Steve Jensen1. 1. Graduate School of Integrative Medicine, Swinburne University of Technology, Victoria, Australia. jensen@tpg.com.au
Abstract
BACKGROUND: Headaches emanating from sources in the cervical spine, so-called cervicogenic headache (CGH), are much more common than is usually thought by practitioners not trained in musculoskeletal medicine. OBJECTIVE: This article outlines a basic clinical assessment of the neck which will enable the general practitioner to determine whether or not there is a possible neck source for the presenting headache. DISCUSSION: The skills of musculoskeletal clinical assessment are relatively simple and easy to acquire, and can ensure that this important clinical entity is not overlooked. Reproduction of the patient's pain during the musculoskeletal examination indicates that a musculoskeletal cause is likely. Static diagnostic imaging studies of the neck have no role in the diagnosis of CGH. Spinal manual therapy has been shown to be efficacious in the treatment of CGH. Treatment aimed at relevant myofascial trigger points can also be useful. Specifically targeted diagnostic injection is required for definitive anatomical diagnosis. If such diagnostic procedures lead to a diagnosis of facet joint pain, treatment with radiofrequency neurotomy has proven efficacy.
BACKGROUND:Headaches emanating from sources in the cervical spine, so-called cervicogenic headache (CGH), are much more common than is usually thought by practitioners not trained in musculoskeletal medicine. OBJECTIVE: This article outlines a basic clinical assessment of the neck which will enable the general practitioner to determine whether or not there is a possible neck source for the presenting headache. DISCUSSION: The skills of musculoskeletal clinical assessment are relatively simple and easy to acquire, and can ensure that this important clinical entity is not overlooked. Reproduction of the patient's pain during the musculoskeletal examination indicates that a musculoskeletal cause is likely. Static diagnostic imaging studies of the neck have no role in the diagnosis of CGH. Spinal manual therapy has been shown to be efficacious in the treatment of CGH. Treatment aimed at relevant myofascial trigger points can also be useful. Specifically targeted diagnostic injection is required for definitive anatomical diagnosis. If such diagnostic procedures lead to a diagnosis of facet joint pain, treatment with radiofrequency neurotomy has proven efficacy.