Week 3: Cervicogenic Headache Flashcards
How prevalent are headaches?
- Lifetime prevalence 93-98%
- Very prevalent, very costly
What are cervicogenic headaches?
- Attributable to problems in the neck or upper cervical spine
- Affected by cervical movements
Where are cervicogenic headaches usually located
- Primarily occipital
- Radiate into head and face
- Unilateral
What percentage of headache sufferers c/o of neck pain associated w/ their headache?
70%
How prevalent are cervicogenic headaches?
- 14-18% of chronic headaches
- 15-20% of recurrent headaches
What is the anatomical basis for the pain pattern of cervicogenic headaches?
Afferents from CN V and spinal nerves C1-C3 go to the trigeminocervical nucleus
Clinical features for differential diagnosis
- Sex
- Lateralization
- Location
- Frequency
- Severity
- Duration
- Pain character
- Triggers
- Associated symptoms
Differential diagnosis for headaches based on sex (female:male)
- Cervicogenic: 50:50
- Migraine: 75:25
- Tension-type: 60:40
Differential diagnosis for headaches based on lateralization
- Cervicogenic: unilateral w/o sideshift
- Migraine: unilateral w/ sideshift
- Tension-type: diffuse bilateral
Differential diagnosis for headaches based on location
- Cervicogenic: occipital to frontoparietal and orbital
- Migraine: frontal, periorbital, temporal
- Tension-type: diffuse
Differential diagnosis for headaches based on frequency
- Cervicogenic: chronic, episodic
- Migraine: 1-4/month
- Tension-type: 1-30/month
Differential diagnosis for headaches based on severity
- Cervicogenic: moderate-severe
- Migraine: moderate-severe
- Tension-type: mild-moderate
Differential diagnosis for headaches based on duration
- Cervicogenic: 1 hr-weeks
- Migraine: 4-72 h
- Tension-type: days to weeks
Differential diagnosis for headaches based on pain character
- Cervicogenic: non-throbbing, nonlancinating, pain usually starts in the neck
- Migraine: throbbing, pulsating
- Tension-type: dull
Differential diagnosis for headaches based on triggers
- Cervicogenic: neck movement, posture, limit ROM, pressure over C0-C3
- Migraine: multiple, neck movement not typical
- Tension-type: multiple, neck movement not typical
Differential diagnosis for headaches based on associated symptoms
- 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
Possible signs of intracranial pathology
- 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
Pain distribution due to vascular issues
- Vertebral artery: unilateral in neck
- Internal carotid: unilateral in neck + temporal region
- Further questioning is needed for differential diagnosis
Concerning history for headache indicating cervical artery dysfunction
“I have pain in my neck and/or head UNLIKE ANYTHING I HAVE EVER HAD BEFORE.”
Major risk factors of cervical artery dysfunction
- Known hypertension
- Hypeercholsterolemia
- Hyperlipidemia
- Diabetes
- Smoker
- BMI >30
- Repeated/recent injury
- Upper cervical instability
5 D’s And 3 N’s
- 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)
Other red flags indicating cervical arterial disease
- 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
Mean age of cervicogenic headache onset
42
Pain area for cervicogenic headache
- Posterior head and neck, possibly radiating shoulder or arm pain
- Primarily ipsilateral
