OS approach to Cervicogenic Headache Flashcards
What is Cervicogenic Cephalgia (CHA)?
Pain from Cervical SD referred to head
Unilateral!
CHA can be associated with? (3)
Tendonitic of Cerv-M.
Tender points
Cervical joint inflammation
Females or males more?
Females
This is common after?
Whiplash/neck trauma
Is there a pattern?
No, but is episodic/recurrent
Suboccipital Triangle Muscles (3) and action
- Obliquus Capitis Superior (SB same side)
- Obliquus Capitis Inferior (Rt same side)
- Rectus Capitis Posterior Major
- B/L contraction => extension
- U/L contraction => SB/Rt same side
What is the Myodural Bridge?
- Direct anatomic link btw msk and dura mater
- Form posterior OA membrane and directly fuse w/spinal dura btw C1-2 and C2-3 (could elicit pain in occipital region
- Fascia and tendon of rectus capitis post minor
SCM contraction
U/L = SB towards and rotate away
B/L = Flexion of H and N
Trap
Primary elevator of adductor of UE
Connects shoulder, thoracic spine and H and N
Semispinalis
Splenius Capitic
longissimus capitis
- Connect T-spine to H and N
- B/L contraction = extension
- Splen and long U/l = SB/Rt same side
- Sem U/L = R away
Rotatores and Multifidi
Multifidi (1-3 spinal levels)
Rotatores: connect successive vertebra
U/L = Rt away
Intertransversarii
Connect V. TP to TP
B/L = Extension
U/L = SB same
Tectospinal tract coordinates eye and ___ movements?
Neck
Vestibular function is linked to?
Neck motion
Neck motion is linked to ___ and ____ motion
Shoulder and upper back
Trigeminal Nerve descending into the upper cervical spine =?
Trigeminal nucleus caudalins (TNC)
How far down does TNC go?
To C4
What N. innervates SCM and Trap?
XI
C1-3 converge with what?
TNC
Do sensory N. Converge with TNC?
Yes (V1, V2 and V3)
Sympathetics are related to Superior cervical ganglia. What level is it located at?
Anterior to C2
Where are sympathetic Pre-gang fibers?
T1-4
Activating sympathetics causes?
Pupil dilation and decreased glandular secretions
Greater and lesser occipital nerves from what levels?
C1-3
Innervate post. Scalp
What can cause occipital neuralgia?
- Trauma
2. Entrapment of occipital nerves, upper cervical zygapophyseal joints and C2
C2 neuralgia. Where is pain? anything else?
- Deep/dull from occiput to rest of head
- Paroxysmal sharp pain on top of dull pain
- Ipsilateral eye lacrimation and conjunctival injection are common
C3 neuralgia is associated with?
Whiplash
C3 neuralgia, where is the pain?
Frontotemporal and periorbital regions
What causes CHA?
Cervica SD (OA and AA = MC)
-Whiplash pts (C2-3 joint pain)
Can V and XI be involved in Cervical SD?
Yes via TNC
How do upper cervical/suboccipital spasms transmit and cause head pain?
Via Myodural bridge
C1 and 2 facets produce pain where and via what nerve?
Post auricular region
Via greater occipital N.
What can treat cervicogenic pain?
Trigger point resolution
Bo-tox injections
Are cytokines and NO higher in CHA or migraines?
CHA
= more pain
Is trigeminovascular system activated in CHA?
No. No calcitonin seen
CC of CHA?
Mod-severe deep, non-throbbing/lancinating pain
What causes CHA?
- Neck movement
- Sustained head position
- Whiplash
Location of pain
Anywhere but U/L
Where does pain radiate?
- Ipsilateral H and N and shoulder/arm
TART changes in CHA?
T: tissue tecture OA/AA C2-4
A: H and N position
R: rotation (AA and C1-2)
T: Pain induced by motion/palpation
Evidence for OMM?
Manipulation/PT relieve pain
Are there any complications?
None reported
