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Upper Cervical Headaches

Upper Cervical Headaches. Margaret Anderson. Headaches. Symptom of a disorder in articular, muscular or other soft tissue of the neck

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Upper Cervical Headaches

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  1. Upper CervicalHeadaches Margaret Anderson

  2. 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.

  3. Other sources of headaches • TMJ • Intercranial conditions: neoplasm or meningitis • Vascular headaches • Migraineous type: • Cluster headaches

  4. 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

  5. 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

  6. 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

  7. Behavior Ease factors 24 hour day • Rest, usually posture: lying down or sitting quietly • Medications • If chronic analgesics or NSAID offer little relief • May wake with headache because of poor sleeping position or busy previous day • Cervical stiffness • May build up at end of day

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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?

  13. 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:

  14. 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

  15. Presentation • Severity • Irritability • Stage • Stability • PRECAUTIONS AND CONTRAINDICATIONS

  16. THINK ABOUT: • Mechanical factors • Functional • Psychosocial: well balanced elderly woman • Possible causes

  17. 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

  18. 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.

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