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Spine > Cervicogenic headaches > Flashcards

Cervicogenic headaches Flashcards

1
Q

Types of HAs

A
  • Sinus
  • Migraine
  • Tension
  • Cluster
  • Cervicogenic
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2
Q

Sinus HA

A

Pain is usually behind forehead and or cheekbones

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3
Q

Migraine HA

A
  • Unilateral but may shift sides

Associated with:
* Aura
* Nausea
* Photo or phono phobia
* Vomitting
* Throbbing

  • Long lasting (24-72 hours)
  • May be triggered by foods, smells, light, exertion, stress
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4
Q

Tension HAs

A
  • Bilateral (Frontal and occipital region; can go into upper trap)
  • Triggered by emotional stress
  • Shorter lasting (30’ up to several days)
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5
Q

Cluster HAs

A
  • Unilateral (Orbital, supraorbital or temporal)

Associated with:
* Eye tearing
* nasal stiffness
* facial sweating
* ptosis (drooping of eyelid)

  • Short duration: 2-15 minutes
  • Triggered by stress, alcohol, tobacco, etc.
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6
Q

Cervicogenic HA Classification

A
  • Pain primarily in neck and occipital region but may project to forehead and around eye
  • Pain triggered/aggravated by neck movements or sustained postures

One or more of the following:
* Limitation of PROM - especially rotation (usually upper cervical)
* Neck muscle tenderness and tone (Usually TrP tenderness of Suboccipitals, Upper Trap, Levator, SCM
* Active trigger points in the muscles above that refer into head

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7
Q

____ Ratio of Femal to Male ratio for Cervicogenic HAs

A

4:1

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8
Q

____ of subjects with (all types of) headaches have had previous cervical/thoracic pain

A

72-100%

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9
Q

Medical Screening to rule out what?

A

Rule out:
* Fracture
* Ligamentous Instability
* Cervical Artery Insufficency (Refers similar to facets)

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10
Q

Cervicogenic HAs - Subjective

A
  • Commonly Hx of trauma (MVA)
  • Unilateral neck/suboccipital pain with associated headache symptoms aggravated with movement
  • Referral of symptoms into the head (temporal region most common)
  • “Mechanical nature to their pain”: Specific movements or sustained postures aggravate condition
  • Intermittent and fluctuates with specific activity
  • Lying down (unloading of spine) relieves symptoms
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11
Q

Cervicogenic HAs - Objective

A

AROM Assessment in Sitting
* Restricted motion and/or pain esp. with overpressure ESPECIALLY WITH ROTATION (upper cervical involvement)

PROM Assessment in Supine:
* Restriction of motion with ISOLATED UPPER CERVICAL ASSESSMENT (Occiput-C1 OR C1-C2 motion)

Joint Mobility:
* Suboccipital traction alleviates symptoms
* Hypomobility of Occiput-C1 or C1-C2 mobility assessment (Cervical Flex/Rot assessment)

Soft Tissue Mobility/Flexibility
* Tenderness and flexibility deficits of suboccipital muscles, upper trapezius or SCM

Motor Coordination:
* Altered motor coordination and proprioceptive awareness
– Deep neck flexors, neck extension and lower trap activation/endurance
– Neck Joint Position Error Testing (JPET)

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12
Q

People with cervicogenic heads most often have dysfunction with which spinal levels?

A
  • Levels Occiput (C0) - C4
  • Highest: Occiput - C1 and C1-C2 greatest dysfunction
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13
Q

People with cervicogenic HAs will have the greatest limitations in motion where?

A
  • Rotation!
  • May also have some limitations with extension as well
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14
Q

Assessment of C1-C2 mobility: Cervical Flexion-Rotation Test

A

Significant Difference in C1-C2 ROM
- Control/Migraine Aura: Avg 39 degrees
- Cervicogenic HAs: Avg 20 degrees

Positive test is less than 32 degrees

Very reliable (98.3% agreement); Kappa - Excellent (0.81)

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15
Q

What are the most aggravated muscles/referral points for Cervicogenic HAs?

A
  • Suboccipitals: near ear
  • Upper Trapezius: Ram like
  • SCM: C around eye/eyebrow or circular on forehead
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16
Q

Cervicogenic Irritability

A

High:
* Pain before end ranges of rotation during cervical flex/rotation test
* Minimal pressure palpation/mobility assessment produces pain

Moderate:
* Pain at end ranges of rotation during cervical flex/rotation test
* Moderate pressure palpation or mobility assessment produces pain

Low:
* Pain with overpressure into end ranges of rotation during cervical flex/rotation test
* Maximal pressure palpation mobility assessment produces pain

17
Q

Cervicogenic HA interventions

A

Patient Education

Manual Techniques
* Manual-STM
– Soft tissue clearing along the suboccipitals
– Upper trapezius and levator scap
* Suboccipital release/Stretch
* Upper cervical mobilization techniques
– C1-C2 Muscle Energy/Contract-Relax Stretching (MET)
– Upper Cervical Rotation Distraction Non-Thrust Mobilization
– General thoracic and cervical mobilizations

Self- joint and soft tissue Mobilizations/ Stretching:
- Upper cervical SNAGs

  • Motor coordination exercises
18
Q

Patient Education - Cervicogenic HAs

A

Acute or Chronic
- Reassurance of what it is not(fractures, etc.) - Cognitive
* Address person’s attitudes and behaviors – Behavioral (STRESS, sleeping, posture, etc)
* Use words that Heal! (not harm)

If trauma (MVA), tissues need time to heal (4-6 weeks)
- During healing, do not stress tissues too much
- When they do heal, motion/stretching is good. Address FAB

If chronic,
- address “tissue sensitivity”, not “tissue damage”
- Graded exercise

Pain coping strategies:
- Diaphragmatic breathing
- Imagery

Work to identify triggers

Posture plays a role

19
Q

Patients should expect what improvements with interventions for cervicogenic HAs?

A
  • Decrease in frequency, intensity and duration
20
Q

Manual Therapy and Motor coordination

A

Multi factorial: Address:
* Soft tissue tone of the suboccipital and upper trap and SCM
* Joint restrictions of the upper cervical region
* Motor control of the deep cervical stabilizers

21
Q

Self Mobilizations SNAGS - RCT

A
  • Cervicogenic HA individuals
  • 12 week HEP:
    – C1-2 Self Snag
    – Placebo Self Snag
  • Increase in Flexion-rotation test ROM of 15 degrees
  • Decrease in HA severity index at 4 and 12 month follow up
22
Q

____ decreases headaches in the long term when provided as the sole line of treatment

A

Self SNAGS

Spine (19 decks)

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