Headaches: Chiropractic Specialist
Headaches and Migraines - A Chiropractic Approach
A cervicogenic headache is a relatively common cause of chronic headache that is often misdiagnosed or unrecognized. Cervicogenic headache is a syndrome characterized by chronic hemicranial pain that is referred to the head from either bony structures or soft tissues of the neck.
The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibers from the upper cervical roots.
This functional convergence of upper cervical and trigeminal sensory pathways allow the bi-directional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.
A functional convergence of sensorimotor fibers in the spinal accessory nerve (CN XI) and upper cervical nerve roots ultimately converge with the descending tract of the trigeminal nerve and might also be responsible for the referral of cervical pain to the head
Pathophysiology – Why it happens?
First three cervical spinal nerves and their rami are the primary peripheral nerve structures that can refer pain to the head
Diagnostic Criteria from North American Cervicogenic Headache Society
Key signs/symptoms
Precipitation of head pain
Due to neck movement and/or sustained awkward head positioning
Due to external pressure over upper cervical or occipital region on symptomatic side
Decrease range of motion in neck
Ipsilateral neck, shoulder, or arm pain of a vague non-radicular nature or radicular arm pain
Testing
Extension with rotation toward the side of pain Applying digital pressure to involved facet regions or over the ipsilateral greater occipital nerve Muscular trigger points are found in suboccipital, cervical, and shoulder musculature Imaging modalities useful for differential dx.
Treatment
Note: Medications alone are often ineffective or provide only modest benefit for this condition.
Conservative tx. (Natural Headache Treatments)
Cervical adjustments
Therapeutic exercise
Biofeedback
Relaxation/Massage
Cognitive-behavioral therapy
Non-conservative tx.
Trigger point injections – Anesthetic
Radio-frequency thermal neurolysis
Epidural steroid injections may be indicated in patients with multilevel disc or spine degeneration
Pharmacologic route
Anti-depressants
Anti-epileptics
Analgesics
Muscle relaxants
The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve (trigeminal nucleus caudalis) are believed to interact with sensory fibers from the upper cervical roots.
This functional convergence of upper cervical and trigeminal sensory pathways allow the bi-directional referral of painful sensations between the neck and trigeminal sensory receptive fields of the face and head.
A functional convergence of sensorimotor fibers in the spinal accessory nerve (CN XI) and upper cervical nerve roots ultimately converge with the descending tract of the trigeminal nerve and might also be responsible for the referral of cervical pain to the head
Pathophysiology – Why it happens?
First three cervical spinal nerves and their rami are the primary peripheral nerve structures that can refer pain to the head
Diagnostic Criteria from North American Cervicogenic Headache Society
Key signs/symptoms
Precipitation of head pain
Due to neck movement and/or sustained awkward head positioning
Due to external pressure over upper cervical or occipital region on symptomatic side
Decrease range of motion in neck
Ipsilateral neck, shoulder, or arm pain of a vague non-radicular nature or radicular arm pain
Testing
Extension with rotation toward the side of pain Applying digital pressure to involved facet regions or over the ipsilateral greater occipital nerve Muscular trigger points are found in suboccipital, cervical, and shoulder musculature Imaging modalities useful for differential dx.
Treatment
Note: Medications alone are often ineffective or provide only modest benefit for this condition.
Conservative tx. (Natural Headache Treatments)
Cervical adjustments
Therapeutic exercise
Biofeedback
Relaxation/Massage
Cognitive-behavioral therapy
Non-conservative tx.
Trigger point injections – Anesthetic
Radio-frequency thermal neurolysis
Epidural steroid injections may be indicated in patients with multilevel disc or spine degeneration
Pharmacologic route
Anti-depressants
Anti-epileptics
Analgesics
Muscle relaxants
Prevalence – How common?
General population is estimated to be between 0.4% and 2.5%. Although in pain management clinics, the headache prevalence is as high as 20% of patients that experience chronic headaches.
Mean age of patients is 42.9 years and women are four times more likely to experience headaches.
Mean age of patients is 42.9 years and women are four times more likely to experience headaches.