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Cervicogenic Headaches (G44.841)

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Mind Map on Cervicogenic Headaches (G44.841), created by Lauren Retica on 08/08/2016.
Lauren Retica
Mind Map by Lauren Retica, updated more than 1 year ago
Lauren Retica
Created by Lauren Retica over 9 years ago
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Resource summary

Cervicogenic Headaches (G44.841)
  1. Epidemiology
    1. Women affected 4 times more than Men (Page, 2011)
      1. Mean age of onset = 33 years (Antonaci & Sjaastad, 2011)
      2. Aetiology/Pathophysiology
        1. Still debated - different theories
          1. Likely referral pain from dysfunctions or abnormalities of joints, muscles, fascia, neural or bone structures of the cervical region (Brukner & Kahn, 2012)
            1. Trigeminal Pathway theory: pain is due to the convergence of upper cervical neural pathways into the trigeminal spinal nucleus (Page, 2011)
            2. Clinical Features
              1. Pain features:
                1. usually unilateral but can be bilateral (Brukner & Kahn, 2012)
                  1. Steady, dull ache
                    1. Intermittent or constant
                      1. Moderate to severe
                        1. usually begins in sub-occipital muscles and spreads to frontal, temporal or retro-orbital areas (Antonaci & Sjaastad, 2011)
                        2. Characteristic 'tight band' feeling wrapped around head (Brukner & Kahn, 2012)
                          1. Often associated with: neck pain/stiffness, light-headedness, dizziness, tinnitus, nausea, vomiting (rare) (Brukner & Kahn, 2012)
                          2. Examination procedure
                            1. Observation
                              1. Abnormal posture seen: rounded shoulders, forward head carriage, upper cervical spine extended, chin protruded. (Brukner & Kahn, 2012)
                                1. Active and passive range of motion decreased in all movements, especially rotation (Fernández-de-las-Peñas, 2014)
                                2. Palpation
                                  1. upper cervical extensors will have increased tone, weakness of flexors (Brukner & Kahn, 2012)
                                    1. Trigger points in cervical, sub-occipital and shoulder muscles
                                  2. Imaging
                                    1. MRI or CT – can’t diagnose but will help with working diagnosis
                                  3. Treatment/Management
                                    1. Pharmacological treatment
                                      1. Analgesics (NSAIDs)
                                        1. Antidepressants
                                          1. Anti-epileptics
                                            1. Muscle relaxants
                                              1. Anaesthetic injections
                                              2. Manual Therapy
                                                1. Careful HVLA
                                                  1. Muscle stretching
                                                    1. MET
                                                      1. Cervical traction (articulation)
                                                      2. Good posture education e.g desk posture
                                                      3. Prognosis/Natural Healing
                                                        1. Will depend on mechanism causing the headache
                                                        2. References
                                                          1. Page, P. (2011). CERVICOGENIC HEADACHES: AN EVIDENCE-LED APPROACH TO CLINICAL MANAGEMENT. International Journal of Sports Physical Therapy, 6(3), 254–266.
                                                            1. Brukner, P., Khan, K., & Brukner, P. (2012). Brukner & Khan's clinical sports medicine. Sydney: McGraw-Hill.
                                                              1. Antonaci, F., & Sjaastad, O. (2011). Cervicogenic Headache: A Real Headache. Current Neurology and Neuroscience Reports, 11(2), 149-155. doi: 10.1007/s11910-010-0164-9
                                                                1. Fernández-de-las-Peñas, C., & Cuadrado, M. L. (2014). Cervicogenic Headache Encyclopedia of the Neurological Sciences (Second Edition) (pp. 738-742). Oxford: Academic Press.
                                                                2. Differential diagnosis
                                                                  1. Aneurysm of internal carotid or vertebral artery
                                                                    1. Lesion of posterior cranial fossa
                                                                      1. Compression of C2 nerve root
                                                                        1. Migraine (Antonaci & Sjaastad, 2011)
                                                                          1. Fibromyalgia (Antonaci & Sjaastad, 2011)
                                                                            1. Muscular tightness of sub-occipital muscles
                                                                              1. Cervical spondylosis
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