Central Sensitization and Neuropathic Pain in Cervicogenic Headache

Cervicogenic headache is a secondary headache that arises from disorders or dysfunctions of the cervical spine and its associated structures. Pain usually starts in the neck region and radiates toward the occipital and temporal areas. The condition can be provoked by neck movements and may be accompanied by neck stiffness or discomfort. The pathophysiology involves the convergence of sensory inputs from the cervical nerves and the trigeminal system at the brainstem level, which may lead to the referral of pain from the neck to the head.

In recent years, researchers have proposed that abnormal central nervous system activity and neuropathic pain components may contribute to the chronicity and treatment resistance of cervicogenic headache. Central hypersensitivity refers to increased excitability of pain-related neurons, while neuropathic pain is characterized by nerve dysfunction resulting in unusual pain sensations. A limited number of studies have addressed these mechanisms together in cervicogenic headache.

The present case-control study was conducted at Yozgat Bozok University to evaluate central nervous system hypersensitivity and neuropathic pain features in patients with cervicogenic headache compared to healthy controls. Data collection took place between July 2025 and October 2025. Individuals aged 18 to 65 years who fulfilled the diagnostic criteria for cervicogenic headache were included in the patient group. Exclusion criteria included neurological disorders, systemic diseases, cognitive impairment, or other rheumatic or chronic pain conditions. Healthy volunteers of similar age and sex without headache or chronic pain were selected as the control group.

Data were obtained using a structured questionnaire covering demographic and clinical information and a series of standardized scales. Pain-related disability was measured with the Headache Impact Test and the Neck Disability Index. Emotional status was evaluated with the Hospital Anxiety and Depression Scale. Sleep quality was assessed with the Jenkins Sleep Scale. Health-related quality of life was examined with the Short Form 36 questionnaire. The presence of nerve-related pain was assessed with the Pain Detect Questionnaire, and central nervous system hypersensitivity was evaluated with the Central Sensitization Inventory.

All assessments were administered face to face in the outpatient clinics by trained clinicians. Statistical analyses were performed using appropriate parametric and non-parametric tests after checking normality of data distribution. The study was approved by the Institutional Clinical Research Ethics Committee, and all participants signed written informed consent forms prior to enrollment.

Eligibility Criteria

Inclusion criteria

• Adults aged 18 to 65 years
• Patient group: Clinical diagnosis of cervicogenic headache according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria
• Healthy control group: Age- and sex-matched individuals without cervicogenic headache or other chronic pain conditions
• Adequate cognitive function and literacy to complete questionnaires
• Voluntary participation with written informed consent

Exclusion criteria

• Age younger than 18 years or older than 65 years
• Inability to communicate effectively
• Illiteracy
• Refusal to participate
• Presence of systemic diseases including diabetes mellitus, hypothyroidism, chronic kidney disease, or malignancy
• Neurological diseases associated with neuropathic pain
• Rheumatologic diseases including rheumatoid arthritis, ankylosing spondylitis, or fibromyalgia
• Withdrawal of consent or incomplete data during the study