Parapharyngeal Tumor Mimicking Cervicogenic Headache

Nasopharyngeal cancer can occur in any age group and is often misdiagnosed. Cervicogenic headache (CEH) is a clinical condition, putatively originating from nociceptive structures in the neck. A patient with CEH-like symptoms occurring as a result of nasopharyngeal cancer invasion is reported. A 77-year-old man was admitted to the anesthesiology department (pain unit) with a 3-month history of severe unilateral headache. The headache began in the right part of the neck and spread to the right frontoorbital region and was always unilateral. There was no history of neck trauma, and the headache did not increase with neck movement. Analgesics were ineffective. The visual analog scale score for pain was 6. Neurological examination demonstrated tenderness over the right greater occipital nerve and reduced range of motion in the cervical spine. Cervical computerized tomography revealed a solid tumor in the right parapharyngeal region, adjacent to the C2-C3 vertebrae. To the authors’ knowledge, this is the first case in the literature of tumoral invasion of nasopharyngeal cancer presenting as CEH. Cervical neuroimaging is obligatory in patients with late-onset, severe CEH.

cervical neuroimaging; cervicogenic headache; elderly; headache; parapharyngeal tumor

1. Bailey BJ, Pillsbury HC III. Head and Neck-Otolaryngology. Philadelphia: JB Lippincott, 1993.

2. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. Headache 1990;30: 725–726.

3. Coskun O, Ucler S, Karakurum B, et al. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia 2003;23:842–845.

4. Martelletti P. Proinflammatory pathways in cervicogenic headache. Clin Exp Rheumol 2000;18(2 suppl 19):33–38.

5. Delfini R, Salvati M, Passacantilli E, Pacciani E. Symptomatic cervicogenic headache. Clin Exp Rheumol 2000;18(2 suppl 19):29–32.

6. Sjaastad O, Fredriksen TA, Pfaffenrath V. Cervicogenic headache: Diagnostic criteria. The Cervicogenic Headache International Study Group. Headache 1998;38:442–445.

7. Headache Classification Subcommittee of International Headache Society. The International Classification of Headache Disorders, ed 2. Cephalalgia 2004;24(suppl 1): 9–160.

8. Rosenberg WS, Swearingen B, Poletti CE. Contralateral trigeminal dysaesthesias associated with second cervical nerve compression: A case report. Cephalalgia 1990;10: 259–262.

9. Fredriksen TA, Salvesen R, Stolt-Nielsen A, Sjaastad O. Cervicogenic headache: Long-term postoperative follow-up. Cephalalgia 1999;19:897–900.

10. Michler RP, Bovim G, Sjaastad O. Disorders in the lower cervical spine. A cause of unilateral headache? A case report. Headache 1991;31:550–551.

11. Kerr FWL. Structural relation of the trigeminal spinal tract to upper cervical roots and solitary nucleus in the cat. Exp Neurol 1961;4:134–138.

12. Sjaastad O, Fredriksen TA, Bono G, Nappi G. Cervicogenic Headache: Basic Concepts. London: Smith-Gordon, 2003.

13. Pfaffenrath V, Dandekar R, Mayer ET, Hermann G, Pöllmann W. Cervicogenic headache: Results of a computer-based measurement of cervical spine mobility in 15 patients. Cephalalgia 1988;8:45–48.

14. Fredriksen TA, Fougner R, Tangerud A, Sjaastad O. Cervicogenic headache. Radiological investigation concerning head/neck. Cephalalgia 1989;9:139–146.

15. Pfaffenrath V, Dandekar R, Pöllmann W. Cervicogenic headache—The clinical picture, radiological findings and hypotheses on its pathophysiology. Headache 1987; 27:495–499.