The International Headache Society (IHS) [1] defines headache as any pain located in the head, more specifically, above the orbitomeatal line and/or nuchal ridge. Facial pain is located below this line, anterior to the pinnae. The International Association for the Study of Pain [2] situates cervical spinal pain between the superior nuchal line and the first thoracic spinous process.

Described almost a century ago, cervicogenic headache (CEH) is not a rare entity, but it remained scientifically ostracized until the end of the last century. It is defined as a headache caused by cervical spine disorders, including bony, disk, and soft tissue elements [1]. Two groups proposed the most commonly used sets of diagnostic criteria: the IHS and the Cervicogenic Headache International Study Group (CHISG). There are some nuances between the two proposals, but unilaterality, reduced cervical mobility, and pain triggered by external compression seem to be the most valuable criteria in both.

CEH's phenomenology is explained by trigeminocervical convergence mechanisms at the trigeminal nucleus caudalis (TNC) level. Dysfunctional cervical structures can stimulate this nucleus, producing pain symptoms in the neck, suboccipital region, and especially in the territory of the first trigeminal nerve. On the other hand, blocking the cervical roots acts as a modulating effect, changing dysfunctional mechanisms and promoting pain relief. It is, therefore, not uncommon for patients to report a history of pathology involving the cervical spine, from whiplash in young patients to degenerative processes in older ones. The physical examination frequently reveals reduced cervical mobility and strength and increased sensitivity in this region.

Semiologically, this unilateral and fixed headache, of moderate intensity, chronic pattern, with triggers related to cervical posture, can also express migraine features. Probably due to the activation of the TNC, the same region involved in the genesis of migraine pain, some symptoms of CEH overlap with those of migraine. Nausea, photo- and phonophobia, worsening with movement, are common, which can often lead to a false diagnosis of migraine. It should also be noted that symptoms of neck stiffness or neck pain are not uncommon in the premonitory phase of migraine, which can be a diagnostic trap.

In this review, we evaluate the historical aspects of CEH, its diagnostic criteria, epidemiology, other semiological aspects, differential diagnoses, clinical investigations, diagnostic maneuvers, and treatment. Professor Sjaastad [3], considered to be the father of CEH, also served as inspiration for this review through his words about this disorder: “Gutta cavat lapidem, non vi, sed saepe dadendo" (the drop excavates the stone, not by force, but by falling frequently).