Cervicogenic Headaches

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Cervicogenic Headaches
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Cervicogenic Headache

• Defined 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.

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Causes

• Ergonomics
• Subluxation
• Repetitive motion
• Shoulder
• Neck

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Repetitive Motion

• Most commonly affects those who overuse a
  unilateral or bilateral repetitive motion
  
• Witches
• Butter churners
• Ice cream scoopers
• Receptionists
• Painters
• Hair stylists

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Our Patient

• Name Dixie
• Occupation Receptionist
• Age 43
• Duties answering phone (no headset) extensive
  computer work Brewing and Serving Coffee

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Symptoms

• Headaches
• Neck pain and stiffness that would start in the
  occipital region and travel overhead to the
  frontal region
  
• Visualization

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Findings

• Weak SITS group posterior deltoid Middle
  Trapezius
  
• Facilitated SCM Scalenes Upper Trapezius
  Levator Scapulae suboccipital muscles
  
• VSC cervical spine

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Goals

• Short Term
• Restore patient to full ROM
• Decrease Pain
• Mid Rehab
• Return to full ROM with 4-5/5 strength
• Late Rehab
• Return to full function/activity

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Goals (Cont.)

• Long Term
• Wellness Care
• Proper Mechanics
• Proper Ergonomics

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Stretching

• Active and passive stretches for
• SCM
• Scalenes
• Pectoralis group
• Superior Trapezius

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Early Strengthening

• Cervical
• ROM
• Extension 3x10
• Rotation 3x10
• Isometrics
• Chin Tucks with towel resistance
• Rotation with finger resistance

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Early Strengthening

• Scapula
• Isometrics (with doctor or in a door way)
• External Rotation 2x10
• Internal Rotation 2x10
• Abduction at 20-30 degrees 2x10
• Wall Angels

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Mid-Stage Strengthening

• Cervical
• Full ROM
• Add resistance with band or doctor resistance
  3x10
  
• Chin tucks
• With a band or ball against a wall standing 3x10

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Mid-Stage Strengthening

• Scapula
• Ball dribbles on wall
• Up and down 2 x15
• Lateral 2x15
• Wide Rows with band resistance 3x10
• Full ROM
• Add resistance 3x10

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Late Stage Strengthening

• Cervical
• Chin tucks
• Progress to seated on a ball still using band
  3x10
  
• Patient should by now have full ROM with 5/5
  strength if not continue will bands and increase
  resistance
  

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Late Stage Strengthening

• Scapula
• PNF D1 pattern 3x10
• PNF D2 pattern 3x10
• Deceleration with external rotation 2x10
• teach with doctor performing resistance teach to
  use a band at home
  

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Ergonomics

• Proper ergonomics must be in place for full
  rehabilitation to occur
  
• Desk set up
• Headset
• Cervical pillow
• Slow adaptation
• Will assist in stretching anterior cervical
  muscles

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Basics of Ergonomics

• Best Work Zone
• As far forward as your wrist when you hold your
  arm slightly bent
  
• As wide as the shoulders
• Upper level at about heart height
• Lower level at about waist height

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Work Zones
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Ergonomic Desk Set Up
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Cervical Pillow

• 1st week Patient should lie on cervical pillow
  for 5 minutes per night then sleep on regular
  pillow
  
• 2nd week Repeat 1st week increasing time to 10
  minutes per night
  
• 3rd week Increase time to 15 minutes per night

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Manipulative Therapy

• Chiropractic Adjustments
• Myofacial Release
• Trigger Points

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Chiropractic Adjustment

• Find and remove subluxation

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Myofacial Release

• Increases
• Blood and lymph flow
• Breaks adhesions
• Decreases
• Edema
• Congestion
• Nerve activity

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Trigger Points

• Upper Trapezium
• Levator Scapulae
• Pectoralis Muscles

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Massage

• Traction
• Effleurage - stroking movements over large
  surface areas of the body
  
• Petrissage - while squeezing the skin, raise a
  large fold of skin btwn thumb and other fingers.
  Push thumb toward fingers and release.
  
• Pincement

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Works Cited

• Cesar Fernandez-de-las-Penas. Myofascial Trigger
  Points and Their Relationship to Headache
  Clinical Parameters in Chronic Tension-Type
  Headache. Headache 2006 461264-1272.
• Cibulka, Michael. Sternocleidomastoid muscle
  imbalance in a patient with recurrent headache.
  Manual Therapy. 11 (2006) 78-82
  
• Ettekoven, H. Efficacy of physiotherapy including
  a craniocervical training programme for
  tension-type headache a randomized clinical
  trial. Cephalalgia. 2006, 26 983-991
• McAtee, Robert. Facilitated Stretching. 2nd.
  Champaign Human Kinetics Publishers, 1999.
  
• Mueller, Loretta. Cervicogenic Headache A
  Diagnostic and Therapeutic Dilemma. Headache and
  Pain. April 2003 pg 29-36.