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Gagnon P, Dunning J, Bliton P, Charlebois C, Henry N, Gorby P, Mourad F. Dry needling in the management of chronic tension-type headache associated with levator scapulae syndrome: A case report. Clin Case Rep 2024; 12:e8858. [PMID: 38689684 PMCID: PMC11060885 DOI: 10.1002/ccr3.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Key Clinical Message The use of DN to the muscular trigger points and distal periosteal enthesis of the levator scapulae may be a useful adjunct intervention within a multi-modal plan of care for the management of work-related chronic tension-type headaches associated with LSS. Abstract Chronic tension-type headaches (CTTH) have a lifetime prevalence of 42% and account for more lost workdays than migraine headaches. Dry needling (DN) is being increasingly used by physical therapists in the management of CTTH; however, to date, the supporting evidence is limited. The purpose of this case report was to describe how three sessions of DN targeting myofascial trigger points in the levator scapulae (LS) muscle and its distal enthesis was used to treat a 63-year-old male patient who presented with work-related CTTH associated with levator scapulae syndrome (LSS). The patient was treated for five visits over the course of 2 months. At discharge and 6-month follow-up, the patient reported full resolution of symptoms. Self-report outcomes included the numeric pain rating scale and the Neck Disability Index. The use of DN to the LS muscle and its distal enthesis may be a valuable addition to a multi-modal plan of care in the treatment of work-related CTTH associated with LSS.
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Affiliation(s)
- Peter Gagnon
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physical Therapy of BoulderBoulderColoradoUSA
| | - James Dunning
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Montgomery Osteopractic Physical Therapy & AcupunctureMontgomeryAlabamaUSA
| | - Paul Bliton
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- William S. Middleton VA HospitalMadisonWisconsinUSA
| | - Casey Charlebois
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Arcadia UniversityGlensidePennsylvaniaUSA
| | - Nathan Henry
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Physio RoomColorado SpringsColoradoUSA
| | - Patrick Gorby
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical TherapyMontgomeryAlabamaUSA
- Gorby Osteopractic Physiotherapy, Colorado Springs, COColorado SpringsColoradoUSA
| | - Firas Mourad
- Department of PhysiotherapyLUNEX International University of Health, Exercise and SportsDifferdangeLuxembourg
- Luxembourg Health & Sport Sciences Research Institute ASBLDifferdangeLuxembourg
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Demont A, Lafrance S, Benaissa L, Mawet J. Cervicogenic headache, an easy diagnosis? A systematic review and meta-analysis of diagnostic studies. Musculoskelet Sci Pract 2022; 62:102640. [PMID: 36088782 DOI: 10.1016/j.msksp.2022.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnosis of cervicogenic headache (CGH) remains a challenge for clinicians as the diagnostic value of detailed history and clinical findings remains unclear. OBJECTIVES To update and evaluate available evidence of the prevalence and the diagnostic accuracy of the detailed history and clinical findings for CGH in adults with headache. DESIGN Systematic review with meta-analysis. METHODS CINAHL, Cochrane Central, Embase, PEDro and PubMed were searched for studies before March 2022 that reported detailed history and/or clinical findings related to the diagnosis of cervicogenic headache. Study selection, risk of bias assessment (QUADAS-2 and PROBAST), and data extraction were performed. Meta-analyses for the cervical flexion-rotation test (CFRT) was performed. Certainty of the evidence was assessed with the GRADE approach. RESULTS Eleven studies were included. Moderate certainty evidence indicated that the CFRT differentiated CGH from lower cervical facet-induced headache, migraine, concomitant headaches or asymptomatic subjects (Se 83.0% [95%CI:70.0%-92.0%]; Sp 83.0% [95%CI:71.0%-91.0%]; positive LR 5.0 [95%CI:2.6-9.5]; negative LR 0.2 [95%CI:0.1-0.4]; n = 4 studies; n = 182 participants). Several diagnostic classifications and test clusters based on headache history and clinical findings can be useful, despite uncertain accuracy, in formulating the diagnosis of CGH. CONCLUSION Evidence support to undertake an evaluation of headache history and signs and symptoms and a physical examination of the patient neck to diagnose CGH. During the physical examination, a positive or negative CFRT probably has a small to moderate effect on the probability of a patient having a CGH. The diagnostic value of the other findings remains unclear. TRIAL REGISTRATION #CRD42020201772.
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Affiliation(s)
- Anthony Demont
- INSERM 1123 ECEVE, Faculty of Médecine, Université Paris-Diderot, Paris, France.
| | - Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Leila Benaissa
- Physiotherapy School, Université d'Orléans, Orléans, France
| | - Jérôme Mawet
- Department of Neurology, Emergency Headache Center (Centre d'Urgences Céphalées), Lariboisiere Hospital, Assistance Publique des Hopitaux de Paris, France
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Love SM, Hopkins BD, Migdal CW, Schuster NM. Occipital headache evaluation and rates of migraine assessment, diagnosis, and treatment in patients receiving greater occipital nerve blocks in an academic pain clinic. PAIN MEDICINE 2022; 23:1851-1857. [PMID: 35595240 DOI: 10.1093/pm/pnac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diagnosis of patients with occipital headache can be challenging, as both primary and secondary causes must be considered. Our study assessed how often migraine is screened for, diagnosed, and treated in patients receiving greater occipital nerve blocks (GONBs) in a pain clinic. DESIGN IRB-approved, retrospective observational study. SETTING Academic multidisciplinary pain clinic. SUBJECTS 143 consecutive patients who received GONBs. RESULTS About 75% of patients had been evaluated by neurologists and about 25% by non-neurologist pain specialists only. 62.2% of patients had photophobia, phonophobia, and nausea assessed. Patients who had been evaluated by a neurologist were more likely to have photophobia, phonophobia, and nausea assessed (75.9% vs 20.0%, OR 12.6, 95% CI 4.90-32.2), more likely to be diagnosed with migraine (48.1% vs 14.3%, OR 5.6, 95% CI 2.0-15), less likely to be diagnosed with occipital neuralgia (39.8% vs 65.7%, OR 0.3, 95% CI 0.2-0.8), and equally likely to be diagnosed with cervicogenic headache (21.3% vs 25.7%, OR 0.8, 95% CI 0.3-1.9) than those evaluated by non-neurologists. Among patients diagnosed with migraine, 82.5% received acute migraine treatment, 89.5% received preventive migraine treatment, and 52.6% were documented as receiving migraine lifestyle counseling. CONCLUSIONS 62.2% of patients with occipital headache receiving GONBs were assessed for migraine, and most received appropriate acute, preventive, and lifestyle treatments when diagnosed. Patients seen by neurologists were significantly more likely to be screened for, and diagnosed with, migraine than those evaluated by non-neurologist pain medicine specialists only. All clinicians should remain vigilant for migraine in patients with occipital headache.
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Affiliation(s)
- Shawn M Love
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | | | | | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, San Diego, CA
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Kissoon NR, O'Brien TG, Bendel MA, Eldrige JS, Hagedorn JM, Mauck WD, Moeschler SM, Olatoye OO, Pittelkow TP, Watson JC, Pingree MJ. Comparative Effectiveness of Landmark-guided Greater Occipital Nerve (GON) Block at the Superior Nuchal Line Versus Ultrasound-guided GON Block at the Level of C2: A Randomized Clinical Trial (RCT). Clin J Pain 2022; 38:271-278. [PMID: 35132029 DOI: 10.1097/ajp.0000000000001023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this single center, prospective randomized controlled trial was to compare clinical outcomes between an ultrasound-guided greater occipital nerve block (GONB) at the C2 vertebral level versus landmark-based GONB at the superior nuchal line. METHODS Patients with occipital neuralgia or cervicogenic headache were randomized to receive either a landmark-based GONB with sham ultrasound at the superior nuchal line or ultrasound-guided GONB at the C2 vertebral level with blinding of patients and data analysis investigators. Clinical outcomes were assessed at 30 minutes, 2 weeks, and 4 weeks postinjection. RESULTS Thirty-two patients were recruited with 16 participants in each group. Despite randomization, the ultrasound-guided GONB group reported higher numeric rating scale (NRS) scores at baseline. Those in the ultrasound-guided GONB group had a significant decrease in NRS from baseline compared with the landmark-based GONB group at 30 minutes (change of NRS of 4.0 vs. 2.0) and 4-week time points (change of NRS of 2.5 vs. -0.5). Both groups were found to have significant decreases in Headache Impact Test-6. The ultrasound-guided GONB had significant improvements in NRS, severe headache days, and analgesic use at 4 weeks when compared with baseline. No serious adverse events occurred in either group. CONCLUSIONS Ultrasound-guided GONBs may provide superior pain reduction at 4 weeks when compared with landmark-based GONBs for patients with occipital neuralgia or cervicogenic headache.
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Affiliation(s)
- Narayan R Kissoon
- Division of Pain Medicine, Department of Anesthesiology
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | | - Jason S Eldrige
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | | | - James C Watson
- Division of Pain Medicine, Department of Anesthesiology
- Department of Neurology, Mayo Clinic, Rochester, MN
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Mousavi-Khatir SR, Fernández-de-Las-Peñas C, Saadat P, Javanshir K, Zohrevand A. The Effect of Adding Dry Needling to Physical Therapy in the Treatment of Cervicogenic Headache: A Randomized Controlled Trial. PAIN MEDICINE 2021; 23:579-589. [PMID: 34687308 DOI: 10.1093/pm/pnab312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the long-term effect of adding real or sham dry needling with conventional physiotherapy in cervicogenic headache. DESIGN A randomized controlled trial. SETTING Physiotherapy Clinic, Rouhani Hospital of Babol University of Medical Sciences, Iran. SUBJECTS Sixty-nine patients with cervicogenic headache. METHODS Patients were randomly assigned into a control group (n = 23) receiving conventional physical therapy; a dry needling group (n = 23) receiving conventional physical therapy and dry needling on the cervical muscles; placebo needling group (n = 23) receiving conventional physical therapy and superficial dry needling at a point away from the trigger point. The primary outcome was the headache intensity and frequency. Neck disability, deep cervical flexor performance and range of motion were secondary outcomes. Outcomes were assessed immediately after treatment and one, three and six months later. RESULTS Sixty-five patients were finally included in the analysis. Headache intensity and neck disability decreased significantly more in the dry needling compared to sham and control groups after treatment and during all follow-ups. The frequency of headaches also reduced more in the dry needling than in control and sham groups, but it did not reach statistical significance. Higher cervical range of motion and enhancement of deep cervical flexors performance was also observed in the dry needling compared to sham and control groups. CONCLUSION Dry needling has a positive effect on pain and disability reduction, cervical range of motion and deep cervical flexor muscles performance in patients with cervicogenic headache and active trigger points, although the clinical relevance of the results was small.
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Affiliation(s)
- Seyedeh Roghayeh Mousavi-Khatir
- Assistant Professor of Physiotherapy (PhD), Department of Physiotherapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, Iran
| | - César Fernández-de-Las-Peñas
- Professor of Physiotherapy (PhD), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain
| | - Payam Saadat
- Associate Professor of Neurology, Department of Psychiatry, School of Medicine, Mobility Impairment Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Khodabakhsh Javanshir
- Physiotherapist, PhD, Associate professor (Corresponding Author), Mobility Impairment Research Center, Physiotherapy Department,, Babol University of Medical Sciences
| | - Amirhossein Zohrevand
- Assistant Professor of Neurosurgery, Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Dunning J, Butts R, Zacharko N, Fandry K, Young I, Wheeler K, Day J, Fernández-de-Las-Peñas C. Spinal manipulation and perineural electrical dry needling in patients with cervicogenic headache: a multicenter randomized clinical trial. Spine J 2021; 21:284-295. [PMID: 33065273 DOI: 10.1016/j.spinee.2020.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/31/2020] [Accepted: 10/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulation, spinal mobilization, and exercise are commonly used in individuals with cervicogenic headache (CH). Dry needling is being increasingly used in the management of CH. However, questions remain about the effectiveness of these therapies and how they compare to each other. PURPOSE The present study aims to compare the combined effects of spinal manipulation and dry needling with spinal mobilization and exercise on pain and disability in individuals with CH. STUDY DESIGN/SETTING Randomized, multicenter, parallel-group trial. PATIENT SAMPLE One hundred forty-two patients (n=142) with CH from 13 outpatient clinics in 10 different states were recruited over a 36-month period. OUTCOME MEASURES The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale. Secondary outcomes included headache frequency and duration, disability (Neck Disability Index), medication intake, and the Global Rating of Change (GROC). Follow-up assessments were taken at 1 week, 4 weeks, and 3 months. METHODS Patients were randomized to receive upper cervical and upper thoracic spinal manipulation plus electrical dry needling (n=74) or upper cervical and upper thoracic spinal mobilization and exercise (n=68). In addition, the mobilization group also received a program of craniocervical and peri-scapular resistance exercises; whereas, the spinal manipulation group also received up to eight sessions of perineural electrical dry needling. The treatment period for both groups was 4 weeks. The trial was prospectively registered at ClinicalTrials.gov (NCT02373605). Drs Dunning, Butts and Young are faculty within the AAMT Fellowship and teach postgraduate courses in spinal manipulation, spinal mobilization, dry needling, exercise and differential diagnosis. The other authors declare no conflicts of interest. None of the authors received any funding for this study. RESULTS The 2 × 4 analysis of covariance revealed that individuals with CH who received thrust spinal manipulation and electrical dry needling experienced significantly greater reductions in headache intensity (F=23.464; p<.001), headache frequency (F=13.407; p<.001), and disability (F=10.702; p<.001) than those who received nonthrust mobilization and exercise at a 3-month follow-up. Individuals in the spinal manipulation and electrical dry needling group also experienced shorter duration of headaches (p<.001) at 3 months. Based on the cutoff score of ≥+5 on the GROC, significantly (X2=54.840; p<.001) more patients (n=57, 77%) within the spinal manipulation and electrical dry needling group achieved a successful outcome compared to the mobilization and exercise group (n=10, 15%) at 3-month follow-up. Between-groups effect sizes were large (0.94<standardized mean score difference<1.25) in all outcomes in favor of the spinal manipulation and electrical dry needling group at 3 months. In addition, significantly (X2=29.889; p<.001) more patients in the spinal manipulation and electrical dry needling group (n=49, 66%) completely stopped taking medication for their pain compared to the spinal mobilization and exercise group (n=14, 21%) at 3 months. CONCLUSION Upper cervical and upper thoracic high-velocity low-amplitude thrust spinal manipulation and electrical dry needling were shown to be more effective than nonthrust mobilization and exercise in patients with CH, and the effects were maintained at 3 months.
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Affiliation(s)
- James Dunning
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA.
| | - Raymond Butts
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; PRISMA Health Physical Therapy Specialists, Columbia, SC, USA
| | - Noah Zacharko
- Osteopractic Physical Therapy of the Carolinas, Fort Mill, SC, USA
| | - Keith Fandry
- Back in Action Physical Therapy, Scottsdale, AZ, USA
| | - Ian Young
- American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy, Montgomery, AL, USA; Tybee Wellness & Osteopractic, Tybee Island, GA, USA
| | - Kenneth Wheeler
- ClearCut ORTHO Physical Therapy Specialists, Fort Worth, TX, USA
| | - Jennell Day
- Peak Physical Therapy & Sports Rehab, Helena, MT, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Cátedra de Clínica, Investigación y Docencia en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio, Universidad Rey Juan Carlos, Madrid, Spain
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Sjaastad OM, Fredriksen TA. Neck and headache—Do we see paths through the jungle? An overview and an hypothesis. CEPHALALGIA REPORTS 2019. [DOI: 10.1177/2515816319863045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and overview: It is widely accepted that cervicogenic headache (CEH) originates in the neck. In many circles, it is also accepted that neck–tongue syndrome belongs to the headaches that have their origin in the neck. For many headache researchers, the list: “headaches stemming from the neck” ends here. The objective of this overview was to explore the field and to determine whether there are grounds for adding other headaches to this list. Discussion: We suggest that headaches stemming from the neck possibly consist of five different subgroups: CEH, neck–tongue syndrome, tractor drivers’ headache, posterior headache subsequent to protracted neck-ache, and chronic paroxysmal hemicrania with mechanical attack precipitation. An overview of the clinical characteristics of each putative subgroup with comments is given.
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Affiliation(s)
- Ottar M Sjaastad
- Department of Neurology and Clinical Neurophysiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torbjørn A Fredriksen
- Department of Neurosurgery, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
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Szikszay TM, Luedtke K, Harry von P. Increased mechanosensivity of the greater occipital nerve in subjects with side-dominant head and neck pain - a diagnostic case-control study. J Man Manip Ther 2018; 26:237-248. [PMID: 30083047 DOI: 10.1080/10669817.2018.1480912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives: To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions. Methods: Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38). Results: Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004). Discussion: Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON. Level of Evidence: 3b.
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Affiliation(s)
| | - Kerstin Luedtke
- University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Psychometric properties of the Numeric Pain Rating Scale and Neck Disability Index in patients with cervicogenic headache. Cephalalgia 2018; 39:44-51. [DOI: 10.1177/0333102418772584] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Self-reported disability and pain intensity are commonly used outcomes in patients with cervicogenic headaches. However, there is a paucity of psychometric evidence to support the use of these self-report outcomes for individuals treated with cervicogenic headaches. Therefore, it is unknown if these measures are reliable, responsive, or result in meaningful clinically important changes in this patient population. Methods A secondary analysis of a randomized clinical trial (n = 110) examining the effects of spinal manipulative therapy with and without exercise in patients with cervicogenic headaches. Reliability, construct validity, responsiveness and thresholds for minimal detectable change and clinically important difference values were calculated for the Neck Disability Index and Numeric Pain Rating Scale. Results The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46–0.97]), while the Numeric Pain Rating Scale exhibited moderate reliability (ICC = 0.72; [95 % CI: 0.08–0.90]) in the short term. Both instruments also exhibited adequate responsiveness (area under the curve; range = 0.78–0.93) and construct validity ( p < 0.001) in this headache population. Conclusions Both instruments seem well suited as short-term self-report measures for patients with cervicogenic headaches. Clinicians and researchers should expect at least a 2.5-point reduction on the numeric pain rating scale and a 5.5-point reduction on the neck disability index after 4 weeks of intervention to be considered clinically meaningful.
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10
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Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks TR, Cleland JA. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord 2016; 17:64. [PMID: 26852024 PMCID: PMC4744384 DOI: 10.1186/s12891-016-0912-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/29/2016] [Indexed: 01/03/2023] Open
Abstract
Background Although commonly utilized interventions, no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache (CH). The purpose of this study was to compare the effects of manipulation to mobilization and exercise in individuals with CH. Methods One hundred and ten participants (n = 110) with CH were randomized to receive both cervical and thoracic manipulation (n = 58) or mobilization and exercise (n = 52). The primary outcome was headache intensity as measured by the Numeric Pain Rating Scale (NPRS). Secondary outcomes included headache frequency, headache duration, disability as measured by the Neck Disability Index (NDI), medication intake, and the Global Rating of Change (GRC). The treatment period was 4 weeks with follow-up assessment at 1 week, 4 weeks, and 3 months after initial treatment session. The primary aim was examined with a 2-way mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization and exercise) as the between subjects variable and time (baseline, 1 week, 4 weeks and 3 months) as the within subjects variable. Results The 2X4 ANOVA demonstrated that individuals with CH who received both cervical and thoracic manipulation experienced significantly greater reductions in headache intensity (p < 0.001) and disability (p < 0.001) than those who received mobilization and exercise at a 3-month follow-up. Individuals in the upper cervical and upper thoracic manipulation group also experienced less frequent headaches and shorter duration of headaches at each follow-up period (p < 0.001 for all). Additionally, patient perceived improvement was significantly greater at 1 and 4-week follow-up periods in favor of the manipulation group (p < 0.001). Conclusions Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months. Trial registration NCT01580280 April 16, 2012.
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Affiliation(s)
- James R Dunning
- Alabama Physical Therapy & Acupuncture, Montgomery, AL, USA. .,Nova Southeastern University, Ft. Lauderdale, FL, USA. .,AAMT Fellowship in Orthopaedic Manual Physical Therapy, Columbia, SC, USA.
| | - Raymond Butts
- Research Physical Therapy Specialists, Columbia, SC, USA.
| | | | | | - Cesar Fernandez-de-Las Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
| | - Marshall Hagins
- Department of Physical Therapy, Long Island University, Brooklyn, NY, USA.
| | | | | | | | | | - Joshua A Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA.
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Çoban G, Çöven İ, Çifçi BE, Yıldırım E, Yazıcı AC, Horasanlı B. The importance of craniovertebral and cervicomedullary angles in cervicogenic headache. Diagn Interv Radiol 2015; 20:172-7. [PMID: 24317332 DOI: 10.5152/dir.2013.13213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Many studies have indicated that cervicogenic headache may originate from the cervical structures innervated by the upper cervical spinal nerves. To date, no study has investigated whether narrowing of the craniovertebral angle (CVA) or cervicomedullary angle (CMA) affects the three upper cervical spinal nerves. The aim of this study was to investigate the effect of CVA and/or CMA narrowing on the occurrence of cervicogenic headache. MATERIALS AND METHODS Two hundred and five patients diagnosed with cervicogenic headache were included in the study. The pain scores of patients were determined using a visual analog scale. The nonheadache control group consisted of 40 volunteers. CVA and CMA values were measured on sagittal T2-weighted magnetic resonance imaging (MRI), on two occasions by two radiologists. Angle values and categorized pain scores were compared statistically between the groups. RESULTS Intraobserver and interobserver agreement was over 97% for all measurements. Pain scores increased with decreasing CVA and CMA values. Mean angle values were significantly different among the pain categories (P < 0.001). The pain score was negatively correlated with CMA (Spearman correlation coefficient, rs, -0.676; P < 0.001) and CVA values (rs, -0.725; P < 0.001). CONCLUSION CVA or CMA narrowing affects the occurrence of cervicogenic headache. There is an inverse relationship between the angle values and pain scores.
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Affiliation(s)
- Gökçen Çoban
- From the Departments of Radiology (G.Ç. e-mail: , B.E.Ç., E.Y.), Neurosurgery (İ.Ç.), and Neurology (B.H.), Başkent University School of Medicine, Konya, Turkey; the Department of, Biostatistics (A.C.Y.), Başkent University School of Medicine, Ankara, Turkey
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12
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Valença MM, da Silva AA, Bordini CA. Headache Research and Medical Practice in Brazil: An Historical Overview. Headache 2015; 55 Suppl 1:4-31. [DOI: 10.1111/head.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Marcelo Moraes Valença
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
- Neurology and Neurosurgery Unit, Hospital Esperança; Brazil
| | - Amanda Araújo da Silva
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
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Gadotti IC, Olivo SA, Magee DJ. Cervical musculoskeletal impairments in cervicogenic headache: a systematic review and a meta-analysis. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x252082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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14
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Liebert A, Rebbeck T, Elias S, Hawkins D, Adams R. Musculoskeletal physiotherapists' perceptions of non-responsiveness to treatment for cervicogenic headache. Physiother Theory Pract 2013; 29:616-29. [DOI: 10.3109/09593985.2013.783894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Role of greater occipital nerve blocks and trigger point injections for patients with dizziness and headache. Neurologist 2012; 17:312-7. [PMID: 22045281 DOI: 10.1097/nrl.0b013e318234e966] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The trigeminocervical system is integral in cervicogenic headache. Cervicogenic headache frequently coexists with complaints of dizziness, tinnitus, nausea, imbalance, hearing complaints, and ear/eye pain. Controversy exists as to whether this constellation of symptoms may be cervically mediated. OBJECTIVES To determine whether a wider spectrum of cervically mediated symptoms exist, and to investigate a potential role of greater occipital nerve blocks (GON) and trigger point injections (TPI) in these patients. METHODS Retrospective review of GON/TPI performed in a tertiary otoneurology/headache clinic from May 2006 to March 2007 for suspected cervically mediated symptoms. Data included chief complaint, secondary symptoms, response to injection, pre-GON/TPI posterior vertex sensation changes to pinprick, cervical spine examination, and response to vibration of cervical and suboccipital musculature. RESULTS Total number of 147 patients were included. Chief complaints in decreasing frequency: dizziness (93%), tinnitus (4%), headache (3%), and ear discomfort (0.7%). Overall symptoms in decreasing frequency: dizziness (97%), headache (88%), neck pain (63%), tinnitus (23%), and ear discomfort (22%). Improvements after GON/TPI: neck range of motion (71%), headache (57%), neck pain (52%), ear discomfort (47%), dizziness (46%), and tinnitus (30%). Dizziness responders had neck position asymmetries (84%), reproducible dizziness by cervical and suboccipital musculature vibration (75%), and preinjection posterior vertex sensory changes (60%). CONCLUSIONS A wider spectrum of cervically mediated symptoms may exist by influence of trigeminocervical and vestibular circuitry through cervical afferent neuromodulation. Certain examination findings may help to predict benefit from GON/TPI.
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Park SW, Park YS, Nam TK, Cho TG. The effect of radiofrequency neurotomy of lower cervical medial branches on cervicogenic headache. J Korean Neurosurg Soc 2011; 50:507-11. [PMID: 22323937 PMCID: PMC3272511 DOI: 10.3340/jkns.2011.50.6.507] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 09/15/2011] [Accepted: 12/19/2011] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Cervicogenic headache (CGH) is known to be mainly related with upper cervical problems. In this study, the effect of radiofrequency neurotomy (RFN) for lower cervical (C4-7) medial branches on CGH was evaluated. METHODS Eleven patients with neck pain and headache, who were treated with lower cervical RFN due to supposed lower cervical zygapophysial joint pain without symptomatic intervertebral disc problem or stenosis, were enrolled in this study. CGH was diagnosed according to the diagnostic criteria of the cervicogenic headache international study group. Visual analogue scale (VAS) score and degree of VAS improvement (VASi) (%) were checked for evaluation of the effect of lower cervical RFN on CGH. RESULTS The VAS score at 6 months after RFN was 2.7±1.3, which were significantly decreased comparing to the VAS score before RFN, 8.1±1.1 (p<0.001). The VASi at 6 months after RFN was 63.8±17.1%. There was no serious complication. CONCLUSION Our data suggest that lower cervical disorders can play a role in the genesis of headache in addition to the upper cervical disorders or independently.
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Affiliation(s)
- Seung Won Park
- Department of Neurosurgery, Spine Center, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Yong Sook Park
- Department of Neurosurgery, Spine Center, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Taek Kyun Nam
- Department of Neurosurgery, Spine Center, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Tack-Geun Cho
- Department of Neurosurgery, Hallym University College of Medicine, Seoul, Korea
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Abstract
Although theories regarding headache originating in the neck have existed for more than 150 years, the term "cervicogenic headache" originated in 1983. Early descriptions pinpoint the characteristic symptoms as dizziness, visual disturbances, tinnitus, and "posterior" headache, conceivably as a consequence of arthrosis, infliction upon the vertebral artery, or with a "migrainous" background and occurring in "advanced age." Cervicogenic headache (mean age of onset, 33 years) displays a somewhat different picture: unilateral headache, starting posteriorly, but advancing to the frontal area, most frequently the main site of pain; usually accompanied by ipsilateral arm discomfort, reduced range of motion in the neck, and mechanical precipitation of exacerbations (eg, through external pressure upon hypersensitive, occipital tendon insertions). Treatment options in treatment-resistant cases include cervical stabilization operations and extracranial electrical stimulation. In a personal, population-based study of 1,838 individuals (88.6% of the population), a prevalence of 2.2% "core" cases was found.
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Vincent MB. Cervicogenic headache: a review comparison with migraine, tension-type headache, and whiplash. Curr Pain Headache Rep 2010; 14:238-43. [PMID: 20428974 DOI: 10.1007/s11916-010-0114-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cervicogenic headache (CEH) is a well-recognized syndrome. Proposed diagnostic criteria differentiate CEH from migraine and tension-type headache (TTH) in most of the cases. The best differentiating factors include side-locked unilateral pain irradiating from the back and evidence of neck involvement--attacks may be precipitated by digital pressure over trigger spots in the cervical/nuchal areas or sustained awkward neck positions. Migrainous traits may be present in some cases. Cervical lesions are not necessarily seen, and most common cervical lesions do not produce CEH. Whiplash may occasionally induce headaches. This is suspected when the pain onset and the whiplash trauma are close in time. Whiplash-related headaches tend to be short-lasting, admitting mostly a TTH or a CEH-like phenotype. Neuroimaging abnormalities are not necessarily expected in CEH. Whiplash patients must undergo cervical imaging mostly in connection with the trauma, as no abnormalities are pathognomonic in chronic cases.
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Affiliation(s)
- Maurice B Vincent
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Av das Américas, 1155 room 504, CEP 22631-000, Rio de Janeiro, Brazil.
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Knackstedt H, Bansevicius D, Aaseth K, Grande RB, Lundqvist C, Russell MB. Cervicogenic headache in the general population: the Akershus study of chronic headache. Cephalalgia 2010; 30:1468-76. [PMID: 20974607 DOI: 10.1177/0333102410368442] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to study the prevalence of cervicogenic headache (CEH) in the general population. METHODS An age- and gender-stratified random sample of 30,000 persons aged 30-44 years received a mailed questionnaire. Those with self-reported chronic headache were interviewed by neurological residents. The criteria of the Cervicogenic Headache International Study Group and the International Classification of Headache Disorders, second edition, were applied. RESULTS The questionnaire response rate was 71% and the participation rate of the interview was 74%. The prevalence of CEH was 0.17% in the general population, with a female preponderance. Fifty per cent had co-occurrence of medication overuse and 42% had co-occurrence of migraine. The pericranial muscle tenderness score was significantly higher on the pain than non-pain side (p < .005). The cervical range of motion was significantly reduced compared to healthy controls (p < .005). The mean duration of CEH was eight years. Based on patients' self-reports, greater occipital nerve (GON) blockage and cryotherapy was reported effective in 90% of those who had this procedure, while other treatment alternatives were reported less effective.
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22
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Abstract
Upper cervical pain is frequent in different primary headaches and not sufficient evidence for cervicogenic headache (CH). Biological markers should help to differentiate CH from other headache disorders. In most cases, imaging techniques of the cervical spine are not helpful for the diagnosis of CH. Symptoms and signs of neck involvement, such as a mechanical precipitation of attacks, a restriction in range of motion of the cervical spine, and the existence of ipsilateral neck, shoulder, or arm pain, seem to be reasonably valid for the diagnosis of CH, but its reliability and validity should be confirmed in larger studies. Positive diagnostic blockades of cervical structures or its nerve supply are not specific for CH. Neurophysiological investigations give some insight into the pathophysiological mechanisms of CH but are not diagnostic. In CH, calcitonin gene-related peptide levels do not differ between the symptomatic and the asymptomatic side, between the jugular and the cubital blood, and between days with and without headache. There is no evidence for an activation of the trigeminovascular system in CH. It can be concluded that CH is not just a migraine variant triggered by neck dysfunction but a functional entity.
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Affiliation(s)
- A Frese
- Department of Neurology, University of Münster, Münster, Germany.
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23
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Sjaastad O, Bakketeig LS. Migraine without aura: comparison with cervicogenic headache. Vågå study of headache epidemiology. Acta Neurol Scand 2008; 117:377-83. [PMID: 18031560 DOI: 10.1111/j.1600-0404.2007.00966.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- O Sjaastad
- Department of Neurology, St Olavs Hospital, Trondheim University Hospitals (NTNU), Trondheim, Norway.
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Sjaastad O, Bakketeig LS. Prevalence of cervicogenic headache: Vågå study of headache epidemiology. Acta Neurol Scand 2008; 117:173-80. [PMID: 18031563 DOI: 10.1111/j.1600-0404.2007.00962.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the prevalence and various clinical characteristics of cervicogenic headache (CEH) in the population at large. METHODS CEH was searched for in Vågå, Norway, where 1838 18 to 65-year-old citizens, i.e. 88.6% of this age group, underwent an interview/clinical examination. The Cervicogenic Headache International Study Group criteria include: (I) unilaterality of head pain, (II) reduction, range of movement, neck, (III/IV) ipsilateral shoulder/arm discomfort, (V/VI) mechanical provocation of similar pain, objectively or subjectively. RESULTS A prevalence of 4.1% was found. In 41 cases with the highest number of CEH criteria ('core' cases), there was a male preponderance (F/M: 0.71). While cervicogenic traits (mechanical precipitation etc.) were frequently present in CEH, 'migraine traits', like nausea, vomiting, and throbbing seemed to be rarely present. In 97% of the cases, pain exacerbations began in the neck/occipital region. CONCLUSIONS CEH may be one of the three large, recurrent headaches. In this series, there was no female preponderance. Nuchal onset of pain is a characteristic trait.
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Affiliation(s)
- O Sjaastad
- Department of Neurology, St. Olavs Hospital, Trondheim University Hospitals (NTNU), Trondheim, Norway.
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Hall T, Briffa K, Hopper D. Clinical evaluation of cervicogenic headache: a clinical perspective. J Man Manip Ther 2008; 16:73-80. [PMID: 19119390 PMCID: PMC2565113 DOI: 10.1179/106698108790818422] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Headache is a common complaint that affects the majority of the population at some point in their lives. The underlying pathological bases for headache symptoms are many, diverse, and often difficult to distinguish. Classification of headache is principally based on the evaluation of headache symptoms as well as clinical testing. Although manual therapy has been advocated to treat a variety of different forms of headache, the current evidence only supports treatment for cervicogenic headache (CGH). This form of headache can be identified from migraine and other headache forms by a comprehensive musculoskeletal examination. Examination and subsequent diagnosis is essential not only to identify patients with headache where manual therapy is appropriate but also to form a basis for selection of the most appropriate treatment for the identified condition. The purpose of this paper is to outline, in clinical terms, the classification of headache, so that the clinician can readily identify those patients with headache suited to manual therapy.
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Affiliation(s)
- Toby Hall
- School of Physiotherapy, Curtin University of Technology, Bentley, Western Australia
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26
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Abstract
Headache in an elderly patient can be a sign of serious, potentially life-threatening disorders. All patients require a full assessment, including a complete neurologic examination. Particular emphasis should be placed on excluding subarachnoid hemorrhage, subdural hematoma, giant cell arteritis, intracranial neoplasm, cerebrovascular accident, acute-angle-closure glaucoma, and infectious etiologies such as meningitis and encephalitis. Once life-threatening disorders are excluded, the geriatrician can focus on more benign etiologies such as migraine, tension headache, and medication withdrawal. Treatment depends on the underlying etiology. This article discusses headaches that require emergent treatment and then describes more benign etiologies of headaches.
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Affiliation(s)
- Richard A Walker
- Department of Emergency Medicine, University of Nebraska Medical Center, 981150 Nebraska Medical Center, Omaha, NE 68198, USA.
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Skolasky RL, Riley LH, Albert TJ. Psychometric properties of the Cervical Spine Outcomes Questionnaire and its relationship to standard assessment tools used in spine research. Spine J 2007; 7:174-9. [PMID: 17321966 DOI: 10.1016/j.spinee.2006.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 07/12/2006] [Accepted: 07/18/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Cervical Spine Outcomes Questionnaire (CSOQ), a disease-specific outcomes instrument, has not been systematically compared with the Short Form-36 (SF-36) or the Neck Disability Index (NDI). PURPOSE To examine the psychometric properties of the CSOQ and to compare them with those of the SF-36 and NDI. STUDY DESIGN Prospective analysis of outcomes data in patients undergoing surgery. METHODS We used telephone surveys (CSOQ) and clinical assessments (SF-36 and NDI) to evaluate 534 patients undergoing anterior cervical decompression and fusion at 23 nationwide sites. The psychometric properties of the CSOQ were analyzed for floor/ceiling effect, internal consistency of items within the CSOQ, and concurrent validity with the SF-36 and NDI. RESULTS The CSOQ domain scores showed good psychometric properties (Cronbach's alpha >0.70). Only physical symptoms (other than pain) showed a ceiling effect. The CSOQ domain scores had good concurrent validity (Spearman rank correlation coefficient >0.70) with the mental health score of the SF-36 and the total disability score of NDI. CONCLUSIONS The CSOQ domain scores provide a disease-specific assessment of functional limitations resulting from cervical spine disorders. The domain scores for functional disability and psychological distress provide similar information to that provided by the NDI and SF-36. The CSOQ domain scores for pain severity provide information that is more specific to cervical disc disease than does the physical health score of the SF-36.
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Affiliation(s)
- Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
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28
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Sjaastad O, Wang H, Bakketeig LS. Neck pain and associated head pain: persistent neck complaint with subsequent, transient, posterior headache. Acta Neurol Scand 2006; 114:392-9. [PMID: 17083339 DOI: 10.1111/j.1600-0404.2006.00717.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND During the Vågå headache epidemiology study, there were indications that various types of work, such as carpentry and hairdressing, frequently seemed to be linked to a combination of neckache and headache. OBJECTIVES A post hoc study was conducted among 1838, 18- to 65-year-old Vågå citizens, looking for patients with combined neck/headache. DESIGN Face-to-face interview was conducted. RESULTS Combined neckache and headache were detected in 121 (6.6%) individuals. The bilateral headache originated in the neck; it was mild/moderate, symptom-poor, and frequently provoked by awkward neck positions. No such headache occurred without a neckache. Headache in this group of patients resembles tractor drivers' headache, except for the provoking factor itself. CONCLUSIONS This headache is not listed in headache classification systems/textbooks on headache. This headache must be distinguished from the unilateral cervicogenic headache proper because of the different treatment perspectives.
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Affiliation(s)
- O Sjaastad
- Department of Neurology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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Abstract
The connection between headache and the cervical spine has been a theme of debate for decades. Cervicogenic headache is a headache related to the cervical spine that often is misdiagnosed and treated inadequately because of confusing and varying terminology. In this article, we discuss our experience in diagnosing and treating cervicogenic headache.
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Affiliation(s)
- Hilton Mariano da Silva
- Facultade de Medicina de Ribeirão Preto, Departamento da Neurologia, Ribeirão Preto, SP, Brazil.
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Horikoshi T, Uchida M, Watanabe A, Ikegawa H, Umeda T. Jugular Compression and Radionuclide Cisternographic Patterns in Patients With Chronic Headache. Headache 2006; 46:150-7. [PMID: 16412162 DOI: 10.1111/j.1526-4610.2006.00302.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We investigated the value of the jugular compression test (JCT) in screening patients with chronic headache attributable to persistent cerebrospinal fluid (CSF) leakage. METHODS Clinical records of 35 consecutive patients who underwent both 111In-diethylenetriamine pentaacetic acid radioisotope (RI) cisternography and JCT were retrospectively analyzed. RESULTS A strong correlation was seen between JCT and RI cisternographic findings. Most patients who reported a feeling of fullness in the ear, hearing loss or headache during JCT had positive findings on RI cisternograms indicative of CSF leakage. In contrast, no RI study abnormalities were seen in patients reporting no symptoms in JCT. CONCLUSIONS Among patients complaining of refractory headache and other miscellaneous symptoms, JCT may represent a simple, economic, and reliable technique in the screening of candidates for RI cisternography to evaluate CSF leakage. A subgroup of patients with chronic headache may have persistent CSF leakage.
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Affiliation(s)
- Toru Horikoshi
- Department of Neurosurgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
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Ahn Y, Lee SH, Chung SE, Park HS, Shin SW. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology 2005; 47:924-30. [PMID: 16133482 DOI: 10.1007/s00234-005-1436-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 06/23/2005] [Indexed: 10/25/2022]
Abstract
A discogenic cervical headache is a subtype of cervicogenic headache (CEH) that arises from a degenerative cervical disc abnormality. The purpose of this study was to evaluate the clinical outcome of percutaneous endoscopic cervical discectomy (PECD) for patients with chronic cervical headache due to soft cervical disc herniation. Seventeen patients underwent PECD for intractable headache. The inclusion criteria were soft disc herniation without segmental instability, proven by both local anesthesia and provocative discography for headache unresponsive to conservative treatment. The mean follow-up period was 37.6 months. Fifteen of the 17 patients (88.2%) showed successful outcomes based on the Macnab criteria. Pain scores on a visual analog scale (VAS) improved from a preoperative mean of 8.35 +/- 0.79 to 2.12 +/- 1.17, postoperatively (P < 0.01). The mean disc height decreased from 6.81 +/- 1.08 to 5.98 +/- 1.07 mm (P < 0.01). There was no newly developed segmental instability or spontaneous fusion on follow-up radiography. In conclusion, PECD appears to be effective for chronic severe discogenic cervical headache under strict inclusion criteria.
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Affiliation(s)
- Y Ahn
- Department of Neurosurgery, Wooridul Spine Hospital, Kangnam-gu, Seoul, Korea.
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Abstract
It is discussed controversially whether cervicogenic pain in the head and/or neck is a pathogenic entity. The good results obtained with manual therapy in patients with head and neck pain contradict the refusal of the majority of the neurologists to accept the diagnosis "cervicogenic headache." Complaints about headache are frequently encountered in the general ENT clinic. In many cases, the diagnosis of the different types of headaches can be based on the anamnesis. It is difficult to define a tension headache, because it is not a sharply defined syndrome and the disturbance of the neck represents only one of many factors. The versatile picture of the cervicogenic headache is caused by the complex neural connections in the region of the upper cervical spine. The differential diagnosis of the cervicogenic headache is described.
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Affiliation(s)
- M Hülse
- Abteilung Phoniatrie, Pädaudiologie, Neurootologie, Hals-Nasen-Ohren-Klinik der Universität Heidelberg, Klinikum Mannheim
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Abstract
Cervicogenic headache is a relatively common and still controversial form of headache arising from structures in the neck. The estimated prevalence of the disorder varies considerably, ranging from 0.7% to 13.8%. Cervicogenic headache is a 'side-locked' or unilateral fixed headache characterised by a non-throbbing pain that starts in the neck and spreads to the ipsilateral oculo-fronto-temporal area. In patients with this disorder, attacks or chronic fluctuating periods of neck/head pain may be provoked/worsened by sustained neck movements or stimulation of ipsilateral tender points. The pathophysiology of cervicogenic headache probably depends on the effects of various local pain-producing or eliciting factors, such as intervertebral dysfunction, cytokines and nitric oxide. Frequent coexistence of a history of head traumas suggests these also play an important role. A reliable diagnosis of cervicogenic headache can be made based on the criteria established in 1998 by the Cervicogenic Headache International Study Group. Positive response after an appropriate nerve block is an essential diagnostic feature of the disorder. Differential diagnoses of cervicogenic headache include hemicrania continua, chronic paroxysmal hemicrania, occipital neuralgia, migraine and tension headache. Various therapies have been used in the management of cervicogenic headache. These range from lowly invasive, drug-based therapies to highly invasive, surgical-based therapies. This review evaluates use of drug therapy with paracetamol and NSAIDs, infliximab and botulinum toxin type A; manual modalities and transcutaneous electrical nerve stimulation therapy; local injection of anaesthetic or corticosteroids; and invasive surgical therapies for the treatment of cervicogenic headache. A curative therapy for cervicogenic headache will not be developed until increased knowledge of the aetiology and pathophysiology of the condition becomes available. In the meantime, limited evidence suggests that therapy with repeated injections of botulinum toxin type A may be the most safe and efficacious approach. The surgical approach, which includes decompression and radiofrequency lesions of the involved nerve structures, may also provide physicians with further options for refractory cervicogenic headache patients. Unfortunately, the paucity of experimental models for cervicogenic headache and the relative lack of biomolecular markers for the condition mean much is still unclear about cervicogenic headache and the disorder remains inadequately treated.
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Affiliation(s)
- Paolo Martelletti
- Department of Internal Medicine, 2nd School of Medicine, Headache Centre, University La Sapienza, 00189 Rome, Italy.
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Hall T, Robinson K. The flexion–rotation test and active cervical mobility—A comparative measurement study in cervicogenic headache. ACTA ACUST UNITED AC 2004; 9:197-202. [PMID: 15522644 DOI: 10.1016/j.math.2004.04.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Revised: 03/22/2004] [Accepted: 04/14/2004] [Indexed: 11/26/2022]
Abstract
A single blind, age and gender matched, comparative measurement study was designed to assess active range of cervical motion and passive range of rotation in cervical flexion in asymptomatic and cervicogenic headache subjects. Both procedures are commonly used in clinical practice to evaluate patients with cervicogenic headache. We studied 20 women and eight men with side dominant cervicogenic headache (mean age 43.3 years) matched with 28 asymptomatic subjects. Two experienced manipulative therapists, who were blind to each other's measurement, noted active ranges of cervical motion and passive cervical rotation performed in the flexion-rotation test using the Cervical Range of Motion Device. Headache severity was assessed by a questionnaire. Additionally, one therapist prior to neck motion assessment determined the dominant symptomatic cervical motion segment. Active cervical motion in each direction was identical between the cervicogenic and control groups. In contrast, average rotation in flexion was 44 degrees to each side in the asymptomatic group and 28 degrees towards the headache side in the symptomatic group. C1-2 was deemed to be the dominant segmental level of headache origin in 24 of 28 subjects. In those 24 subjects range of rotation during the flexion-rotation test was inversely correlated to headache severity.
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Affiliation(s)
- T Hall
- Curtin University of Technology, Hayman Road, Bentley, Western Australia, Australia.
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36
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Coskun O, Ucler S, Karakurum B, Atasoy HT, Yildirim T, Ozkan S, Inan LE. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia 2004; 23:842-5. [PMID: 14510932 DOI: 10.1046/j.1468-2982.2003.00605.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cervicogenic headache (CH) is a syndrome which is postulated to originate from nociceptive structures in the neck or head. The anatomical neck or head structures that are responsible for the pain in CH have not been clearly identified, but the pain in these patients probably originates from the structures of the cervical spine. In this study, cervical MRI were studied in 22 patients with cervicogenic headache and 20 control patients who did not have any disease which may effect the bone and muscle structures of cervical region. MRI imaging of cervical vertebra showed a disc bulging in 10 (45.4%) out of 22 patients with CH and in 9 (45.0%) of 20 controls (P > 0.05). The distribution of pathological lesions in patients and controls were not significantly different (P > 0.05). As a result, MRI may not be an adequate method to detect pathological findings underlying the aetiology of CH such as nerve roots, intervertebral joints and periosteum.
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Affiliation(s)
- O Coskun
- Ministry of Health, Department of Neurology, Ankara Resarch Hospital, Ankara, Turkey.
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Abstract
Careful evaluation of the chronic headache patient can reveal the presence or absence of musculoskeletal factors to be causative or contributory to the headache condition. This article presents a review of the literature surrounding physical findings in patients with cervicogenic and musculoskeletal sources of pain and specific treatment with physical therapy. Included in the discussion is the identification of muscular and joint involvement in a given headache, the relevance of postural, range of motion, and strength deficits, and appropriate individualized treatment strategies with a review of relevant outcome studies. Possible mechanisms for treatment effects also are considered.
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Affiliation(s)
- Julie Mills Roth
- Michigan Head Pain & Neurological Institute, 3120 Professional Drive, Ann Arbor, MI 48104, USA.
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38
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Graff-Radford SB, Newman AC. The role of temporomandibular disorders and cervical dysfunction in tension-type headache. Curr Pain Headache Rep 2002; 6:387-91. [PMID: 12207852 DOI: 10.1007/s11916-002-0081-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
It has been estimated that 30% to 80% of the population has at least one tension-type headache each year. Tension-type headaches can be located in any region of the head, which can confuse a differential diagnosis with temporomandibular joint disorders and cervical dysfunction. The roles of temporomandibular joint disorders and cervical dysfunction in tension-type headache are evaluated. Definitions, pathophysiology, and treatment considerations for each are discussed.
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Affiliation(s)
- Steven B Graff-Radford
- The Pain Center, Cedars Sinai Medical Center, 444 South San Vicente Blvd. #1101, Los Angeles, CA 90048, USA.
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39
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Abstract
The influence of pregnancy upon the head pain of cervicogenic headache (CEH) has been studied in 14 patients (number of pregnancies 25). Migraine was used as control group (n = 49; number of pregnancies 116). CEH was diagnosed according to The Cervicogenic Headache International Study Group guidelines. Migraine was diagnosed according to International Headache Society (IHS) guidelines; a further requirement was that at least eight of nine solitary IHS diagnostic requirements of migraine were present. In 79%-or more-of CEH patients, attacks seemed to appear just as usual during pregnancy; in one patient, attacks stopped completely, and in two there may have been a minor reduction of attacks. A significantly lower number of migraine patients (up to 18%) were more or less uninfluenced by pregnancy (CEH vs. migraine P < 0.0001, chi2 test). The lack of response to pregnancy may be a sort of biological marker in CEH. It may also help in clinically distinguishing CEH from migraine when CEH starts early in life, i.e. prior to pregnancies.
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Affiliation(s)
- O Sjaastad
- Vågå Communal Health Centre, Vågåmo, Norway
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40
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Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (Phila Pa 1976) 2002; 27:1835-43; discussion 1843. [PMID: 12221344 DOI: 10.1097/00007632-200209010-00004] [Citation(s) in RCA: 416] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter, randomized controlled trial with unblinded treatment and blinded outcome assessment was conducted. The treatment period was 6 weeks with follow-up assessment after treatment, then at 3, 6, and 12 months. OBJECTIVES To determine the effectiveness of manipulative therapy and a low-load exercise program for cervicogenic headache when used alone and in combination, as compared with a control group. SUMMARY OF BACKGROUND DATA Headaches arising from cervical musculoskeletal disorders are common. Conservative therapies are recommended as the first treatment of choice. Evidence for the effectiveness of manipulative therapy is inconclusive and available only for the short term. There is no evidence for exercise, and no study has investigated the effect of combined therapies for cervicogenic headache. METHODS In this study, 200 participants who met the diagnostic criteria for cervicogenic headache were randomized into four groups: manipulative therapy group, exercise therapy group, combined therapy group, and a control group. The primary outcome was a change in headache frequency. Other outcomes included changes in headache intensity and duration, the Northwick Park Neck Pain Index, medication intake, and patient satisfaction. Physical outcomes included pain on neck movement, upper cervical joint tenderness, a craniocervical flexion muscle test, and a photographic measure of posture. RESULTS There were no differences in headache-related and demographic characteristics between the groups at baseline. The loss to follow-up evaluation was 3.5%. At the 12-month follow-up assessment, both manipulative therapy and specific exercise had significantly reduced headache frequency and intensity, and the neck pain and effects were maintained (P < 0.05 for all). The combined therapies was not significantly superior to either therapy alone, but 10% more patients gained relief with the combination. Effect sizes were at least moderate and clinically relevant. CONCLUSION Manipulative therapy and exercise can reduce the symptoms of cervicogenic headache, and the effects are maintained.
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Affiliation(s)
- Gwendolen Jull
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
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41
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Abstract
The main objective of the present investigation was to search for cervicogenic headache (CEH) after whiplash injury. Whiplash patients (n= 587), were followed for a year after their emergency service consultation. A total of 222 patients with headache after 1 month went through interview and examinations at 6 weeks, 6 months and 1 year. All included persons received a questionnaire after 1 year. De novo CEH seemed to be present in 8% at 6 weeks and in 3% at 1 year. Previous car accidents, pre-existing headache and neck pain were more frequent in chronic CEH individuals than in those in the cohort without CEH. Range of motion in the neck was reduced in 65% of chronic CEH individuals hours after the accident, compared with 41% in the cohort. Cybex inclinometer, at 6 weeks and 1 year, demonstrated reduced extension in the neck. CEH seems to be present after whiplash injury, particularly in the early phase. It seems similar to, but probably not identical to, non-whiplash CEH.
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Affiliation(s)
- M Drottning
- Department of Neurology, Ullevål sykehus, Ullevål University Hospital, Oslo, Norway.
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42
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Abstract
Cervicogenic headache is a chronic, hemicranial pain syndrome in which the source of pain is located in the cervical spine or soft tissues of the neck but the sensation of pain is referred to the head. The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve converge with sensory fibers from the upper cervical roots. This convergence of upper cervical and trigeminal nociceptive pathways allows the referral of pain signals from the neck to the trigeminal sensory receptive fields of the face and head. The clinical presentation of cervicogenic headache suggests that there is an activation of the trigeminovascular neuroinflammatory cascade, which is thought to be one of the important pathophysiologic mechanisms of migraine. Another convergence of sensorimotor fibers has been described involving intercommunication between the spinal accessory nerve (CN XI), the upper cervical nerve roots, and ultimately the descending tract of the trigeminal nerve. This neural network may be the basis for the well- recognized patterns of referred pain from the trapezius and sternocleidomastoid muscles to the face and head. Diagnostic criteria have been established for cervicogenic headache but its presenting characteristics may be difficult to distinguish from migraine, tension-type headache, or hemicrania continua. A multidisciplinary treatment program integrating pharmacologic, nonpharmacologic, anesthetic, and rehabilitative interventions is recommended. This article reviews the clinical presentation of cervicogenic headache, its diagnostic evaluation, and treatment strategies.
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Affiliation(s)
- D M Biondi
- Pain Rehabilitation and Headache Management Programs, Spaulding Rehabilitation Hospital, 125 Nashua Street, Boston, MA 02114, USA.
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43
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Antonaci F, Fredriksen TA, Sjaastad O. Cervicogenic headache: clinical presentation, diagnostic criteria, and differential diagnosis. Curr Pain Headache Rep 2001; 5:387-92. [PMID: 11403744 DOI: 10.1007/s11916-001-0030-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Since the first attempt at setting down diagnostic criteria was made in 1990, there has been considerable progress in the field of cervicogenic headache (CEH). CEH makes up a "final common pathway" for several neck disorders that may originate at different levels of the cervical spine. CEH has been defined as being mainly a unilateral headache without sideshift; it may accordingly also be bilateral. Anesthetic blockades are mandatory for scientific work. If the pain is bilateral, it is particularly important that blockades are carried out. Pain stemming from the neck usually spreads to the oculofrontotemporal area. The most characteristic features are symptoms and signs of neck involvement (such as mechanical precipitation of attack, and so forth). Migraine without aura and tension-type headache are the most difficult differential diagnosis problems.
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Affiliation(s)
- F Antonaci
- Service of Neurophysiopathology, Department of Neurological Sciences, C. Mondino Foundation, University of Pavia, Via Palestro 3, 27100 Pavia, Italy.
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44
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Antonaci F, Ghirmai S, Bono G, Sandrini G, Nappi G. Cervicogenic headache: evaluation of the original diagnostic criteria. Cephalalgia 2001; 21:573-83. [PMID: 11472384 DOI: 10.1046/j.0333-1024.2001.00207.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A variety of headaches are frequently associated with the occurrence of neck pain. The purpose of this paper was to describe the adherence to diagnostic criteria of a series of patients enrolled on the basis of two clinical criteria: (1) unilateral headache without side-shift, and (2) pain starting in the neck and spreading to the fronto-ocular area. One hundred and thirty-two patients (36 male and 96 female) entered the study. Sixty-two patients were assigned to Group A (patients fulfilling criteria 1 and 2), 40 to Group B (criterion 2 only) and 12 to Group C (criterion 1, only). Eighteen subjects were excluded because X-rays of the neck were not available. Patients were evaluated regardless of whether or not they fell into one or more of the following diagnostic categories: cervicogenic headache (CEH), migraine without aura (M) and headache associated with disorders of the neck (HN) (IHS definitions). Fulfillment of the diagnostic criteria for CEH was found to be particularly frequent in Group A. A higher frequency of CEH diagnosis was found when two criteria were used (Group A) than in Group B (P = 0.001); in the former group a higher mean number of diagnostic criteria for CEH were also present (P = 0.001). Group A patients more frequently presented pain episodes of varying duration or fluctuating, continuous pain and moderate, non-excruciating, non-throbbing pain than Group B patients (P = 0.04 and P = 0.08, respectively). In Group C patients, the frequency of these two criteria was relatively low (17%) especially of the first mentioned variable. The presence of at least five of the seven 'pooled' CEH criteria (present in > or = 50% of the patients) might be deemed a reliable cut-off point, allowing the headache to be diagnosed as 'probable' CEH. If patients fulfilling M or HN criteria in addition to the CEH criteria are added to the 'pure' CEH group a total of 74% of Group A patients may have a CEH picture. The temporal pattern of pain and the quality of pain in Group A showed good sensitivity and specificity (> or = 75) when compared with Group B; therefore, the chances of diagnosing a definite CEH are significantly more frequent in patients presenting with unilateral pain that also begins as a neck pain. Head/neck trauma and radiological abnormalities in the cervical spine were not significantly associated with CEH, M or HN diagnoses. An improvement of the current diagnostic IHS criteria might make it possible to avoid the existing, partial overlap of CEH with HN and M. Extensive use should be made of the GON, and other, blockades in the routine work-up of CEH, both in the differential diagnosis and in the mixed forms (CEH + M, and CEH + HN), in order to improve the efficiency of the current diagnostic system.
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Affiliation(s)
- F Antonaci
- Headache Centre, University of Pavia, IRCCS C. Mondino Foundation, Pavia, Italy.
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45
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Abstract
BACKGROUND CONTEXT The notion that headaches may originate from disorders of the cervical spine and can be relieved by treatments directed at the neck is gaining recognition among headache clinicians but is often neglected in the spine literature. PURPOSE To review and summarize the literature on cervicogenic headaches in the following areas: historical perspective, diagnostic criteria, epidemiology, pathogenesis, differential diagnosis, and treatment. STUDY DESIGN/SETTING A systematic literature review of cervicogenic headache was performed. METHODS Three computerized medical databases (Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Mantis) were searched for the terms "cervicogenic" and "headache." After cross-referencing, we retrieved 164 unique citations; 48 citations were added from other sources, for a total of 212 citations, although all were not used. RESULTS Hilton described the concept of headaches originating from the cervical spine in 1860. In 1983 Sjaastad introduced the term "cervicogenic headache" (CGH). Diagnostic criteria have been established by several expert groups, with agreement that these headaches start in the neck or occipital region and are associated with tenderness of cervical paraspinal tissues. Prevalence estimates range from 0.4% to 2.5% of the general population to 15% to 20% of patients with chronic headaches. CGH affects patients with a mean age of 42.9 years, has a 4:1 female disposition, and tends to be chronic. Almost any pathology affecting the cervical spine has been implicated in the genesis of CGH as a result of convergence of sensory input from the cervical structures within the spinal nucleus of the trigeminal nerve. The main differential diagnoses are tension type headache and migraine headache, with considerable overlap in symptoms and findings between these conditions. No specific pathology has been noted on imaging or diagnostic studies which correlates with CGH. CGH seems unresponsive to common headache medication. Small, noncontrolled case series have reported moderate success with surgery and injections. A few randomized controlled trials and a number of case series support the use of cervical manipulation, transcutaneous electrical nerve stimulation, and botulinum toxin injection. CONCLUSIONS There remains considerable controversy and confusion on all matters pertaining to the topic of CGH. However, the amount of interest in the topic is growing, and it is anticipated that further research will help to clarify the theory, diagnosis, and treatment options for patients with CGH. Until then, it is essential that clinicians maintain an open, cautious, and critical approach to the literature on cervicogenic headaches.
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Affiliation(s)
- S Haldeman
- Department of Neurology, University of California, Irvine, Medical Center, 101 The City Drive South, Orange, CA 92868, USA.
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