138. Understanding and Treating Cervicogenic Headaches

In this episode of the PT Snacks Podcast, we dive into the topic of cervicogenic headaches. We explore what cervicogenic headaches are, how to identify them, and how to differentiate them from other types of headaches. We also discuss evidence-based treatment options including manual therapy, joint mobilization, dry needling, and specific exercises. Don't forget to check the show notes for a special promo code for MedBridge subscriptions!

00:00 Introduction to Headache Case Study

00:48 Welcome to PT Snacks Podcast

01:04 Understanding Cervicogenic Headaches

02:50 Symptoms and Diagnosis

04:08 Differentiating from Other Headaches

04:55 Physical Examination Techniques

06:27 Treatment Options

07:31 Advanced Treatment and Resources

08:17 Med Bridge Subscription Offer

09:01 Conclusion and Contact Information

Medbridge Courses for Deeper Dives:

“Management of Cervicogenic Headache” – Cheryl Sparks

“Evidence-Based Treatment of the Cervical Spine” – Dr. Chad Cook

“Headache Assessment & Intervention” – Smelser & Kercheville

Transcript

0:27

Let's say you have a patient that's coming in with headaches on the referral and you're talking to them and you find out their headache is on one side of their head. They've been to neurologists, they've had brain scans. And things just don't seem to have an explanation. But during your exam, you notice something. So when she turns her head to the right, it reproduces her pain. Pressure on her upper neck also recreates your pain. Something that we would wanna investigate would be, is this a cervicogenic headache? So in today's episode, we're gonna break down what it is, how to spot it, how to rule out some other things that might be good to have on your differential diagnosis list, and how to treat it with today's most recent evidence, evidence-based practice. Hey everybody. Welcome to PT Snacks podcast. This is Kasey, your host, and if you are tuning in for the very first time, welcome. What you need to know is that this podcast is meant for physical therapists and physical therapist students who are looking to grow your fundamentals in bite-size segments of time. Now today's topic, we're gonna be talking about a specific type of headache called cervicogenic headaches. And this is actually pretty much the main headache that physical therapists can actually be very effective with. Not to say that we can't help with other things, but. The more we can spot these and help people out, the better that these people are gonna feel. So when I am referring to cervicogenic headaches, I'm talking about a referred headache that starts in the neck and is perceived in the head or in the face. It usually presents as unilateral pain. And often with it, this patient might have less range of motion. It might be reduced, but in order for it to really be a cervicogenic headache, the source must be in the neck. Now in our physical exam, if we are examining the neck and we'll cover this a little bit more and it reproduces their pain with some of our testing, that can be a good indication that this is, so, this is a ergogenic headache, but really the ideal scenario, which is. Not really ideal in an actual real life situation is that the headache goes away with a diagnostic nerve block. That's really like the best way to see is it cervicogenic, but obviously not something that's very convenient for like any patient I. Now most commonly comes from structures that are innervated by C one through C3, and according to bag and govin, in their 2009 article, 70% actually comes from the C two to C3 facet joint. So these structures send a nociceptive input to the trigeminal cervical nucleus, which in turn prefers pain to the oput eye or temple. Now let's talk about who gets this. So it is mo more common in females, and we often see this with people who maybe have to hold their head in a prolonged awkward position, like at a, a desk or maybe, I've had a history of neck trauma, like whiplash injuries, and in the clinic what this is gonna look like is unilateral non throbbing pain that doesn't switch sites. It's usually pretty steady and pain can range from mild to severe. Typically pain either worsens with neck movement or sustained postures or with direct pressure. So yes, you can push on it and see if it hurts, but also it might be that having their head up against a certain thing really recreates the symptoms. It could last hours, it could last weeks. So there is some variability on how long this goes on. Typically we'll see a little bit less range of motion in the neck, and sometimes even in the shoulder on the ipsilateral side. Autonomic signs like light sensitivity, nausea, things like that can happen, but they're not near as typical as like a migraine. So. We do wanna be mindful of ruling out other potential causes for what this headache is. So as we know, headaches can overlap with a lot of different types. We'll probably dive into this more in a future episode, but migraines typically may have some throbbing. They may shift sides. They may often have light sensitivity, nausea and aura. Tension type headaches tend to have a band like pressure that's across the forehead and generally bilateral, imaging can be helpful to rule out more serious pathologies like spinal cord. Issues arising from the spinal cord or spinal nerve roots. If there's any tumors or even any Ari malformation. So good to ask about what tests that people have already had done for their neck, especially if it's chronic and in. In your exam, just like I, in your exam, you're looking to see do they have less range of motion? Are you able to reproduce pain with any of the neck movement or palpation of the upper cervical segments? And in your manual exam, does it show that there are any restricted segmental areas, especially in the upper cervical or any tenderness with that? And there's also a test called a cervical flexion rotation test, where basically. If they're in supine, you flex their neck as far as you can, and then you rotate both sides. And for it to be a positive test, it would often be limited on the symptomatic side. So if they had right sided neck pain, for instance, and you're turning them towards the right, that would be symptomatic if it was a positive for this test. So. Keeping in mind why we're looking at all this. We are seeing if this is cervicogenic headache because we are looking for a source of a tissue that is innervated by C one through C3 that could cause this if we're not able to reproduce. Reproduce it in our exam, then we may need to look into some other things. But if we're examining, if this is more joint muscle related, et cetera, and we're able to reproduce it with palpation of the muscles or assessing the joints range of motion, that helps us to further roll in, okay, this makes sense for it to be a cervicogenic headache. And then when we are gonna treat it in order to treat it. Physical therapy, luckily is the first line of defense. So if. We, so typically the best evidence we have in terms of treatment is gonna be manual therapy, joint mobilization. For C one through three snag techniques, dry needling and graston have also been shown to be beneficial to help reduce muscular guarding. Obviously see what your patient is comfortable with, and then motor controller and exercise, so. Cranial cervical flexion training, like deep neck flexors, scapular stabilization, isometric, neck strengthening. All of these things have been cited in research studies to be beneficial for helping people to actually recover from these headaches. And if PT is not enough, if it's failing, then that's when people may go on to consider diagnostic. Nerve blocks, cervical facet joint injections, and in chronic cases, maybe even radiofrequency ablation, to help them to actually have some relief. Now, obviously that's a very quick overview of this case. We could definitely go in deeper, but if you want to take a deeper dive, med Bridge has several courses that talk in much more detail on headaches. So one of which is Management of Cervicogenic Headaches by Cheryl Sparks. She covers diagnostic tools, manual therapy, and case applications. Chad Cook has a course called Evidence-Based Cervical Spine Treatment and. It's where you can learn more about how to apply manual therapy based on clinical patterns. And then Smer and Kers Seville have a course called Headache Assessment Intervention, and this course is about helping to differentiate cervicogenic headaches from other headache types using evidence-based frameworks. So. If you don't have a Med Bridge subscription, they're actually a sponsor of the show and they're offering listeners over a hundred dollars off their year subscription to basically access to all these courses as well as webinars. They even have a home exercise, a home exercise app where you can put together exercises for your patient and that patient's able to watch videos of these and just basically. Go along with it on their phone. So this is really good for if you don't already have an exercise base there. So if you're interested, definitely check out the show notes to get your promo code and also if you're a student, you get an even better discount. So make sure you hunt out that one too,'cause you'll save even more money. If you have any questions, feel free to reach out at Pt Snacks podcast@gmail.com. But other than that, I hope you guys have a great rest of your day, and until next time.