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South College MSK 3 > Week 3: Cervicogenic Headache > Flashcards

Week 3: Cervicogenic Headache Flashcards

1
Q

How prevalent are headaches?

A
  • Lifetime prevalence 93-98%

- Very prevalent, very costly

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2
Q

What are cervicogenic headaches?

A
  • Attributable to problems in the neck or upper cervical spine
  • Affected by cervical movements
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3
Q

Where are cervicogenic headaches usually located

A
  • Primarily occipital
  • Radiate into head and face
  • Unilateral
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4
Q

What percentage of headache sufferers c/o of neck pain associated w/ their headache?

A

70%

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5
Q

How prevalent are cervicogenic headaches?

A
  • 14-18% of chronic headaches

- 15-20% of recurrent headaches

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6
Q

What is the anatomical basis for the pain pattern of cervicogenic headaches?

A

Afferents from CN V and spinal nerves C1-C3 go to the trigeminocervical nucleus

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7
Q

Clinical features for differential diagnosis

A
  • Sex
  • Lateralization
  • Location
  • Frequency
  • Severity
  • Duration
  • Pain character
  • Triggers
  • Associated symptoms
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8
Q

Differential diagnosis for headaches based on sex (female:male)

A
  • Cervicogenic: 50:50
  • Migraine: 75:25
  • Tension-type: 60:40
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9
Q

Differential diagnosis for headaches based on lateralization

A
  • Cervicogenic: unilateral w/o sideshift
  • Migraine: unilateral w/ sideshift
  • Tension-type: diffuse bilateral
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10
Q

Differential diagnosis for headaches based on location

A
  • Cervicogenic: occipital to frontoparietal and orbital
  • Migraine: frontal, periorbital, temporal
  • Tension-type: diffuse
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11
Q

Differential diagnosis for headaches based on frequency

A
  • Cervicogenic: chronic, episodic
  • Migraine: 1-4/month
  • Tension-type: 1-30/month
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12
Q

Differential diagnosis for headaches based on severity

A
  • Cervicogenic: moderate-severe
  • Migraine: moderate-severe
  • Tension-type: mild-moderate
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13
Q

Differential diagnosis for headaches based on duration

A
  • Cervicogenic: 1 hr-weeks
  • Migraine: 4-72 h
  • Tension-type: days to weeks
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14
Q

Differential diagnosis for headaches based on pain character

A
  • Cervicogenic: non-throbbing, nonlancinating, pain usually starts in the neck
  • Migraine: throbbing, pulsating
  • Tension-type: dull
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15
Q

Differential diagnosis for headaches based on triggers

A
  • Cervicogenic: neck movement, posture, limit ROM, pressure over C0-C3
  • Migraine: multiple, neck movement not typical
  • Tension-type: multiple, neck movement not typical
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16
Q

Differential diagnosis for headaches based on associated symptoms

A
  • Cervicogenic: usually absent or similar to migraine (but milder), decreased ROM
  • Migraine: nausea, vomiting, visual changes, phonophobia, photophobia
  • Tension-type: occasionally decreased appetite, phonophobia or photophobia
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17
Q

Possible signs of intracranial pathology

A
  • Sudden onset of severe headache w/ increasing intensity
  • Persistently unilateral headaches
  • Wake the pt during night/early morning
  • Generalized stiff neck/other signs of meningitis
  • Systemic symptoms (weight loss, fever, malaise)
  • Focal neurologic symptoms or signs
18
Q

Pain distribution due to vascular issues

A
  • Vertebral artery: unilateral in neck
  • Internal carotid: unilateral in neck + temporal region
  • Further questioning is needed for differential diagnosis
19
Q

Concerning history for headache indicating cervical artery dysfunction

A

“I have pain in my neck and/or head UNLIKE ANYTHING I HAVE EVER HAD BEFORE.”

20
Q

Major risk factors of cervical artery dysfunction

A
  • Known hypertension
  • Hypeercholsterolemia
  • Hyperlipidemia
  • Diabetes
  • Smoker
  • BMI >30
  • Repeated/recent injury
  • Upper cervical instability
21
Q

5 D’s And 3 N’s

A
  • Dizziness
  • Drop attacks
  • Diplopia (double vision)
  • Dysarthria (motor speech disorder)
  • Dysphagia (swallowing difficulties)
  • Ataxia (lack of movement control)
  • Nausea
  • Numbness
  • Nystagmus (repetitive, uncontrolled eye movement)
22
Q

Other red flags indicating cervical arterial disease

A
  • Altered taste
  • Altered facial or peri-oral sensation
  • Visual changes
  • Unusual headaches/neck pain
  • Facial numbness
  • Tinnitus (ringing in ears)
  • Gait disturbances
  • Hoarseness
  • Vomiting
  • Memory loss
  • Motor loss
23
Q

Mean age of cervicogenic headache onset

A

42

24
Q

Pain area for cervicogenic headache

A
  • Posterior head and neck, possibly radiating shoulder or arm pain
  • Primarily ipsilateral
25
Q

What provokes cervicogenic headaches?

A

Sustained/awkward neck positions

26
Q

Tests for cervicogenic headaches

A
  • External pressure over upper cervical or occipital region (trigger points)
  • Abnormal joint mobility testing
    • cervical flexion-rotation test
  • Cranial cervical flexion test
  • Neck flexor muscle endurance test
27
Q

How is the Cervical Flexion-Rotation Test (CFRT) conducted?

A

The neck is put in full flexion and then rotated to the right and left

28
Q

Average normal rotation in CFRT

A

39 degrees

29
Q

Average rotation with cervicogenic headache in CFRT

A

20 degrees

30
Q

Positive CFRT

A

<32 degrees

31
Q

Purpose of Cranial Cervical Flexor Test (CCFT)

A

Assess deep cervical flexor strength

32
Q

Patient position for CCFT

A

Supine w/ occiput on the table

33
Q

Procedure for CCFT

A
  • Pt flexes cervical spine by tucking chin

- Pt should be able to generate 26-30 mmHg for 10 seconds

34
Q

Purpose of neck flexor muscle endurance test

A

Assess deep cervical flexion strength

35
Q

Patient position for neck flexor muscle endurance test

A

Hook lying with occiput on table

36
Q

Procedure for neck flexor muscle endurance test

A
  • Patient tucks chin and holds head up
  • While maintaining flexion, raise head off table 2.5 cm
  • Time stops when pt can’t hold head up and maintain chin tuck
37
Q

Normal test for neck flexor muscle endurance test

A

> 38 seconds

38
Q

Diagnostic cluster for cervicogenic headache (Jull, 2007)

A
  • Decreased AROM cervical extension
  • Palpable pain somewhere from OA to C3-4 joint dysfunctions
  • Deep cervical flexor strength impairments w/ CCFT
39
Q

Diagnostic cluster for cervicogenic headache (Zito, 2006)

A
  • Palpably painful C1/C2 joint dysfunctions

- Pec minor muscle length shortened-

40
Q

Evidence indicates what treatment is most effective for treating acute neck pain with headaches?

A
  • Active mobility exercise

- Self-SNAG exercise

41
Q

Evidence indicates what treatment is most effective for treating subacute neck pain with headaches?

A
  • Cervical mob/manip

- Self-SNAG exercise

42
Q

Evidence indicates what treatment is most effective for treating chronic neck pain with headaches?

A
  • Cervical or cervicothoracic mob/manip

- Shoulder girdle and neck stretch/strength/endurance

South College MSK 3 (22 decks)

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