Document Type

Article

Publication Date

12-2025

Publisher

Springer

Source Publication

Current Pain and Headache Reports

Source ISSN

1531-3433

Original Item ID

DOI: 10.1007/s11916-025-01420-0

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.

Comments

Published version. Current Pain and Headache Reports, Vol. 29 (2025). DOI. © 2025 Springer.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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