OS Approach to Patient with Cervicogenic HA - Laura Branham

Question 1

What causes CHA?

Answer 1

cervical somatic dysfunction

Often OA and AA dysfunction

Question 2

What is CHA?

Answer 2

cervicogenic cephaligia

Pain referred to the head unilaterally from cervical dysfunction.

Question 3

What is CHA associated with?

Answer 3

Tendonitis of cervical muscles
Trigger points and tender points
Cervical joint inflammation

Question 4

CHA is common after what, what are risk factors?
What gender does it affect most?
What age?

Answer 4

Neck trauma, whip lash, compensatory cervical somatic dysfunciton due to T/L/Pelvic/Shoulder/Leg length or costal dysfunctions, stress/sustained neck postures
Females > Males
ALL AGES

Question 5

Area and Muscles associated with CHA (3)

Answer 5

Suboccipital Triangle

• Obliquus capitis superior (SB)
• Obliquis capitis inferior (Rot)
• Rectus capitis posterior major (Bilateral contraction results in extension, unilateral contraction results in SB/R to same side)

Question 6

What is Myodural Bridge?
What does it directly fuse with?
What is its clinical significance?

Answer 6

The direct anatomic link between teh MSK sysystem and dura mater. The fascia and tendon of rectus capitis posterior minor with surrounding perivascular sheaths.

Spinal dura of C1-2 and C2-3.

Possible mechanism for eliciting pain in occipital region. It has cervical dura sensory nerves sensitive to stretch from stain and prolonged contraction of posterior suboccipital muscles.

Question 7

What is the trigeminal tract that descends into upper cervical spine? What is its significance?
Descends as low as what C level?
What CN also converges here?

Answer 7

TNC - Trigeminal Nucleus Caudalis. All afferents from the trigeminal, spinal accessory, and peripheral nerves go to this point.

As low as level C4

CRANIAL NERVES: 11 AND 5
Spinal Accessory (11), Trigeminal regions (SENSORY),
Afferents from C1-3 (tentorisum, spinal dura, post scalp, ligaments, vert artery, discs, cervical mm, zygapophyseal, etc)

Question 8

What CN is involved in increased muscle tension (viscerosomatic reflex)

Answer 8

Vagus

Question 9

Where is the superior cervical ganglia located?

What does it carry?

Answer 9

Anterior to C2
Preganglionic fibers from T1-4
Postganglionic fibers to vaculature and mucous membranes of head (mid ear, lacrimal gland, pupils)

Question 10

What are peripheral nerves?
What do they innervate?
Associated with what clincial presentation?

Answer 10

Greater and lesser occipital nerves (c1-3).
They innervate the posterior scalp.
Occipital nerualgia

Question 11

C2 neuralgia S/S
Location.
Characerizaiton of pain
Other.

Answer 11

deep, dull pain fromocciput to parietal, temporal, periorbital, frontal region
shock/sharp pain on top of dull

Ips lacrimation and conjuctival injection comon

Question 12

C3 neuralgia.
Associated with what injury?
Transmits pain to what regions?

Answer 12

Whiplash

Periorbital and frontotemporal.

Question 13

What fascets produce pain in posterior auricular region via greater occipital nerve?

Answer 13

C1 and C2

Question 14

What treatement can relieve cervicogenic pain?

Answer 14

Botulinum toxin injections and resolution of myofascial trigger points.

Question 15

Contrasted to migraine patients, CHA patients often have higher levels of what?
Lack of what?

Answer 15

Higher proinflammatory cytokines and NO promote hyperalgesia (when compared to migraine patients).
Lower calcitonin gene-related peptide in CHA pts indicates that trigeminovascular system is not activated by CHA (unlike migraine).

Question 16

What does manipulation do?

Answer 16

Decreases joint afferent stimulus to cord. Decreases efferent motor to paraspinal muscle. Releases strain on CT and joints.

Question 17

Possible treatments (and combinations)

Answer 17

OMM - soft tissue, myofascial, cranial, counterstrain, FPR, Still's
analgesia
Muscle relaxation
surgical
Psychological counseling

Question 18

Red Flags in HA assessment

Answer 18

New onset
Suddent onset
Fever
Focal neuro deficit

Question 19

CHA presentation

Answer 19

Unilateral head pain, severe, non-throbbing, does not shift from side to side.
Fluctuates in intensity
Radiates from occipital to frontal regions
WHIPLASH
Restricted head ROM, ipsilateral shoulder pain, arm pain