Cervicogenic Headache

Question 1

Cervicogenic HA

Answer 1

• myofascial pain source
• caused by a disorder or lesion in c-spine
• Neck pain
• Female

Question 2

Cervicogenic HA: Criteria

Answer 2

Headache with:
1. Clinical, Lab, or imaging evidence of lesion or disorder in c-spine or soft tissue of neck
2. Evidence of cause (at least 2)
* HA in temporal relation to onset of cervical disorder
* HA has improved in parallel w/cervical disorder or lesion
* reduced cervical ROM & provocative movements make HA worse
* Cervical block resolves HA

Question 3

How do you distinguish cervicogenic HA from other headaches?

Answer 3

Cervicogenic:
* unilateral w/o sideshift
* provoke HA by pressure on neck muscles and/or head movement
* restricted ceervical range of motion
* posterior to anterior radiation of pain
* Hx of head trauma
* eliminate or decrease HA by dx blocks

Question 4

Diagnostic testing for suspected cervicogenic headache

Answer 4

• Altered neck posture (restricted cervical ROM)
• Active neck movement triggers head pain
• Muscle Trigger points in suboccipital, cervical, shoulder
• Stimulate trigger points-> refer pain to head
• No cervical radiculopathy, but pt reports scalp paraesthesia or dyesthesia
• Dx imaging: MRI & CT can’t dx but supports dx
• Systemic diseases that affects muscles, bones or joints
  –Rheumatoid Arthritis (RA)
  –Systemic lupus erythematous (SLE)
  –thyroid or parathyroid disorders
  – primary muscle disease

Question 5

Suspected Cervicogenic HA differential Dx:

Answer 5

• Posterior fossa tumor
• Arnold-Chiari malformation
• Cervical spondolysis or arthropathy
• herniated intervertebral disc
• spinal nerve compression or tumor
• arteriovenous malformation
• vertebral artery dissection
• intra/extramedullary spinal tumors

Question 6

Headache secondary to TMD: criteria

Answer 6

muscles, tendons, joint, and/or associated structures
HA with:
1. Clinical or image evidence of a pathological process affecting the TMJ, muscles of mastication, or associated structures
2. Evidence of cause (at least 2)
* HA in temporal relation to onset of TMD
* HA worsened in parallel w/TMD progression
* HA improved in parallel w/improvement of TMD
3.. HA is produced or exacerabated by:
* active jaw movements
* passive movements through ROM of jaw
* provocative maneuverrs

Question 7

Headache secondary to TMD: Management

Answer 7

Target source of pain:
Muscle
1. Thermotherapy
2. Splint therapy
3. Physical therapy
4. Manage loading-Clenching awareness, soft diet
5. Pharmacotherapy (NSAIDs-pain control)
6. Trigger point injections/Temporal tendon injections

TMJ: (1-4 are the same)
* Pharmacotherapy=Steroids
* Surgery (Arthrocentesis)
* Intra-articular injections

Question 8

Red Flags

Answer 8

send pt to ER

2SNOOP4
* Systemic Symptoms (Fever, weight loss, fatigue)
* Secondary risk factors (HIV, cancer, immunosuppresion)
* Neuro symptoms or abnormal signs (Confused, impaired alertness)
* Onset: Suddent, abrupt, or split-second (Thunder Clap)
* Older age: new onset or progressive headache, middle age > 50y.o.
* Previous HA Hx: first headache or different (change in attack pattern, frequency, severity, clincal features)
* Postural or positional aggravation
* Precipitated by Valsalva maneuver or exertion
* Papilledema