Definition:

Cervicogenic headache as the name suggest refers to a headache of cervical
origin. Cervicogenic headache are unilateral starting from one side of the posterior head and neck
radiating to the front and sometimes associated with ipsilateral arm discomfort, another type of
CGH present with bilateral head and neck pain aggravated by neck positions and specific
occupations such as hairdressing, carpentry and truck /tractor driving. The neck pain precedes or
co-exists with the headache aggravated by specific neck movements or sustained postures.
Aetiology
Its particular aetiology remains unclear. However, it suggests that CGH is a final common pathway
for pain generating disorders of the neck

Pathophysiology

CGH results from a convergence of sensory input from the upper cervical spine into the trigeminal
spinals nucleus including input from upper cervical facets, upper cervical muscles,C2-3
intervertebral disc, vertebrae and internal carotid arteries, dura mater of the upper spinal cord and
posterior cranial fossa

Diagnosis and assessment

CGHs are a secondary type of headache, it is important to determine the primary causes as the
name suggest by performing a thorough musculoskeletal assessment of the cervical spine. Specific
patterns of muscle imbalance in the cervical spine are noted. These patterns of muscle tightness
and weakness known as "Upper Crossed Syndrome".

Postural assessment
Foward head posture is thought to increase stress on the upper cervical segments. It was noted to
be more common in CGH also associated with weakness and decreased endurance of the deep
flexors.

Active range of motions
Decreased active range of motions noted in patients with CGH.

Muscle Length
Consistent with upper crossed syndrome, patients with CGH often present with tightness of
SCM,upper trapezius,levator ,scalenes,suboccipitals,pectoralis minor and pectoralis major.

Muscle strength and activation
Patients with cervical dysfunction often have weakness, decreased strength and endurance of the
deep neck flexors. The active neck flexion movement pattern test to identify weak deep neck
flexors. This pattern is compensated by tightness of the SCM producing an early protraction of the
chin upward at the beginning of the motion.

Manual assessment
Palpable joint dysfunction of the upper cervical spine discriminates CGH from other type of
headaches as well as high probability of myofascial trigger point pain particularly from overactivity
of SCM, upper trapezius and temporalis.

Intervention

Mobilisation and manipulation are effective for treatment of patients with CGH although
manipulation appears superior to mobilisation in the short term.
Muscle energy technique is useful in helping reduce tightness and trigger point of the SCM,upper
trapezius,levator,scalenes,suboccipitals,pectoralis minor and pectoralis major.

Exercise prescription
Variety of upper quarter strengthening exercises including:
Shoulder abduction
Shoulder retraction
Push-up
Chest press
Shrug
Arm curl
Bent-over row
Chest flies
CGH are thought to be a dysfunction of the sensorimotor rather than a true structural problem,
sensorimotor training should be included in the program such as progressive exercise on unstable
surfaces to promote reflexive stabilisation and postural stability. Unstable surfaces include the use
of exercise balls or foam pads.

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