, and treatments for nociplastic pain should address factors contributing to maladaptive central pain modulation. Due to centrally mediated analgesic effects, muscle relaxants are strongly recommended for managing both nociceptive and nociplastic CGH pain. Antidepressant medications may be most relevant for nociplastic CGH pain. Cervical spinal mobilization and manipulation interventions are strongly recommended for both nociceptive and nociplastic CGH pain. Nociplastic CGH pain may benefit from educational interventions regarding lifestyle factors such as physical activity, diet and weight management, sleep hygiene, and stress reduction. The anesthetic blockade, glucocorticoid injection, and radiofrequency denervation are strongly recommended for nociceptive CGH pain. Patients with persistent nociplastic CGH pain may benefit from neuromodulation interventions.
Summary Pain phenotyping may facilitate more precise clinical management of patients with CGH. This review provides evidence-informed recommendations for CGH pain phenotyping, including specific subgroups, clinical criteria, and stratified treatment approaches. Further prospective investigation is needed to determine the effects of pain phenotyping on clinical outcomes in patients with CGH.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Cropes, Michael; Deacon, Albojay; Nelson, Evan O.; Deuel, Daniel; Sandgren, Andrew; Abd-Elsayed, Alaa; and Houdek, Tiffany, "Exploring Pain Phenotyping in Cervicogenic Headache Management" (2025). Physical Therapy Faculty Research and Publications. 259.
https://epublications.marquette.edu/phys_therapy_fac/259
Comments
Published version. Current Pain and Headache Reports, Vol. 122 (2025): 1-19. DOI. © 2025 Springer. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.