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Upper Cervical/Craniovertebral Junction
Headache Syndromes and Neck Pain
115
Medical
Graduate
11/15/2015

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Term
3 headache groups
Definition
cervicogenic
tension type
migraine
Term
cervicogenic headache is considered what type of headache
Definition
secondary
Term
anatomic basic for cervicogenic headaches: nervous system (3 nervous, 1 skeletal)
Definition
trigeminiocervical nucleus
Dura Mater of upper SC and posterior cranial fossa
Upper 3 cervical nn
Term
anatomic basic for cervicogenic headaches: connective tissue
Definition
joints and ligaments of upper 3 segments
Term
anatomic basic for cervicogenic headaches: muscles
Definition
anterior and posteiror mm
SCM and Upper Trap
Term
anatomic basic for cervicogenic headaches: vascular system
Definition
upper part of the vertebral aa
Term
anatomic basic for cervicogenic headaches: other potential causes (3 nervous)
Definition
irritation of DRG and nerve root betwen posterior arch of C1 and articular process of C2
Compression of the C2 ventral ramus at the articular process of C1 and C2
Entrapment of the Greater Occipitla nerve within the suboccipital mm or triangle
Term
Pain Distribution of Cervical Structures: occipital condyles
Definition
frontal
Term
Pain Distribution of Cervical Structures: occpital cervical tissues
Definition
frontal
Term
Pain Distribution of Cervical Structures: C1 Dorsal ramus
Definition
Orbit, frontal, vertex
Term
Pain Distribution of Cervical Structures: C1-C2
Definition
temporal, suboccipital
Term
Pain Distribution of Cervical Structures: C3 dorsal ramus
Definition
occiput, mastoid, frontal
Term
Dx criteria for Cervicogeneic headache: s/s of neck involvement (3)
Definition
precipitaoitn of comparable head pain by neck movement or sustained akward head postures
external pressure over the upper cervicla or occipital region or symptomatic side
restriction of ROM of neck
ipsilateral neck, shoulder, or arm pain
Term
Dx criteria for Cervicogeneic headache: how many s/s of neck invovelment need to be present
Definition
1 or more
Term
Dx criteria for Cervicogeneic headache: unilateral head pain without
Definition
sideshift
Term
Dx criteria for Cervicogeneic headache: head pain characteristics
Definition
moderate-severe, non-throbbing and non lancinating pain, usually starting in neck
episodes vary in duration
flucutating continuous pain
Term
Dx criteria for Cervicogeneic headache: marginal effect or lack of effect with what drug
Definition
indomethician
Term
Dx criteria for Cervicogeneic headache: gender
Definition
female
Term
Dx criteria for Cervicogeneic headache: infrequent hx of what
Definition
not infrequent hx of head or indirect neck trauma, usually more than medium severity
Term
Dx criteria for Cervicogeneic headache: how many episodes per month
Definition
more than 5-15 less severe episodes per month
Term
Dx criteria for migraine: 2 types of migraine headaches
Definition
without aura
with aura
Term
Dx criteria for migraine: which migrain is the common migraine
Definition
migraine without aura
Term
Dx criteria for migraine: symptoms of a migraine without aura
Definition
typically unilateral
pulsing quailty of moderate or severe intensity
aggravated by routine physical activity
associated with nausea, photophobia, phonophobia
Term
Dx criteria for migraine: symptoms of migraine with aura
Definition
reversible aura symptoms
typically develop gradually over 4 mins
last no longer than 60 mins
Term
Dx criteria for migraine: headache attacks lasts how long with what stipulation
Definition
4-72 hours untreated or unsuccessfully treated
Term
Dx criteria for migraine: headache has at least 2 of the 4 following characteristics
Definition
unilateral location
pulsating quality
moderate or severe pain intensity
aggravation by or causing avoidance of routine physical activity (walking or climbing stairs)
Term
Dx criteria for migraine: during headache at least one of the following 2
Definition
naseau and/or vomiting
photophobia and phonobia
Term
Dx criteria for migraine: not attributed to what
Definition
another disorder
Term
Dx criteria for migraine: how many attacks fulfilling criteria B-D (characteristics, naseau/phobias, differential dx)
Definition
at least 5 attacks
Term
Dx criteria for Tension Headaches: episodes description
Definition
infrequent episodes
Term
Dx criteria for Tension Headaches: infrequent episodes lasting how long
Definition
minutes to days
Term
Dx criteria for Tension Headaches: pain location
Definition
bilateral
Term
Dx criteria for Tension Headaches: pain quality
Definition
pressing or tightening
Term
Dx criteria for Tension Headaches: pain intensity
Definition
mild to moderate
Term
Dx criteria for Tension Headaches: effect of routine physical activity
Definition
does not worsen with routine physical activity
Term
Dx criteria for Tension Headaches: when compared to symptoms of migraines, 1 symptom is not present but 2 may be
Definition
no nausea
photophobia or phonobia may be present
Term
Dx criteria for Tension Headaches: criteria A
Definition
at least 10 episodes occuring on <1 day per month on average (<12 days per year) and fulfilling critera B-D
Term
Dx criteria for Tension Headaches: B (duration of headache)
Definition
lasting from 30 min to 7 days
Term
Dx criteria for Tension Headaches: criteria C (headache has at least 2 of the following characteristics) [4]
Definition
bilateral location
pressing/tightening (non pulsating) quality
mild or moderate intensity
not aggravated by routine physical acitivty such as walking or climbing stairs
Term
Dx criteria for Tension Headaches: criteria D (both of the following) [2]
Definition
no nausea or vomiting (anorexia may occur)
no more than one of photophobia or phonophobia
Term
Dx criteria for Tension Headaches: criteria E
Definition
not attributed to another disorder
Term
2 other caues of head and facial pain
Definition
hypertensive, post-traumatic
Term
hypertensive headaches occur in which population
Definition
diastolic readings above 120 mmHg
intensity does not parallel the height of the BP levels
Term
Post-traumatic headaches description
Definition
more prolonged and enduring headache than chronic daily
Term
Post traumati cheadaches may be associated with what (6)
Definition
subdural hematoma
epidural hematoma
intracerebral hematoma
aneurysm
subarachnoid hemorrhage
cerebral contusion
Term
Sinus headache location
Definition
behind the forehead and or cheekbones
Term
cluster headache location
Definition
pain in and around one eye
Term
tension headache location and description
Definition
pain is like a band squeezing the head
Term
migraine pain and location
Definition
pain, nausea, and visual changes are typical of classic form on one side of the face
Term
Differential dx for head and facial pain: (4)
Definition
meningitis
cerebrovascular disease
intracranial bleed
tumor
Term
an infection of the meninges and subarachnoid space
Definition
meningitis
Term
classic triad of meningitis
Definition
fever, neck stiffness, and an altered mental status
Term
head and facial pain d/t cerbrovascular disease is dependent on what
Definition
size and location of the hemorrhage
Term
what should be looked for if cerebrovascular disease is supsected
Definition
neurlogical signs and symptoms
Term
head and facial pain for an intracranial bleed is dependent on what
Definition
rate or arterial or venous bleeding
Term
red flags for intracranial bleeding
Definition
first headache i have ever had
worst headache I have ever had
Term
s/s of tumor causing head and facial pain
Definition
seziures or presence of neurological signs
Term
S/S of headaches requiring neurologic assessment: senses impairment
Definition
visual disturbances
numbness or altered sensation
alteration of smell, taste, or hearing
Term
S/S of headaches requiring neurologic assessment: visual disturbances
Definition
blindness
diplopia
distortions
spots
loss of vision to one side
Term
S/S of headaches requiring neurologic assessment: MMT results
Definition
loss of strength or coordination
Term
S/S of headaches requiring neurologic assessment: mental impairments
Definition
cognitive impairments
Term
S/S of headaches requiring neurologic assessment: relating to the heart beat
Definition
pulsating pain in synchrony with heart beat
Term
S/S of headaches requiring neurologic assessment: general sickness symptoms (3)
Definition
associated with projectile vomiting
fever
voice, hoarce, chronic cough
Term
S/S of headaches requiring neurologic assessment: interruption of ADL
Definition
headache that awakens one from sleep
Term
diagnostic algorithm for exam of pt with headache pain: 1 of 5
Definition
exclude intracranial causes on history and physical exam
Term
diagnostic algorithm for exam of pt with headache pain: step 2 of 5
Definition
exclude headaches with viral or other infective illness
Term
diagnostic algorithm for exam of pt with headache pain: step 3 of 5
Definition
exclude drug induced headache or those related to alcohol or substance abuse
rebound headaches d/t caffiene or NSAID usage
Term
diagnostic algorithm for exam of pt with headache pain: 4 of 5
Definition
consider exercise related headache syndrome
Term
diagnostic algorithm for exam of pt with headache pain: 5 of 5
Definition
differntiate between vascular, tension type, or cervicogenic
Term
Common Clinical Exam Findings associated with Cervicogenic headache: posture
Definition
forward head posture
Term
Common Clinical Exam Findings associated with Cervicogenic headache: neural allodynia meaning what
Definition
pain to a non painful stimulus
Term
Common Clinical Exam Findings associated with Cervicogenic headache: this postive test
Definition
cervical flexion rotation test
Term
Common Clinical Exam Findings associated with Cervicogenic headache: decreased control of what muscles
Definition
deep cervical flexors
longus colli and capitus
Term
Common Clinical Exam Findings associated with Cervicogenic headache: painful cervical jt especially which facet
Definition
C2-C3 facet
Term
Types of movement limitation in upper cervical spine: rotation
Definition
C1-C2
Term
Types of movement limitation in upper cervical spine: which movement limitation is key to ID upper cervical pathology
Definition
rotation
Term
Types of movement limitation in upper cervical spine: flexion
Definition
C0-C1
C1-C2
C2-C3
Term
Types of movement limitation in upper cervical spine: extension
Definition
C0-C1
C2-C3
Term
Types of movement limitation in upper cervical spine: sidebending
Definition
C0-C1
C2-C3
Term
Types of movement limitation in upper cervical spine: decreased mobility of these structures
Definition
suboccipital muscle/facia
Term
Types of movement limitation in upper cervical spine: tx
Definition
ID jt restriction and direct manual tx or specfic exercise direction appropriately
Term
Types of movement limitation in upper cervical spine: note about tx
Definition
no disc from C0-C1 or C1-C2 but may see rapid lasting changes if ID appropriate tx direction
Term
how is hypermobility ID'd (3)
Definition
mechanism of injury
hx of systemic disease processes
mechanical exam
Term
radiographic exam of hypermobility
Definition
atlanto-ondontiod ratio/interval (ADI)
Term
With teh ADI what motion increases the ratio
Definition
flexion
Term
With the ADI what motion decreases the ratio
Definition
extension
Term
ADI that suggests hypermobility: adults
Definition
>3.5
Term
ADI that suggests hypermobility: children under 12
Definition
>4.5 mm
Term
increased ADI associated with injury to transverse ligament d/t (6)
Definition
trauma
RA
Neoplastic disease
Down's syndrome
Ehler's danlos syndrome
prolonged corticosteroid use
Term
Intervention principles for specfic exercise category: exercises (2)
Definition
co-contraction
muscle lengthening
Term
Intervention principles for specfic exercise category: control (2)
Definition
deep cervical flexor
scapular
Term
Intervention principles for specfic exercise category: training (3)
Definition
kinesthetic
proprioceptive
balance
Term
3 potential causes for dizziness
Definition
systemic
central
peripheral
Term
Systemic causes for dizziness (3)
Definition
pharmocologic
hypotension
disease of endocrine system
Term
central causes for dizziness (4)
Definition
reflex vertigo
vestibular neuritis
Ramsay hunt syndrome
VBI dysfunction
Term
Peripheral causes of dizziness (2)
Definition
labyrinthitis
BPPV
Term
most common cause of dizziness in the elderly and incidience increases with age
Definition
benign paroxysmal positional vertigo
Term
BPPV is associated with changes in what
Definition
head position
Term
BPPV is most commonly associated with accumulation of what within the posterior semicircular canals
Definition
debris (otoconia) moving
Term
BPPV is is most commonly associated with accumulation of debris (otoconia) moving within what
Definition
posterior semicircular canals
Term
symptoms associated with BPPV other than dizziness (2)
Definition
vertigo and nystagmus
Term
maneuver used to dx BPPV
Definition
hallpike-dix
Term
common clinical symptom in pts with cervicl and upper quadrant pain
Definition
dizziness
Term
cervicogenic dizziness is thought to be related to disturbance of what reflex
Definition
tonic neck reflex
Term
cervicogenic dizziness is thought to be related to disturbance of the tonic reflex input from what to what
Definition
neck to the vestibular nucleus
Term
cervicogenic can be a result of a disturbance by dysfunction of what
Definition
cervical jts
Term
cervicogenic dizziness can abe a result of misperception in processing of information from what
Definition
proprioceptive afferents of cervical mechanoreceptors
Term
cervicogenic dizziness can abe a result of misperception in processing of information from proprioceptive afferents of cervical mechanoreceptors d/t what
Definition
trauma and dysfunction
Term
how to ID cervicogenic dizziness
Definition
head stabilized body rotated test
Term
cervicogenic dizziness intervention
Definition
address articular and muscular impairments
Term
Upper Cervical fx: 3 clinical findings
Definition
painful neck splinting
neck and occipital numbness
pain and stiffness in neck with reluctance to move
Term
Upper Cervical fx: 60% of all fracture
Definition
ondontoid
Term
Upper Cervical fx: how is a ondontoid fx dx
Definition
open mouth x ray
Term
Upper Cervical fx: how is a ondontoid fx dx
Definition
open mouth x ray
Term
Upper Cervical fx: jefferson fx
Definition
fracture of lateral mass, burst fracture of C1
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