Headache, cervicogenic

• Cephalagia
• Headache

• 307.81 Tension headache
• 339 Other headache syndromes
• 339.1 Tension type headache
• 339.2 Post-traumatic headache
• 339.8 Other specified headache syndromes

• G44.209 Tension-type headache, unspecified, not intractable
• G44.309 Post-traumatic headache, unspecified, not intractable
• G44.88 Headache attributed to head and or neck trauma

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation1

Description

• Pain in the head or neck region
• Dysfunction in the cervical spine
  • Suboccipital
  • C1-C3 vertebral region
• One of 5 National Institutes of Health (NIH) headache classifications

Essentials of Diagnosis

• International Classification of Headache Disorders-II (ICHD-II) criteria2
  • Secondary headaches are based on etiology
    • May be caused by whiplash injury, intracranial headaches, neck injury, vascular disorders
• NIH definition for cervicogenic headache
  • Disorder of the cervical spine

General Considerations

• Headaches can be harmless or disabling
• May be a sign of more severe pathology in head or brain region
• Sinuses and vision problems can cause headaches

Demographics

• Cervical spine injury can affect any age group

Signs and Symptoms

• Stiff neck
• Limited mobility
• One-sided
• Pain may radiate to arm

Functional Implications

• Difficulty maintaining sitting postures secondary to neck pain
• Inability to sleep
• Weakness with upper extremity lifting
• Inability to drive or work secondary to intolerance for light or sound
• Difficulty with neck movements (driving) secondary to pain

Possible Contributing Causes

• Forward-head, rounded-shoulders posture due to tight pectoralis, weak periscapular, and deep neck flexor muscles
• Prolonged position of cervical side-bending toward impaired nerve or prolonged extension
• Facet hypertrophy
• Trauma
• Hydration
• Nutrition deficiency
• Muscular tightness
• Stress

Differential Diagnosis

• Tumor
• Glaucoma
• Sinusitis
• Myofascial pain syndrome
• Rhomboid/trapezius spams
• Degenerative disk disease
• Lyme disease
• Temporomandibular joint dysfunction
• Arnold Chiari malformation
• Migraineheadaches
• Cluster headaches
• Toxic headaches

Imaging

• MRI helps to visualize the head/brain region in diagnosis
• X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen of cervical spine
• CT

• Physical examination cluster to rule in cervical radiculopathy3
  • Spurling’s test
  • Rotation limited to ipsilateral side
  • Upper limb nerve tension test
  • Diminished brachioradialis reflex

• To hospital for imaging
• To nutritionist for dietary/nutritional counseling, evaluate for nutritional deficiency
• To optometrist for eye examination
• To neurologist for imaging

• Restricted mobility of the upper-/mid-thoracic spine and subcranial spine
• Hypermobile mid-cervical spine
• Tight pectoralis major and minor
• Noted weakness of longus coli and longus capitus
• Noted weakness of periscapular muscles

• Rest
• Hydration
• Joint manipulation to the thoracic and upper cervical spine
  • Suboccipital release
  • Myofascial release
• Cervical distraction and traction to relieve nerve compression
• Cranio-cervical flexion exercises
• Address ...