Download Upper Cervical Headaches - Fearon Physical Therapy

Margaret Anderson
Headaches
 Symptom of a disorder in articular, muscular or other
soft tissue of the neck
 Occur thro the convergence of cervical and trigeminal
afferents on common neurones in the
trigeminocervical nucleus and any structure
innervated by any of upper 3 cervical nerves.
Other sources of headaches
 TMJ
 Intercranial conditions: neoplasm or meningitis
 Vascular headaches
 Migraineous type:
 Cluster headaches
Headaches
 Common areas of cervical headaches are frontal,
orbital, temporal and occipital
 Headaches are commonly unilateral but can be
bilateral.
 Does not change sides as can occur in migraine
Headaches
 Quality :
 Ache, deep, boring and less commonly throbbing pain.
 Superficial, shooting pain of lancinating pain is typical
of true neuralgia.
 Neurogenic symptoms in benign cervical
musculoskeletal headaches is rare.
 Headache is a referred pain rather that an irritation or
compression of cervical nerve root but one must
always ask about sensory changes in the scalp
Behavior of Headaches
 Often cause and effect difficult to establish
 When do they occur: daily, 2 or 3 times a week or once a
month. Establish a pattern and their duration
 Initiating factors
 Associated symptoms
 Nausea/vomiting
 Eye or ear symptoms
 Consider provoking activities
 Driving
 Reading with chin in hand
 Hairdressers basins
 Difficulty swallowing may indicate a C3 discogenic problem
Behavior
Ease factors
 Rest, usually posture: lying
 May wake with headache
down or sitting quietly
 Medications
because of poor sleeping
position or busy previous day
 Cervical stiffness
24 hour
 May build
up atday
end of day
 If chronic analgesics or
NSAID offer little relief
History
 May present with headaches for weeks, months
 May result from injury or past history of neck trauma
 Perpetual strain to upper cervical joints can be poor
posture.
 Insidious onset of headaches may be direct response to
onset of DJD
 Headaches of upper cervical origin often coexist with
migraines.
Case Study,
 65 year old female. Looks after grandchildren, works
on various charitable committees, ‘always busy’
 AREA
 Left sided dull sub-occipital pain which radiates behind left
eye.
 Sub-occipital area ‘sore to touch’ and ‘feels swollen’
 She denies right-sided pain, pain radiating into the upper
extremity or any numbness and tingling.
Behavior
 Her headaches come on for no apparent reason, but
she will wake at midnight after a busy day or 4am if not
busy.
 If severe she will take Tylenol and return to sleep
 During the day she never has a headache but will
sometimes wake with one, which lasts for about an
hour; she is unaware of any cervical stiffness.
History
 Her headaches came on about 6 months ago when her
husband was seriously ill. She thought it was due to
stress. Her husband recovered but the headaches
remain.
 She had headaches about 7 years ago which were
successfully treated with manipulation
Planning the Physical Exam
 Severity
 Irritability
 Nature
 Stage & stability
 Precautions and contraindications
 Do you think you will reproduce the headache or find a
comparable sign?
Physical Exam
 Observation: poking chin posture, unable to correct, stuck in upper









cervical extension because of tight upper cervical and upper trapezius
musculature
Flexion unable to unroll upper cervical, no pain with overpressure
Left rotation 85° stiff, no pain
Right rotation 70° tight Left sub-occipital, no pain
PPIVMS C2/3 blocked to opening and closing in rotation and lateral
flexion
Palpation: tight upper cervical muscles, L>R, tender to touch
L C2/3 unilateral PA stiff local pain IV >> R
L C1/2 stiff, pain IV
COMPARABLE SIGN IS:
* FOR ASSESSMENT:
Assessment at the end of OE
 Patient says she is no worse/same
 Diagnosis
 Headache of C2/3 > C1/2 origin
 Secondary/chronic muscle shortening and spasm
 Postural adaptation because of aging
Presentation
 Severity
 Irritability
 Stage
 Stability
 PRECAUTIONS AND CONTRAINDICATIONS
THINK ABOUT:
 Mechanical factors
 Functional
 Psychosocial: well balanced elderly woman
 Possible causes
Think about:
 Prognosis
 Natural history of the disorder


Chronic problem
Level of recovery
 Rate depends on initial response to treatment, so would
expect how many visits?

Age
 Likelihood of recurrence
Treatment Planning
 Outline treatment for next 2 visits
 Remember 3 aspects of the patient’s problem
 Headache of C2/3 > C1/2 origin = stiff upper cervical
joints.
 Secondary/chronic muscle shortening and spasm
 Postural adaptation because of aging
 Think about options & what you expect to change
easily and start there.
 Note: traction in upper cervical spine tends to
exacerbate headaches.