Cervicogenic Headaches

Question 1

Criteria for Diagnosis

Answer 1

pain localized to neck and occipital area - may project to forehead, orbital region, temples, vertex, and ears
pain precipitted or aggravated by special neck movements or sustained neck posture
At least 1 of the following
- resistance to or limitation of passive neck movements
- changes in neck muscle contour, texture, ton, or response to active or passive stretching and contraction
-abnormal tenderness of neck muscles
Radiological Exam - at least 1 of the following
- movement abnormalities in flex or ext
- abnormal posture
- fxs, congenital abnormalities, RA, or other distinct pathology

Question 2

Common Signs and Symptoms

Answer 2

neck pain and stiffness
episodic 2-3 days/week
may last hours to days
varying intensity - can be mod to severe

usually uni and does not change sides
pain begins in neck and spreads to head

Question 3

Structures Implicated

Answer 3

upper 3 C-segments (esp CO-C1, C2-C3)
neck flexor weakness (esp deep flexors)
common muscle trigger points - upper trap, SCM, suboccipital group, masseter, temporalis

Question 4

Trigeminal Nerve and Headache

Answer 4

trigeminal complex responsible for primary headache pain

stimulation of upper cervical-innervated structures producing head pain in opthalamic distribution of trigeminal

Question 5

Convergence in Trigeminal Spinal Nucleus from

Answer 5

facial skin afferents
dura mater
suboccipital muscles
cervical skin (C2,3 dermatomes)
cervical joints
deep paraspinal muscle afferents
cornea
contra C2

Question 6

Sensitization

Answer 6

after strong noxious input, central pain neurons become hyperexcitable to afferent stimulation (reduced threshold to nociception)

more likely to happen from deeper structures like muscle and joint than skin afferents

Question 7

Cross Sensitization

Answer 7

convergence = more likely headache and neck pain will happen together
central neurons sensitized to dura input = sensitized to cervical input (vice versa)

Question 8

Management

Answer 8

articular - joint mobility of upper cervical joints
muscle dysfunction - flexibility, muscle performance
posture - realignment