Cervicogenic headache: an introduction and manual medicine

Objective. This systematic review aimed to assess the efficacy of manual therapies for headache relief. Method. A systematic search in MEDLINE, LILACS, Cochrane, CINAHL, Scopus and Web of Science databases was conducted for randomized and quasi-randomized trials, with no restrictions for language or year of publication. The descriptors were ‘Headache’, ‘Headache disorders’ and ‘Musculoskeletal manipulations’, in addition to the keyword ‘Manual therapy’ and its equivalents in Portuguese. We included studies that compared massage, chiropractic manipulation, osteopathic manipulation and other spinal manipulation to groups with no intervention, other physiotherapeutic modalities or to a sham group. Results. Seven of the 567 articles initially screened were selected, including patients with tension type headache, cervicogenic headache or migraine. It was not possible to assess the magnitude of the treatment effect on the findings of this review. The main limitations were the absence of randomization and adequate allocation concealment, the lack of blinded evaluators and intention-to-treat analysis and inadequate statistical analysis. Conclusions. We were unable to determine the size of the treatment effect due to the selective description of findings. Owing to the high risk of bias in the articles included, the available evidence regarding the efficacy of manual therapies for headache relief is insufficient.

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Validation of a clinical examination to differentiate a cervicogenic source of headache: a diagnostic prediction model using controlled diagnostic blocks

BMJ Open ◽

10.1136/bmjopen-2019-035245 ◽

2020 ◽

Vol 10 (5) ◽

pp. e035245 ◽

Cited By ~ 2

Author(s):

Scott L Getsoian ◽

Surendra M Gulati ◽

Ikenna Okpareke ◽

Robert J Nee ◽

Gwendolen A Jull

Keyword(s):

Neck Pain ◽

Clinical Examination ◽

Model Building ◽

Clinical Signs ◽

Cervicogenic Headache ◽

Tension Type Headache ◽

Local Source ◽

Diagnostic Model ◽

Convenience Sample ◽

Headache And Neck Pain

ObjectivesNeck pain commonly accompanies recurrent headaches such as migraine, tension-type and cervicogenic headache. Neck pain may be part of the headache symptom complex or a local source. Patients commonly seek neck treatment to alleviate headache, but this is only indicated when cervical musculoskeletal dysfunction is the source of pain. Clinical presentation of reduced cervical extension, painful cervical joint dysfunction and impaired muscle function collectively has been shown to identify cervicogenic headache among patients with recurrent headaches. The pattern’s validity has not been tested against the ‘gold standard’ of controlled diagnostic blocks. This study assessed the validity of this pattern of cervical musculoskeletal signs to identify a cervical source of headache and neck pain, against controlled diagnostic blocks, in patients with headache and neck pain.DesignProspective concurrent validity study that employed a diagnostic model building approach to analysis.SettingHospital-based multidisciplinary outpatient clinic in Joliet, Illinois.ParticipantsA convenience sample of participants who presented to a headache clinic with recurrent headaches associated with neck pain. Sixty participants were enrolled and thirty were included in the analysis.Outcome measuresParticipants underwent a clinical examination consisting of relevant tests of cervical musculoskeletal dysfunction. Controlled diagnostic blocks of C2/C3–C3/C4 established a cervical source of neck pain. Penalised logistic regression identified clinical signs to be included in a diagnostic model that best predicted participants’ responses to diagnostic blocks.ResultsTen of thirty participants responded to diagnostic blocks. The full pattern of cervical musculoskeletal signs best predicted participants’ responses (expected prediction error = 0.57) and accounted for 65% of the variance in responses.ConclusionsThis study confirmed the validity of the musculoskeletal pattern to identify a cervical source of headache and neck pain. Adopting this criterion pattern may strengthen cervicogenic headache diagnosis and inform differential diagnosis of neck pain accompanying migraine and tension-type headache.

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THU0453 THIRD OCCIPITAL NERVE RADIO-FREQUENCY UNDER FLUOROSCOPIC GUIDANCE IN MANAGEMENT OF CERVICOGENIC HEADACHE IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.241 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 463.2-464

Author(s):

A. Alawamy ◽

M. Hassanien ◽

E. Talaat ◽

E. Kamel

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

Neck Pain ◽

Neck Disability Index ◽

Cervicogenic Headache ◽

Control Group ◽

Fluoroscopic Guidance ◽

Occipital Nerve ◽

Nocturnal Pain ◽

Neck Disability

Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared

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Cervicogenic Headache: Lack of Influence of Pregnancy

Cephalalgia ◽

10.1046/j.1468-2982.2002.00408.x ◽

2002 ◽

Vol 22 (8) ◽

pp. 667-671 ◽

Cited By ~ 9

Author(s):

O Sjaastad ◽

TA Fredriksen

Keyword(s):

International Headache Society ◽

Biological Marker ◽

International Study ◽

Cervicogenic Headache ◽

Lower Number ◽

Control Group ◽

Study Group ◽

Head Pain ◽

International Study Group ◽

A Minor

The influence of pregnancy upon the head pain of cervicogenic headache (CEH) has been studied in 14 patients (number of pregnancies 25). Migraine was used as control group ( n = 49; number of pregnancies 116). CEH was diagnosed according to The Cervicogenic Headache International Study Group guidelines. Migraine was diagnosed according to International Headache Society (IHS) guidelines; a further requirement was that at least eight of nine solitary IHS diagnostic requirements of migraine were present. In 79%—or more—of CEH patients, attacks seemed to appear just as usual during pregnancy; in one patient, attacks stopped completely, and in two there may have been a minor reduction of attacks. A significantly lower number of migraine patients (up to 18%) were more or less uninfluenced by pregnancy (CEH vs. migraine P < 0.0001, X2 test). The lack of response to pregnancy may be a sort of biological marker in CEH. It may also help in clinically distinguishing CEH from migraine when CEH starts early in life, i.e. prior to pregnancies.

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