Diagnosis and Treatment of Cervicogenic Headaches:

1. Outcome Measure – head ache outcome scale

2. Cervicogenic—only 15-20% of all headaches
3. Headaches that don’t respond
a. Vascular, post-traumatic, metastatic etc
4. SNOOP for headaches
a. Systematic symptoms or illness
b. Neurologic symptoms/signs
c. Onset recent/sudden
d. Onset after 40
e. Prior hx.
5. Additional Red Flag
a. Vomiting
b. Constitutional s/s
c. Neuro
d. Seizure
e. Head trauma
f. Wakes from sleep
g. Occipital/focal frontal
6. Want recurrent/familiar/consistent/predicable
7. Cervicogenic Headache Definition
a. Should be consistent
b. R/ L specific (unilateral non side shifting)
c. Reproducing from structures in the neck (occiput/c1-3)
d. Reduced range ext and ext
i. Rotation is big one with c1/c2
e. Sensitivity over occipital nerves
f. Provoked by movements/sustained postures
g. Chronic/episodic/mod intensity
8. Tissues at fault
a. Dura mater
b. C1-3 innervated structures
9. Referred pain
a. C0-1—eye ball area
b. C1-2—temporal area wrapping ant-post
i. More often than not C1/2 is at fault
c. C2-3—top of head
10. ROM upper cervical spine
a. Only way to get end range motion
i. Chin tucks and sticking head out into extension
11. Need to be able to differentiate OA rotation limitation/AA rotation limitation or C2/3 flx/ext
(upglide/downglide) restriction
12. Mechanical headaches
a. Most fall in dysfunction category (stuck joints)
13. Diagnostic tools
a. Flexion-rotation test good sensitivity to detect C1/2 origin
b. C2/3 classically stuck (transition zone)
i. C2 has regulating jobs for Upper cx. And lower cx.
c. Posture doesn’t usually affect true cx. headache
d. #1 dx factor = painful hypomobility in upper cx. Spine
e. Almost a universal loss of deep neck flexor endurance
f. Decreased range into extension and axial rotation
14. Treatment
a. Mobilization then exercise
i. Take care of jt. Problems 1st engage the mm second
b. Stabilization
i. Using gravity as primary means of stabilization
c. Motor re-ed (looking down with eyes automatically engages longus colli/deep neck flx)