Headaches associated with diseases of skull and neck

Headaches can be associated with disorder of the skull and the cervical spi ne. In these cases headaches are secondary or symptomatic and may be amenab le to causal therapy. Both the International Headache Society and the World Health Organization have included headaches associated with disorders of t he skull and the cervical spine in their classifications proposing specific diagnostic criteria. This selection of disorders is the result of a consen sus process which especially in the case of disorders of the cervical spine has not been unopposed. Only disorders with an anatomical correlate and a conclusive pathophysiological mode explaining the pain projection into the head have been accepted as causes of headache. Lesions of the skull most likely to cause headache are those that are rapid ly expansive, aggressively osteoclastic, and/or have an inflammatory compon ent involving the pain-sensitive periosteum (multiple myeloma, osteomyeliti s, etc.). Stimulation of the C-2 sensory root and its extensions, the great er and lesser oczipital nerves, may produce pain in the back of the head. F urthermore,the spinal tract of the trigeminal nerve descends to the level o f C-2-C-4; intermingling of impulses from the upper cervical segments with those from VI may lead to referral of pain from these segments to the head. While tumors and inflammatory processes of the craniovertebral junction (r heumatoid arthritis, ankylosing spondylitis) as well as craniocervical dyst onias may cause headaches, cervical spondylosis and cervical disk disease m ostly affecting the lower parts of the cervikal spine are not universally a ccepted as causes of headache.