cervical MSK pathology / headaches

more pathologies, common MSK, headaches

common headaches seen in MSK

tension headache ~ around the back of the head, temples and forehead - like a hat is squeezing the head

migraine ~ typically one side of the head

cervicogenic headache

cluster headache ~ typically behind one eye

post-traumatic headache ~ temples, forehead and neck

history taking for headaches …

• first exclude the red flags ! (5D’s and 3N’s) 

• ask about timing, location / duration, aggs / eases / triggers

• what is their Hx of neck pain? - trauma, migraines

• medication history

what is a migraine headache?

• a sharp, throbbing headache on one side of the face. can cause muscle weakness, nausea, vertigo 

• triggers ~ light, red wine, cheese, smells, family Hx

• unknown cause, more common for women

what are cluster headache? 

pressure behind the eye with irritation. quite rare. intense attacks.

• onset is usually middle age.

• precipitated by alcohol and / or strong smells 

• no family Hx

what is a tension-type headache?

• most common headache leading to mild-moderate pain

• pain on both sides of the head (tight band)

• can be misdiagnosed as cervicogenic

• triggers: stress, tiredness, dehydration, noise

cervicogenic headaches

• from neck C1-C3 or myofascial

• unilateral gradual onset can be hours to months 

• mechanical association (posture, movement)

• Hx of anxiety / stress / trauma 

• pain and tenderness

• agg: movement and posture

• ease: position that takes tension off

• +ve cervical flex-rot test

cervical flexion rotation test

this test is for cervicogenic headache testing (c1-c2) involves passive neck flexion and rotation.

lack of neck rotation range = positive test for cervicogenic headaches to be treated

cervical spondylosis presentation

• disc degeneration due to trauma and/or excessive loading, poor posture, age related degeneration

• axial neck pain ~ may can refer down UL

• cervical radiculopathy ~ derma / myotomal distribution = numbness, pain P&Ns

• cervical myelopathy ~ narrowing spinal foramen = bilateral symptoms such as limb numbness, P&Ns, poor coordination, gait issues

cervical facet dysfunction 

• articular disorder ~ swelling irritates nearby spinal nerves - radiating pain, postural paraspinal spasm 

• clinical features ~ TOP, closing pattern aggravates (extension, rotation, side flexion), unilateral pain

postural cervical pain syndrome (upper-crossed)

• pain across the head, neck, shoulder

• posture - Cx protraction, upper extension, lower flexion and protracted shoulder

• causes ~ bad posture leading to gravitational loading and long-term deformation

• thoracic kyphosis and extension - closing pattern

• symptoms ~ pain, fatigue, lack of rom in CxSp and shoulder, TMJ pain, tension headache

what is non-specific neck pain? 

• commonly mechanical cause 

• symptoms vary with physical activity and time

• may be atraumatic (multi factorial- job, stress) or traumatic (like prior whiplash) unsure source of pain

• can lead to fear of movement or fear avoidance

torticollis (twisted neck)

a stiff neck that is difficult to flex or rotate 

• can be post-traumatic or idiopathic 

• treatment / mgmt ~ pharmacological treatment (botulinum toxin IV, benzodiazepines, muscle relaxants) or surgery

• physio management ~ stretching, rom, neck stabilisation

what is cervical radiculopathy? 

• nerve root compression that causes inflammation and narrowed IVF

• symptoms usually unilateral, bilateral is more severe

• neck and radiating arm pain / numbness in nerve distribution

• motor / sensory disturbance, lack of function 

cervical radiculopathy presentation

• headaches, neck pain, limited rom, dermatomal / myotomal changes, radiating pain

• agg = Cx tension, ipsilateral rotation and SF, +ve Spurlings

• ease = shoulder abduction

• treatment = manual therapy

radiculopathy treatment

• aim to reduce pain and recurrence

• massage, medication, manual therapy, steroid injection

• neural flossing, postural correction, supervised and home based physio

• focusing on opening up, avoiding closing pattern