The headache of challenge in our time: cervicogenic headache.

Cervicogenic headache is a unilateral headache without sideshift, beginning in the posterior of the head but ultimately spreading to the front. It is characterized by rather mild and protracted pain episodes, the pain in many instances eventually becoming chronic, but with an undulating course. There is a marked female preponderance. The special features indicating neck involvement include: whiplash trauma by history, reduction of range of movement in the neck, ipsilateral shoulder and--occasionally--arm pain, and, further, the fact that attacks can be precipitated mechanically by the patients (by neck movements) or by the physician (by external pressure towards circumscribed points in the neck). An important theoretical--and diagnostic--feature is the fact that the anaesthetic blockade of the major occipital nerve results in discontinuation of pain in an area (the oculo-frontal area) where anaesthesia has not been obtained.