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Cervicogenic Headache Assessment

Updated: Jan 31



Subjective History

​Insidious onset

Pain same side as cervical spine

Female

Stiff Cervical spine

Worse end of day

Work related

Postural

Moderate Intensity

Pain one side

Frequency >2-3 per week



Special Orthopaedic Tests


CFRT

  • CFRT - cervical flexion rotation test

  • Reliable and highly specific test for C1/2

  • Positive if loss of 10 degrees or greater is noted





PAIVMs

  • Passive Accessory intervertebral movements PAIVMs C1/2 C2/3

  • Tender on palpation or reproduction of symptoms

  • Reliable and highly sensitive for C1/2 C2/3




Differentiation of symptom driver


Myogenic

  • Postural related ischemic trigger points (Upper trapezius / Sternocleidomastoid/SOMs)

  • Somatic referred pain from Sub Occipital Muscles (SOM)


Arthrogenic

  • Hypo joint capsule &/or lesion with somatic referred pain


Neurogenic

  • Trigeminocervical Nucleus TCN


It can make it difficult to identify the source of pain therefore a possible combination of all three drivers may coexist.



Evidence based treatment options


Mulligan rotation SNAG for C1/2










Self SNAG











Head Nod (Deep Neck Flexor training)












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