Introduction
The Cervicogenic headache Masterclass, taught by Amy Pappinieimi and Dr Zhiqi Liang provides a complete overview of the assessment and management of Cervicogenic Headaches. This position statement provides clinically relevant, actionable information that may be useful to health professionals.
Part 1 - Identifying Common Headache Types
Headaches (HA) can be split into three main categories which are migraines, cervicogenic, and/or tension-type HA. There are a lot of overlapping features between these types of HA, so getting relevant information the subjective interview is crucial in helping you distinguish between them. Cervicogenic HA is typically unilateral and refers to a joint dysfunction with associated muscular problems around the neck.
- Photosensitivity is common in migraines, however can also be present in people with cervicogenic HA. Thus, it is important to clarify this in the interview process.
- You can have a primary HA with referred pain to the neck, without a cervical disorder. A physiotherapist’s role in this instance could be to provide education and reassurance.
Part 2 - Physical Examination
The main goal of the physical examination is to determine whether the patient has a cervical disorder or not. It includes screening for red flags, ROM assessment, PPIVMs, PAIVMs, special tests and a neuromuscular assessment. The clinician should also understand the patient’s baseline status to gain an overall understanding of the condition.
- If the patient already has a HA prior to the physical examination, be very selective with your tests to prevent flaring them up more.
- If the patient is quite sensitised, assess cervical flexion in sitting rather than in a supine position to make it more tolerable.
- During PPIVMs or PAIVMs assessment, make sure the patient’s neck is in a relaxed position on the plinth to aid palpation accuracy and ensure comfort.
- When assessing joint PAIVMs, start with a large movement amplitude to help the patient relax.
Masterclass Preview
Have a sneak peak at some of the physical tests Karen & Secili use in their objective assessment.
Part 3 - Management Strategies
It is important to help the patient piece together all the possible contributing factors to their symptoms. Education and reassurance remain a big component in the management strategy. Overall, a multimodal approach is necessary to treat anyone with headaches with/without a cervicogenic involvement.
- Try and find a relevant outcome measure such as the Neck Disability Index (NDI) or Headache Impact Test (HIT-6) to help both the patient and clinician track progress over time.
- Something that can trigger headaches is diet. Thus during the patient interview, try and delve deeper into their dietary habits.
Part 4 - Treatment Options
Treatment options often include education about potential triggers/prodromal symptoms, manual/exercise therapy, adjunct therapies, referral to other health professionals and lastly, medication. Any chosen treatment should have the patient’s goals in mind and always be individualised to the person in front of you.
- Using a HA diary (can be sourced online) is useful for the patient/clinician to track HA symptoms, frequency and intensity to better manage it.
- Manual therapy can help patients desensitise painful areas.
- It is important to consider timing of medications, as they can be a preventor, rather than a reliever.
