Osteopathic Approach To Cervicogenic Headache

Question 1

Describe the direction to which the following suboccipital triangle muscles move:

• Obliquus capitis superior will SB to which side?
• Obliquus capitis inferior will Rotate to which side?
• Rectus capitis posterior major: Bilateral contraction will lead to ___ and unilateral contraction will SB/R to the __ side

Answer 1

SB same side

R same side

B/L contraction –> extension

U/L contraction –> SB/R same side

Question 2

The Myodural bridge is the fascia and tendon of ___ with surrounding perivascular sheaths. It forms the posterior OA membrane and directly fuse with the spinal dura between ___ (think Cervical levels). It is a direct anatomic link between MSK system and dura mater and a possible mechanism for eliciting pain in occipital regions

Answer 2

Rectus capitis posterior minor

C1-2 and C2-3

Question 3

Describe the movements for the SCM:

• Unilateral contraction:
• Bilateral contraction:

Answer 3

Unilateral –> SB towards R away

Bilateral–> flexion of head and neck

Question 4

What are the functions of the trapezius?

Answer 4

Primary elevator and adductor of UE

Question 5

Describe the movements of semispinalis, splenius capitis, and longissimus capitis:

• Collectively b/l contraction will __
• Splenius capitis and longissimus capitis unilateral contraction will SB/R to the __ side
• Semispinalis capitis unilateral contraction will Rotate ___

Answer 5

Extension

Same side

Rotate away

Question 6

Unilateral contraction of multifidi and rotators will help rotate ___

Answer 6

Away

Question 7

Intertransversarii muscles during bilateral contraction will lead to ___. Unilateral contraction will SB to the __ side

Answer 7

Extension

Same side

Question 8

This tract coordinates eye and neck movements

Answer 8

Tectospinal

Question 9

This CN converges with upper cervical segments and thought to increase efferent motor to spinal neurons –> increased muscle tension (viscerosomatic reflex)

Answer 9

Vagus

Question 10

This CN has motor to trapezius and SCM. Some sensory afferents that may converge to TNC

Answer 10

Spinal accessory

Question 11

These peripheral nerves innervate the zygapophyseal joints, uncovertebral joints, discs, cervical muscles, ligaments, vertebral a., cervical spinal dura, posterior scalp, lower layer of tentorium cerebelli. Afferents from these structures converge with TNC in the cord

Answer 11

C1-3

Question 12

Sympathetics are dense in the dura and along blood vessels. The superior cervical ganglia are located anterior to ___, has preganglionic fibers from ___, and postganglionic fibers to vascculature and mucous membranes of the head

Answer 12

C2

T1-4

Question 13

These peripheral nerves innervate the posterior scalp. Neuropathy of these nerves lead to occipital neuralgia

Answer 13

Greater and lesser occipital nerves (C1-3)

Question 14

This neuralgia is characterized by deep dull pain that radiates from occiput to parietal/temporal/frontal/periorbital. It also has paroxysmal sharp/shock pain superimposed over constant pain. Ipsilateral eye lacrimation and conjunctival injection is common

Answer 14

C2 neuralgia

Question 15

This neuralgia is characterized by somatic dysfunction associated with whiplash injury. Pain is transmitted to frontotemporal and periorbital regions

Answer 15

C3 neuralgia

Question 16

Cause of CHA is cervical somatic dysfunction and often ___ dysfunction. 50% of whiplash pts with chronic pain have ___ joint pain (the vertebral level)

Answer 16

OA and AA

C2-3

Question 17

Upper cervical/suboccipital spasm induces tension transmitted through ___ and elicits head pain

Answer 17

Myodural bridge

Question 18

C1 and 2 facets produce pain in __ region via the greater occipital n.

Answer 18

Posterior auricular

Question 19

What is your diff dx in cervicogenic ha?

Answer 19

Occipital neuralgia
Migraine with and without aura
Tension-type headaches
Mixed-type headaches

Question 20

What sort of CC would you expect to find in your H & P of a CHA pt?

Answer 20

Moderate to severe deep, non-throbbing/non-lancinating pain

Question 21

Where is the location of the HA in CHA?

Answer 21

Occipital, frontal, temporal, or orbital regions

Unilateral head or face pain without sideshift

Question 22

What sort of radiation pattern is followed in CHA?

Answer 22

Ipsilateral head, neck, shoulder and arm

Non radicular in nature generally

Scalp paresthesias or dysesthesia

Question 23

What tissue texture changes do you find in CHA?

Answer 23

Upper cervical (OA/AA, C2-4), suboccipital muscle tension and stiffness in mobility

Question 24

What asymmetries do you find in CHA?

Answer 24

Asymmetry of head and neck position with shoulders

Question 25

What restriction of motion do you find with CHA?

Answer 25

Restriction of cervical rotation (active nad passive motion), restriction of motion AA (C1-2)

Question 26

What is tender in CHA?

Answer 26

Pain induced by motion, palpation; Myofascial trigger points –> suboccipital, C2, C3, C4 tenderness; Suboccipital, cervical or shoulder girdle pain referred to ipsilateral head

Question 27

Manipulation has what effect on afferents (to the spinal cord) and efferents (to paraspinal muscles) as well as connective tissue and joints?

Answer 27

Manipulation decreases join AFFERENT stimulus to cord –> decreases EFFERENT motor to paraspinal muscle –> releases strain on CT and joints

Question 28

Which OMM technique may be contraindicated for CHA patients?

Answer 28

HVLA

Question 29

This group of muscles level the occiput and temporal bones to the horizon and optimize functioning of visual and vestibular systems

Answer 29

Suboccipital triangle muscles