Pathophysiology
- Convergance of sensory neurons from the cx and trigeminal nerve in trigeminocervical nucleus in upper Cx |
- Mechanical irritation of greater occupital nerve |
Demographics
- Women more than men |
- Previous history of trauma (concussion and/or motor vehicle accident) |
- Weightlifters more susceptible |
Presentation
- Neck tenderness and stiffness |
- Often unilateral on same side, but can be bilateral |
- Usually moderate- severe pain |
- Radiates to occiptal, temporal, frontal or supraorbital |
- Can affect ipsilateral arm |
- Symptoms can last from hours to days |
- Patient describes pain as deep and triggered by sustained/awkward cx posture |
- Not usually throbbing |
- Loss of ROM |
- Ipsilateral extension/rotation triggers the POC |
- TTP: ipsilateral suboccipital musculature, Greater occipital nerve and affected facet joints |
- Can have peripheral sensitisation over eyebrow due to neurological interconnections (eyebrow pinch test) |
- Trps in upper traps, suboccipital, cervical and shoulder girdle muscles |
- Loss of strength in DNF |
- Overactive upper traps and SCM |
- MP shows ristricted upper Cx |
- Look at upper crossed signs and breathing pattern (weak cx flexors, rhomboids, lower traps, hypertonic pecs, suboccipital and upper traps) |
Red Flags
SNOOP |
- Headaches becoming worse |
- Sudden onset severe headache, new and unfamiliar headache that peaks quickly |
- Headache after recent head injury |
- Fever, rash, nuchal rigidity |
- Facial numbness/paresthesia |
- Vertigo, diplopia, drop attacks, difficulty speaking/swallowing/walking |
- Nausea/vomiting |
- Extremity numbness |
- Nystagmus |
- Weight loss |
- Hx of cancer |
- Confusion/impaired consciousness/alertness |
- New headache patient >50 years old, consider Giant Cell Arteritis/SOL |
Imaging
- Avoid unless red flags are present |
DDx
- Posterior fossa tumour |
- Arnold-Chiari malformation |
- Cx spondylosis |
- Herniated disc |
- Spinal nerve compression/tumour |
- Arteriovenous malformation |
- VAD |
- VBAI (can mimic Cervicogenic HA) |
Management
- SMT of Cervical and upper Tx (6-8 appointments ) |
- Myofascial releaseand stretching of suboccipitals, SCM, upper traps, levator scap, scalenes, pecs and temporalis |
- In cervicogenic Tension type HA, neural mobilisation and soft tissue techniques can be effective |
- Postural correction + breathing exercises |
- Strengthening of DNF, craniocervical flexion, shoulder abduction, shoulder retraction, lat pull, bicep curls, bent over rows, upper tx mobilisation and pec strengthening |
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