OS approach to Cervicogenic Headache

Question 1

What is Cervicogenic Cephalgia (CHA)?

Answer 1

Pain from Cervical SD referred to head

Unilateral!

Question 2

CHA can be associated with? (3)

Answer 2

Tendonitic of Cerv-M.

Tender points

Cervical joint inflammation

Question 3

Females or males more?

Answer 3

Females

Question 4

This is common after?

Answer 4

Whiplash/neck trauma

Question 5

Is there a pattern?

Answer 5

No, but is episodic/recurrent

Question 6

Suboccipital Triangle Muscles (3) and action

Answer 6

1. Obliquus Capitis Superior (SB same side)
2. Obliquus Capitis Inferior (Rt same side)
3. Rectus Capitis Posterior Major

• B/L contraction => extension
• U/L contraction => SB/Rt same side

Question 7

What is the Myodural Bridge?

Answer 7

1. Direct anatomic link btw msk and dura mater
2. Form posterior OA membrane and directly fuse w/spinal dura btw C1-2 and C2-3 (could elicit pain in occipital region
3. Fascia and tendon of rectus capitis post minor

Question 8

SCM contraction

Answer 8

U/L = SB towards and rotate away

B/L = Flexion of H and N

Question 9

Trap

Answer 9

Primary elevator of adductor of UE

Connects shoulder, thoracic spine and H and N

Question 10

Semispinalis

Splenius Capitic

longissimus capitis

Answer 10

1. Connect T-spine to H and N
2. B/L contraction = extension
3. Splen and long U/l = SB/Rt same side
4. Sem U/L = R away

Question 11

Rotatores and Multifidi

Answer 11

Multifidi (1-3 spinal levels)

Rotatores: connect successive vertebra

U/L = Rt away

Question 12

Intertransversarii

Answer 12

Connect V. TP to TP

B/L = Extension

U/L = SB same

Question 13

Tectospinal tract coordinates eye and ___ movements?

Answer 13

Neck

Question 14

Vestibular function is linked to?

Answer 14

Neck motion

Question 15

Neck motion is linked to ___ and ____ motion

Answer 15

Shoulder and upper back

Question 16

Trigeminal Nerve descending into the upper cervical spine =?

Answer 16

Trigeminal nucleus caudalins (TNC)

Question 17

How far down does TNC go?

Answer 17

To C4

Question 18

What N. innervates SCM and Trap?

Answer 18

XI

Question 19

C1-3 converge with what?

Answer 19

TNC

Question 20

Do sensory N. Converge with TNC?

Answer 20

Yes (V1, V2 and V3)

Question 21

Sympathetics are related to Superior cervical ganglia. What level is it located at?

Answer 21

Anterior to C2

Question 22

Where are sympathetic Pre-gang fibers?

Answer 22

T1-4

Question 23

Activating sympathetics causes?

Answer 23

Pupil dilation and decreased glandular secretions

Question 24

Greater and lesser occipital nerves from what levels?

Answer 24

C1-3

Innervate post. Scalp

Question 25

What can cause occipital neuralgia?

Answer 25

1. Trauma | 2. Entrapment of occipital nerves, upper cervical zygapophyseal joints and C2

Question 26

C2 neuralgia. Where is pain? anything else?

Answer 26

1. Deep/dull from occiput to rest of head 2. Paroxysmal sharp pain on top of dull pain 3. Ipsilateral eye lacrimation and conjunctival injection are common

Question 27

C3 neuralgia is associated with?

Answer 27

Whiplash

Question 28

C3 neuralgia, where is the pain?

Answer 28

Frontotemporal and periorbital regions

Question 29

What causes CHA?

Answer 29

Cervica SD (OA and AA = MC) -Whiplash pts (C2-3 joint pain)

Question 30

Can V and XI be involved in Cervical SD?

Answer 30

Yes via TNC

Question 31

How do upper cervical/suboccipital spasms transmit and cause head pain?

Answer 31

Via Myodural bridge

Question 32

C1 and 2 facets produce pain where and via what nerve?

Answer 32

Post auricular region Via greater occipital N.

Question 33

What can treat cervicogenic pain?

Answer 33

Trigger point resolution Bo-tox injections

Question 34

Are cytokines and NO higher in CHA or migraines?

Answer 34

CHA = more pain

Question 35

Is trigeminovascular system activated in CHA?

Answer 35

No. No calcitonin seen

Question 36

CC of CHA?

Answer 36

Mod-severe deep, non-throbbing/lancinating pain

Question 37

What causes CHA?

Answer 37

1. Neck movement 2. Sustained head position 3. Whiplash

Question 38

Location of pain

Answer 38

Anywhere but U/L

Question 39

Where does pain radiate?

Answer 39

1. Ipsilateral H and N and shoulder/arm

Question 40

TART changes in CHA?

Answer 40

T: tissue tecture OA/AA C2-4 A: H and N position R: rotation (AA and C1-2) T: Pain induced by motion/palpation

Question 41

Evidence for OMM?

Answer 41

Manipulation/PT relieve pain

Question 42

Are there any complications?

Answer 42

None reported