Diagnosis Of Cervicogenic Headache Research Articles

Poster 268: The Role of Cervical C1/2, C2/3 Spinal Injections in the Diagnosis of Cervicogenic Headache

Objective: The diagnosis and treatment of cervicogenic headache (CEH) is challenging. This study was to determine the role of C1-C2 and C2-C3 facet joint and dorsal ramus injections in diagnosis of CEH. Design: Retrospective study. Setting: Academic pain center. Participants: 30 patients with clinical diagnosis of CEH, 13 men and 17 women; mean age of 42 years (range, 18–65y). All patients had failed multiple pharmacologic and other treatments prior to the study. Average disease duration was 6.9 (0.5–20) years.

Migraine without aura: comparison with cervicogenic headache. Vågå study of headache epidemiology

To study migraine without aura (MwoA) prevalence in the commune of Vågå, Norway; 1838 (18- to 65-year-old) individuals were included. A special search was made for cervicogenic characteristics in MwoA, as it has been claimed that such characteristics may frequently be present. A comparison with cervicogenic headache (CEH) was made. The MwoA and tension-type headache (T-TH) diagnosis was based on IHS criteria. CEH diagnosis was based on the principles of The Cervicogenic Headache International Study Group. There were 562 cases of MwoA; prevalence: 31%. There were 425 cases of 'pure' MwoA, i.e. without coexisting T-TH. These 'pure' cases were used for extracting MwoA symptoms. The female/male ratio was 1.69, the corresponding ratio in CEH being 0.71. Typical MwoA symptoms such as nausea/photophobia were most frequently found in migraine. This difference amounted to a factor of > or =2.6. On the other hand, typical CEH traits, like mechanical pain provocation and 'posterior' onset of exacerbations, occurred more frequently in CEH than in MwoA. The difference amounted to a factor of two or more. MwoA and CEH have clearly different characteristics. The differences between MwoA and CEH are staggering. It is unlikely that migraine and CEH are linked in a nosological sense.

Cervicogenic headache

The relationship of the neck to headache has been recognized by physicians for over a century. However, whether the neck is the cause of a separate diagnostic entity, cervicogenic headache or simply a part of other headache complexes is the source of controversy. In recent years, there has been an increasing awareness of neck symptoms associated with headache. Various criteria for the diagnosis of cervicogenic headache have been put forward, but a clear consensus is lacking. Unfortunately, this has resulted in reports of varying prevalence, varying treatment recommendations and literature reports that require scrutiny for diagnostic criteria used in selecting patients to be treated. Review of the literature shows many older uncontrolled studies and later literature reports describe only small numbers of patients. Cervicogenic headache or headache related to the neck afflicts many persons and research with adequate patient inclusion is needed. This paper describes cervicogenic headache and treatment options.

Poster 203: Cervical C1-2 and C2-3 Facet Joints and Dorsal Rami Injections for the Diagnostic and Therapeutic Tools for Cervicogenic Headache

Cervical C1-2 and C2-3 Facet Joints and Dorsal Rami Injections for the Diagnostic and Therapeutic Tools for Cervicogenic Headache. Linqiu Zhou, MD, MS (Jefferson Pain Ctr, Thomas Jefferson University, Philadelphia, PA); Avi Ashkenazi, MD. Disclosure: L. Zhou, None; A. Ashkenazi, None. Setting: Tertiary care university teaching hospital. Patients: 13 patients with cervicogenic headache (5 men, 8 women; mean age, 41y; range, 18 62y). All patients had failed multiple pharmacologic and other treatments prior to the study. Average disease duration was 10.5 years (range, 1.5 27y). 6 patients had a unilateral headache and 7 had bilateral headache. All patients underwent a cervical magnetic resonance imaging (MRI). In 7, MRI demonstrated degenerative disk disease or herniated disk, most commonly at C5-6. Case Descriptions: All patients underwent fluoroscopic guided C1-2 and C2-3 facet joints injections and C2-3 dorsal rami injections. Assessment/Results: 12 (92%) of 13 patients experienced greater than 50% headache relief, with an average duration of 4.5 weeks (range, 2 6wk) from the first injection. C1-2 and C2-3 injections provided a long duration of pain relief. The response to C1-2 and C2-3 injections also supports the diagnosis of cervicogenic headache. Discussion: The diagnosis and treatment of cervicogenic headache are challenging. C1-2 and C2-3 facet joints and C2-3 dorsal rami injections are performed for diagnostic and therapeutic purposes in patients with cervicogenic headache. However, few data are available about their efficacy for this indication. C1-2 and C2-3 facet joints and dorsal rami blocks provided a significant and prolonged pain relief in the majority of patients in this study. The procedure also had a diagnostic value for these patients with cervicogenic headache. Further studies are needed to compare the efficacy of blocking the facet joint versus the dorsal rami in the treatment of these patients. Conclusions: C1-2 and C2-3 facet joints and C2-3 dorsal rami injections provide diagnostic and therapeutic values for cervicogenic headache.

Gastroesophageal Reflux Disease in an 8-Year-Old Boy: A Case Study

Objective To present the diagnosis and management of gastroesophageal reflux disease found in a pediatric patient, to discuss the importance of a detailed case history, and to bring forward some of the most important clues, both verbal and nonverbal, that can lead to the diagnosis. Clinical Features An 8-year-old boy was brought to a chiropractic clinic by his mother complaining of headache and neck pain. Based on the history and physical examination, a diagnosis of cervicogenic headache was made. Intervention and Outcome Treatment consisted of chiropractic manipulation of the upper cervical spine in combination with cranial treatment was applied in addition to dietary advice. The headache returned and the patient was then referred to a colleague for a second opinion. Based on a detailed history, gastroesophageal reflux disease was diagnosed and the patient was referred to a specialist for suitable treatment. Conclusion Because of the position as first-line health practitioners, it is inevitable that doctors of chiropractic will be faced with complaints of a nonbiomechanical nature. It is important to recognize conditions, such as gastroesophageal reflux, at an early stage and to refer appropriately.

Effectiveness of cervical spine manipulation and prescribed exercise in reduction of cervicogenic headache pain and frequency: A single case study experimental design

Introduction Patients commonly present to osteopaths with a complaint of headache. There is a clear rationale for osteopathic manipulative treatment in management of headaches that involve cervical spine dysfunction such as cervicogenic headache. Recent evidence suggests that deficits in muscle performance of the deep neck flexor muscles may be linked to cervicogenic headache, and that specific exercise prescription may play an important treatment role. Evidence also suggests that combining both manipulative treatment and specific exercise may be an effective treatment approach. Methods A prospective case study utilising an A–B–C design was used to evaluate the effectiveness of osteopathic treatment and specific exercise of the deep cervical flexor muscles in reducing cervicogenic headache pain and frequency in a 26-year-old female, with a 16-year history of cervicogenic headache. The diagnosis of cervicogenic headache was based upon clinical examination, medical history and fulfilment of cervicogenic headache diagnostic criteria. The study consisted of a three-week baseline data collection phase, a three-week osteopathic manipulative treatment phase and a three-week home based exercise phase. Outcome measures included the quadruple visual analogue scale, a headache diary, and data recorded from a pressure biofeedback device. Osteopathic treatment involved high velocity low amplitude (HVLA) thrust techniques and a low load exercise programme targeting the deep cervical flexor musculature. Results Visual analysis of plotted outcome measure data indicated a reduction in both intensity of headache pain and frequency. Conclusions The findings of this single case study are limited in their generalisability, but are consistent with the results of other similar studies investigating cervicogenic headache using similar interventions.

Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache

Persistent intermittent headache is a common disorder and is often accompanied by neck aching or stiffness, which could infer a cervical contribution to headache. However, the incidence of cervicogenic headache is estimated to be 14–18% of all chronic headaches, highlighting the need for clear criterion of cervical musculoskeletal impairment to identify cervicogenic headache sufferers who may benefit from treatments such as manual therapy. This study examined the presence of cervical musculoskeletal impairment in 77 subjects, 27 with cervicogenic headache, 25 with migraine with aura and 25 control subjects. Assessments included a photographic measure of posture, range of movement, cervical manual examination, pressure pain thresholds, muscle length, performance in the cranio-cervical flexion test and cervical kinaesthetic sense. The results indicated that when compared to the migraine with aura and control groups who scored similarly in the tests, the cervicogenic headache group had less range of cervical flexion/extension ( P = 0.048 ) and significantly higher incidences of painful upper cervical joint dysfunction assessed by manual examination (all P < 0.05 ) and muscle tightness ( P < 0.05 ). Sternocleidomastoid normalized EMG values were higher in the latter three stages of the cranio-cervical flexion test although they failed to reach significance. There were no between group differences for other measures. A discriminant analysis revealed that manual examination could discriminate the cervicogenic headache group from the other subjects (migraine with aura and control subjects combined) with an 80% sensitivity.

1514 Is diagnosis of Cervicogenic Headaches (CH) specific enough to separate from Migraine Headaches (MH)?

1514 Is diagnosis of Cervicogenic Headaches (CH) specific enough to separate from Migraine Headaches (MH)?

Reliability of Manual Mobility Testing of the Upper Cervical Spine in Subjects with Cervicogenic Headache

The identification of a cervicogenic headache is determined by criteria as stated by the International Headache Society (IHS). One of the criteria involves a finding of abnormal tenderness or resistance to movement in the neck region. The purpose of this study was to examine the inter-examiner and intra-examiner reliability of manual mobility testing of the upper cervical spine in the diagnosis of cervicogenic headaches in symptomatic subjects. Two groups of 20 subjects were required to meet initial criteria for a cervicogenic headache as adapted from the IHS. Subjects were not currently receiving medical treatment for headaches. To determine inter-examiner reliability, two examiners independently examined the 20 subjects (ages 22-48; 5 males and 15 females). Each examiner performed 15 mobility tests in random order on each subject. To establish intra-examiner reliability, a separate group of 20 subjects (ages 21-48; 3 males and 17 females) was evaluated by one examiner on two consecutive days. The Spearman's rho correlation was applied to the total number of abnormal findings recorded across each group of subjects. The Kappa correlation coefficient and percent agreement were used to compare the findings of each of the 15 mobility tests. They were also used to compare the identification of at least one abnormal finding for every subject. For this study, Kappa values ≥0.400 were considered acceptable. The Spearman's rho value for inter-examiner reliability was 0.943. Acceptable inter-examiner reliability was found on 11 out of 15 mobility tests, with Kappa values ranging from –0.053 to 1.000 and percent agreement values ranging from 70 to 100%. There was 100% agreement between examiners on whether the subject met the IHS criteria, resulting in a Kappa value of 1.000. The Spearman's rho value for intra-examiner reliability was also 0.943. Kappa values for intra-examiner reliability were acceptable for 11 out 15 tests and ranged from 0.208 to 1.000. The percent agreement values ranged from 60 to 100%. There was 100% agreement on consecutive days on whether the subject met the IHS criteria, yielding a Kappa value of 1.000. This study found that mobility testing, which includes palpation of the cervical spine, is a reliable tool, specifically in the identification of a cervicogenic headache in symptomatic subjects.

A Descriptive Study of 100 Patients Undergoing Palliative Nerve Blocks for Chronic Intractable Headache and Neck Ache

OBJECTIVE: To ascertain whether repeated (palliative) nerve blocks over a long period of time provide benefit to patients with chronic intractable headache and neck ache.SUBJECTS AND METHODS: One hundred patients who were receiving repeated nerve blocks as part of their pain management regimen completed a structured interview questionnaire. The patients had all been investigated and received a diagnosis of cervicogenic headache. Changes in pain rating, depression rating, anxiety rating, activities of daily living and quality of life were measured.RESULTS: After each nerve block session, the subjects reported significant improvement in their levels of pain, depression and anxiety. They also reported improvements in their quality of life and in their ability to participate in activities of daily living.CONCLUSIONS: Repeated (palliative) nerve blocks appear to be a useful modality in the armamentarium of pain control techniques for patients with chronic intractable headache and neck ache of cervical origin.

Cervicogenic headache: a critical review of the current diagnostic criteria

Opinions are divided on the use of the term cervicogenic headache (CGH) in cases with no evidence of cervical damage. According to Sjaastad et al. (1990), CGH is diagnosed from three features: (1) unilateral headache triggered by head/neck movements or posture; (2) unilateral headache triggered by pressure on the neck; (3) unilateral headache spreading to the neck and the homolateral shoulder/arm. Other characteristics are not essential for CGH diagnosis, including pain improvement after greater occipital nerve (GON)/C2 block. However, other authors give different definitions of CGH, and this may explain why reported frequencies for this headache vary so widely. In this paper we critically review the major diagnostic criteria of Sjaastad et al. for CGH in the light of clinical studies conducted at our institute and other literature findings. In a study of 500 headaches we found only two patients with unilateral headache triggered by head/neck movements or posture, and no cases of neck pressure-induced headache. No clear-cut criteria are given in the literature for differentiating CGH trigger points from myofascial trigger points. In another study of 440 primary headache patients we found that in the unilateral long-lasting headache group (64 migraines and 10 tension-type headaches), a pain involving the occiput/neck was present in 30 migraine and seven tension headache patients; thus, according to the CGH major criteria, 10% (30/307) of `migraines' and 7% (7/96) of `tension headaches' could be diagnosed as CGH. However, one cannot exclude that the association of unilateral pain with posterior irradiation is due to the high prevalence of migraine, tension-type headache and chronic neck pain. The relation between CGH and whip-lash injury has been put in doubt by a recent study which found no difference in headache frequency between trauma and control groups and reported no specific headache pattern in the trauma group. Other reports suggest that, when it occurs, CGH usually disappears within a year of whip-lash, throwing doubt on the appropriateness of surgery for post-traumatic CGH. The lack of specificity of GON/C2 block as a treatment for CGH adds further difficulties to the diagnosis of this headache. We conclude that, although neck structures play a role in the pathophysiology of some headaches, clinical patterns indicating a neck-headache relationship have still not been adequately defined. We believe that further rigorous studies are needed to definitively confirm the validity of CGH as a nosological entity.

Cervicogenic headache Part 1: An anatomic and clinical overview (awarded the OPTP Award for Excellence in a Published review of the Literature ** )

Cervicogenic headache is a headache arising from painful dysfunction of the upper cervical spine. This paper reviews current literature on the anatomy, etiology, clinical presentation and differential diagnosis of cervicogenic headache. Lower cervical spine levels and cervical soft tissue components will be incorporated where they have a direct influence on the upper three segments.

Cervicogenic Headache Part 1: An Anatomic and Clinical Overview

Cervicogenic headache is a headache arising from painful dysfunction of the upper cervical spine. This paper reviews current literature on the anatomy, etiology, clinical presentation and differential diagnosis of cervicogenic headache. Lower cervical spine levels and cervical soft tissue components will be incorporated where they have a direct influence on the upper three segments.

Cervicogenic Headache

That disease or dysfunction of the neck may present as headache is an idea that is not widely accepted in North American traditional medicine. This review focuses on ′cervicogenic headaches′. Topics include the mechanisms of cervicogenic headache, cervical signs to suspect that a patient′s headache originates in the neck, diagnostic manoeuvres that are nonspecific and unreliable, laboratory tests that may assist in establishing a diagnosis of cervicogenic headache and treatment of this condition.

Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second cervical root.

We have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decompressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT-guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.