Neck screening and cervical headache

Question 1

presentations of vertebral artery dissection

Answer 1

ipsilateral posterior neck, pain, occipital headache

C2 to C6 cervical root impairment

Dizziness diplopia disarthria dysphasia drop text nausea, nystagmus, facial numbness, ataxia, vomiting, hoarseness

Question 2

presentations of internal carotid artery dissection

Answer 2

horners syndrome
Tinnitus
Cranial nerve palsys
Scalp Tenderness, neck swelling, orbital pain, anhidrosis

Transient ischemic attack
ischemic stroke
Retinal infarction

Question 3

neurovascular physical examination

Answer 3

blood pressure
BMI
Pulse check
neurological exam
Functional positional test
Ligamentous tests
Eye examination

Question 4

upper motor neuron screen

Answer 4

Clonus
Hoffman’s reflex
Babinski sign
romberg

Question 5

functional positional test, cervical rotation

Answer 5

Affects flow in contralateral vertebral artery

Question 6

Functional positional test cervical extension

Answer 6

affects flow in internal carotid arteries

Question 7

Pain from tension, acute v. sustained contractions

Answer 7

acute
Isometric contractions produced greater intramuscular pressure than isotonic
Increase internal pressure leads to inflammation and myositis

sustained contractions
Leads to ischemic muscle pain, not only from lack of oxygen, but also from accumulated irritating metabolites

Question 8

joint pain

Answer 8

Pain of osteoarthritis, probably due to capsular thickening with resultant limited joint motion

stretching thickened and contracted periarticular tissues on attempted neck motion causes pain in the neck

Question 9

Pain from intervertebral disc

Answer 9

commonly distributed in broad areas with ill defined margins
cloward areas around the scapula don’t apply to the C3 disc

discogenic pain may be central unilateral, bilateral symmetrical or bilateral asymmetrical

Question 10

pain from structures within the vertebral canal

Answer 10

Nerve roots at upper cervical spine
Suboccipital muscles
greater aricular and lesser occipital nerves
Upper trapezius
Vertebral artery within transverse foramen

Question 11

Common syndrome in the upper cervical spine

Answer 11

cervical headache
Rheumatoid arthritis
Acute wry neck joint locking

Question 12

Cervicogenic headache

Answer 12

three parts of the trigeminal nerve
Pars oralis- pons to medulla
pars interpolaris- mid medulla
pars caudalis- medulla to upper cervical region

They interact with the upper cervical roots and can lead to painful sensations being transferred as a headache

Question 13

trigeminocervicical nucleus

Answer 13

primarily involved in transmission of nociceptive information
Can be seen as the pain center for the entire entire head and upper neck

Question 14

only muscles innervated by what levels are capable of producing headaches

Answer 14

C1 C2 C3

Question 15

c3 dorsal ramus syndrome

Answer 15

C2-3 apophyseal joint innervated by C3 dorsal ramus
joint as causation of headaches

Transitional zone in the upper neck , vulnerable to cervical trauma

C2-3 joint relief from anesthetic blocks

Condition is proving to be more common

Question 16

cervical spondylosis and headaches

Answer 16

occipital headaches arise because of spasm of the posterior neck muscles

Arthrosis of the upper cervical joints may be a source of headaches

Question 17

occipital neuralgia and headaches

Answer 17

compression of the greater occipital nerve as a cause of a headache

More likely arthritis of the upper C joints

Question 18

post traumatic headache

Answer 18

after a neck injury

C5 and C6 levels thought to be most frequently affected by neck injury

Traumatic headache is a therefore sign of upper cervical injury concomitant with any more obvious lower c lesion