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    Neck Pain With Headache (Cervicogenic Headache) : Dr. Faisal Mohammad Alyazedi Consultant/ Physical Therapist

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    Rancho Vaibhav Gupta
    Cervicogenic headache arises from musculoskeletal dysfunctions in the cervical spine and results from convergence of pain signals from the neck and upper cervical spine onto trigeminal nerves, leading to referred pain patterns in the head. Common features include unilateral neck pain associated with headache aggravated by neck movement. Treatment involves cervical exercises like self-sustained natural apophyseal glides, mobilization, and deep neck flexor strengthening.

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    Neck Pain With Headache (Cervicogenic Headache) : Dr. Faisal Mohammad Alyazedi Consultant/ Physical Therapist

    Uploaded by

    Rancho Vaibhav Gupta
    57 views15 pages
    Cervicogenic headache arises from musculoskeletal dysfunctions in the cervical spine and results from convergence of pain signals from the neck and upper cervical spine onto trigeminal nerves, leading to referred pain patterns in the head. Common features include unilateral neck pain associated with headache aggravated by neck movement. Treatment involves cervical exercises like self-sustained natural apophyseal glides, mobilization, and deep neck flexor strengthening.

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    Cervicogenic headache arises from musculoskeletal dysfunctions in the cervical spine and results from convergence of pain signals from the neck and upper cervical spine onto trigeminal nerves, leading to referred pain patterns in the head. Common features include unilateral neck pain associated with headache aggravated by neck movement. Treatment involves cervical exercises like self-sustained natural apophyseal glides, mobilization, and deep neck flexor strengthening.

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    57 views15 pages

    Neck Pain With Headache (Cervicogenic Headache) : Dr. Faisal Mohammad Alyazedi Consultant/ Physical Therapist

    Uploaded by

    Rancho Vaibhav Gupta
    Cervicogenic headache arises from musculoskeletal dysfunctions in the cervical spine and results from convergence of pain signals from the neck and upper cervical spine onto trigeminal nerves, leading to referred pain patterns in the head. Common features include unilateral neck pain associated with headache aggravated by neck movement. Treatment involves cervical exercises like self-sustained natural apophyseal glides, mobilization, and deep neck flexor strengthening.

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    Neck Pain with Headache

    (Cervicogenic Headache )
    Dr. Faisal Mohammad Alyazedi
    Consultant/ Physical Therapist
    Assistant Professor
    Chair of Faculty Members & Alike Affairs
    Prince Sultan Military College of Health Sciences
    Definition
    Cervicogenic headache is a term used to define
    headaches that arise from musculoskeletal
    dysfunctions in the cervical spine.2,3
    Mechanism of Pain Referral to the
    Head4
    Convergence of Trigeminocervical
    nucleus with (upper C-spine)

    Nociceptive afferents of the trigeminal


    and upper three cervical spinal nerves
    converge onto second-order neurons
    in the trigeminocervical nucleus in the
    upper cervical spinal cord.
    This convergence mediates the
    referral of pain signals from the neck
    to regions of the head innervated by
    cervical nerves or the trigeminal
    nerve.
    Referred pain patterns

    • Convergence between cervical


    afferents allows for upper
    cervical pain to be referred to
    regions of the head innervated
    by cervical nerves (occipital
    and auricular regions).
    • Convergence with trigeminal
    afferents allows for referral
    into the parietal, frontal, and
    orbital regions.
    • The source of pain is likely
    referred from one or more
    muscular, neurogenic,
    osseous, articular, or
    vascular structures in the
    neck.
    Cervicogenic Headache Classification/
    Clinical Features of Interest
    Common Symptoms
     Non-continuous, unilateral • Positive cervical flexion-
    neck pain associated rotation test. Restriction grater
    than 10˚
    (referred) headache
    • Headache reproduced with
     Headache is precipitated or provocation of the involved
    aggravated by neck upper cervical segments
    movements or sustained • Limited cervical ROM
    position/posture.6 • Restricted upper cervical
    segmental mobility
    • Poor performance on Deep
    Neck Flexors Endurance Test11
    Cervical Flexion-rotation Test (FRT)
    Mobility assessment of atlanto-
    axial joints to the right
    • Patient in supine position
    • Passively and maximally flex the neck
    (to purely assess the upper cervical
    spine)
    • Rotate the cervical spine to one side
    and then the other side. (normal range
    is 44˚to each side)
    • Positive test:
    – If there is restriction of the joint
    movement or reproduction of headache
    with rotation towards the side of
    headache5
    – Rotation restriction greater than 10˚ to
    one side4

     The test has high sensitivity (91˚%) and


    specificity (90˚%) for identifying
    cervicogenic headache.7
    Pain Originated from Lateral Atlanto-
    axial Joints10
     Pain in the occipital or suboccipital region.
     Focal tenderness in the occipital region.
     Focal tenderness over the tip of the left or right
    transvers process of C1.
     Restricted rotation of C1-C2 on manual examination of
    the segment.
     Aggravation of their accustomed headache by passive
    rotation of the C1 vertebra to the left or right.
     21/34 (62%) subjects underwent lateral atlnto-axial
    joint blocks obtain complete relief of their headache.
    SNAG Right Pillar for Right
    Rotation SNAG8,9 Cervical Rotation
    1. The patient in seating position.
    2. The medial border of the
    thumb’s distal phalanx is placed
    on the C1 right transvers
    process. The thumb nail would
    slope in the direction of eyeball
    and the other thumb reinforces
    this position.
    3. Then patient is instructed to
    rotate his neck as far as possible
    to the right.
    4. followed by application of
    overpressure.
    C1-2 Self-SNAG Exercise

    • C1-C2 self-sustained natural


    apophyseal glide (SNAG) for
    cervical right rotation. Force is
    applied to the C1 level via
    horizontal pressure from the
    strap. At the same time, the
    subject actively turns his/her
    head to the right.
    • The purpose is to facilitate C1
    rotation on C2 in the direction
    found to limited on the FRT.
    Deep Neck Flexors strengthening
    • The patient is instructed to
    slowly nod the head and
    flatten the curve of the neck
    without pushing the head
    back into the table/bed.
    • The therapist or patient
    monitor the
    sternocleidomastoid SCM
    muscles to ensure minimal
    to no activation of these
    muscles during the deep
    neck flexor contraction.12
    CPG Recommendation
    (Acute Pain)
    Grade- B
    For patients with acute neck pain with headache,
    clinicians should provide supervised instruction in
    active mobility exercise.
    Grade- C
    Clinicians may utilize C1-2 self-sustained natural
    apophyseal glide (self-SNAG) exercise.
    CPG Recommendation
    (Subacute Pain)
    Grade- B
    For patients with subacute neck pain with headache,
    clinicians should provide cervical manipulation and
    mobilization.
    Grade- C
    Clinicians may provide C1-2 self-SNAG exercise.
    CPG Recommendation
    (Chronic Pain)
    Grade- B
    For patients with chronic neck pain with headache,
    clinicians should provide cervical or cervicothoracic
    manipulation or mobilizations combined with shoulder
    girdle and neck stretching, strengthening, and endurance
    Exercise [stabilization ex.].
    References
    1. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK, Altman RD,
    Beattie P, Boeglin E. Neck Pain: Revision 2017: Clinical Practice Guidelines Linked to the International
    Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical
    Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2017 Jul;47(7):A1-83.
    2. Sizer Jr PS, Phelps V, Azevedo E, Haye A, Vaught M. Diagnosis and management of cervicogenic headache. Pain
    Practice. 2005; 5(3): 255-274.
    3. 2. Martelletti P & van Suijlekom H. Cervicogenic headache: Practical approaches to therapy. Therapy in Practice.
    2004; 18(12): 793-805.
    4. Hall T1, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Efficacy of a C1-C2 self-sustained natural
    apophyseal glide (SNAG) in the anagement of cervicogenic headache. J Orthop Sports Phys Ther. 2007
    Mar;37(3):100-7.
    5. Hall T1, Robinson K. The flexion-rotation test and active cervical mobility--a comparative measurement study in
    cervicogenic headache. Man Ther. 2004 Nov;9(4):197-202.
    6. Bogduk N1. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther. 1992 Jan;15(1):67-70.
    7. Ogince M1, Hall T, Robinson K, Blackmore AM. The diagnostic validity of the cervical flexion-rotation test in
    C1/2-related cervicogenic headache. Man Ther. 2007 Aug;12(3):256-62. Epub 2006 Nov 16
    8. B Vicenzino, W Hing, T Hall, D Rivett - 2011 - Elsevier Australia. Mobilisation with movement: the art and the
    science. 2011 Elsevier Australia.
    9. BR Mulligan. Manual Therapy nags, snags, mwms“etc. 2004 Optp.
    10. Aprill C1, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint.
    Cephalalgia. 2002 Feb;22(1):15-22.
    11. Zito G, Jull G, Story Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache IMan
    Ther. 2006 May; 11(2):118-29
    12. Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic
    headache. Spine 2002;27:1835–43

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