Cervicogenic Flashcards
Trigeminocervical nucleus contains
Afferents from cranial nerve five
spinal nerves C1-C3
Cervicogenic headache
50-50 female male
Unilateral without side shift
Occipital to frontoparietal and orbital
Chronic episode
Moderate to severe
One hour two weeks
Non-throbbing and non-lancinating pain usually from the neck
Neck movement and postures, limited ROM, and pressure over upper cervical are the triggers
Decreased range of motion
Migraine
75 to 25 female male
60% unilateral with sides shift
Frontal , periorbital , temporal
1-4 times per month
Moderate to severe
4 to 72 hours
Throbbing pulsating
Multiple triggers, neck movement not typical
Nausea, vomiting, visual changes, photophobia
tension type headache
60 to 40 female male
diffuse bilaterally
One to 30 per month
Mild to moderate
Days to weeks
dull
Multiple triggers, neck movement not typical
Occasionally decreased appetite, phonophobia, or photophobia
possible signs of intracranial pathology
Sudden onset of severe headaches with increasing intensity
Persistently unilateral headaches
Headaches that with the patient during the night
Generalized stiff neck or other signs of meningitis
Weight loss fever
Neurologic symptoms or signs
major risk factors for arterial disease
Hypertension
Hypercholesterolemia
Hyper lipidemia
Diabetes
Smoker
BMI greater than 30
Repeated or recent injury
Upper cervical instability
Red flags for cervical artery dysfunction
Five Ds and three Ns
Dizziness
Drop attacks
Diplopia
Dysarthria
Dysphasia
Ataxia
Nausea
Numbness
Nystagmus
Standard for diagnosing, cervicogenic headaches
diagnostic blocks
lack specificity
blocks greater occipital nerve can abolish migraines up to 30 days as well
Not feasible in outpatient setting
examination cervicogenic
Mean ages 42
Posterior head and neck
Primarily unilateral
Ipsilateral, neck, shoulder, and arm pain
Provoked by sustained positions
Increasing frequency of short headache attacks
cervical flexion rotation test
Patients with cervicogenic headaches will have less range of motion
Positive test is less than 32°
cranial cervical flexor test
Assess deep cervical flexor strength
Supine with occiput on table
flex cervical spine by tucking in the chin , avoid retraction and isolate movement to upper cervical spine
Normal test the patient is able to generate 26 to 30 pressure for 10 seconds without compensation
neck flexor muscle endurance test
Assess deep cervical flexion strength
Tuck your chin and hold her head up 2.5 cm
Normal is greater than 38 seconds
Diagnostic cluster for cervicogenic headache
Decreased AROM cervical extension
Palpably painful somewhere from OA to C3 -4 joint dysfunctions
deep cervical flexor strength impairments with cranial cervical flexion test
**These conditions are not present in migraine or tension headaches
Two diagnostic cluster for cervicogenic headache
palpably painful C1-2 joint dysfunctions
Pectoralis, minor muscle length shortened
Most likely muscle tightness for cervicogenic headaches, muscles
Upper trapezius
levator
scalenes
sternocleidomastoid
Pec major
pec minor
