Cervicogenic headache

Cervicogenic headache is a type of headache characterised by chronic Hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck.[1][2]

See also


  1. ^ Page, P. (2011). "Cervicogenic headaches: An evidence-led approach to clinical management". International Journal of Sports Physical Therapy. 6 (3): 254–66. PMC 3201065. PMID 22034615.
  2. ^ Biondi, D. M. (2005). "Cervicogenic headache: A review of diagnostic and treatment strategies". Journal of the American Osteopathic Association. 105 (4 supplement): S16–22. PMID 15928349.
Barré–Liéou syndrome

Barré–Liéou syndrome is a traditional medical diagnosis that is not utilized frequently in modern medicine. It is a complex combination of symptoms in patients originally thought to be due to cervical spondylosis independent of age, disease, or trauma. Damage to the posterior cervical sympathetic chain due to the degeneration of the cervical vertebra was theorized to play a role in this syndrome by the prolapsing of disc in the mid-cervical spine, however, the medical theory as was originally postulated was found to contain inconsistencies. The Barré–Liéou syndrome is regarded by many current medical researchers as synonymous with cervicogenic headache, however, this is an active area of modern research and there exist multiple opinions on this subject.

One test to check for Barré–Liéou syndrome is through the use of thermography. An MRI study may also be conducted to rule out any structural problems in the neck which may be the cause of this syndrome. Some of the treatments for this disorder consist of sympathetic nerve blocks, physical therapy, neck brace and traction.

Carotid artery dissection

Carotid artery dissection is a separation of the layers of the artery wall supplying oxygen-bearing blood to the head and brain and is the most common cause of stroke in young adults. (In vascular medicine, dissection is a blister-like de-lamination between the outer and inner walls of a blood vessel, generally originating with a partial leak in the inner lining.)Dissection may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or chiropractic manipulation, but may also happen spontaneously.


Cephalalgiaphobia is fear of headaches or getting a headache. Cephalalgia is a Latin-based term for a headache, cephalic meaning head, and algia meaning pain. Harvey Featherstone introduced this phobia in the mid-1980s as a fear of having headache or migraine pain during a pain-free period Patients with this phobia overuse analgesic medication to avoid headaches. Patients who experience these fears have a history of frequent migraines. To avoid a future headache or migraine a patient will intake analgesic medication to improve their headache. However, doctors do not prescribe pain medications but psychiatric medication to deal with the phobia itself. Non-pharmacological treatments using acupuncture therapy have been shown to reduce the fear of headache pain.


Chiropractic is a form of alternative medicine mostly concerned with the diagnosis and treatment of mechanical disorders of the musculoskeletal system, especially the spine. Some proponents, especially those in the field's early history, have claimed that such disorders affect general health via the nervous system, through vertebral subluxation, claims which are demonstrably false. The main chiropractic treatment technique involves manual therapy, especially spinal manipulation therapy (SMT), manipulations of other joints and soft tissues. Its foundation is at odds with mainstream medicine, and chiropractic is sustained by pseudoscientific ideas such as subluxation and "innate intelligence" that reject science. Chiropractors are not medical doctors.Numerous controlled clinical studies of treatments used by chiropractors have been conducted, with conflicting results. Systematic reviews of this research have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain. A critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition. Spinal manipulation may be cost-effective for sub-acute or chronic low back pain but the results for acute low back pain were insufficient. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. There is not sufficient data to establish the safety of chiropractic manipulations. It is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Several deaths have been associated with this technique and it has been suggested that the relationship is causative, a claim which is disputed by many chiropractors.Chiropractic is well established in the United States, Canada, and Australia. It overlaps with other manual-therapy professions such as osteopathy and physical therapy. Most who seek chiropractic care do so for low back pain. Back and neck pain are considered the specialties of chiropractic, but many chiropractors treat ailments other than musculoskeletal issues. Many chiropractors describe themselves as primary care providers, but the chiropractic clinical training does not support the requirements to be considered primary care providers, so their role on primary care is limited and disputed. Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "innate intelligence", and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.D. D. Palmer founded chiropractic in the 1890s, after saying he received it from "the other world", and his son B. J. Palmer helped to expand it in the early 20th century. Throughout its history, chiropractic has been controversial. Despite the overwhelming evidence that vaccination is an effective public health intervention, among chiropractors there are significant disagreements over the subject, which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic. The American Medical Association called chiropractic an "unscientific cult" in 1966 and boycotted it until losing an antitrust case in 1987. Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among conventional physicians and health plans in the United States.

Digital motion X-ray

Digital motion X-ray

(Digital Motion X-Ray: Non-fluoroscopic)

Conventional radiography is now used for the recording of motion studies. This method does not employ the use of fluoroscopy that has been the most common use of X-rays but rather uses conventional X-rays.

The manner of recording a motion study is to couple an X-ray system with a digital computer and a detection system that records images in real time.

Example: The A2D2, Inc. Model 1713 is a digital system that is capable of recording static images or a dynamic sequence.

Static images are recorded in a 5,000 by 4,000 pixel array with 14 bit capacity. These images are stored in the computer memory for recording and/or playback. Dynamic studies are recorded in real time at a rate of 30 frames per second with resolution of 1990 by 1200 pixels. Typically, one second of data recording is required for a complete motion study at 30 frames per second. Sophisticated software is used to automatically record the study and then to cause it to playback in a bi-directional format.

Patient radiation dose is minimal over the one second time frame. Typical radiation dose is approximately 2 mSv for this one second period. Any form of joint motion can be recorded and analyzed.

Dry needling

Dry needling, also known as myofascial trigger point dry needling, is an alternative medicine technique similar to acupuncture. Dry needling is sometimes also known as intramuscular stimulation (IMS). It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize peripheral nociception (pain), and improve or regulate structural or functional damage.The efficacy of dry needling as a treatment for muscle pain is still not ascertained and there remains no scientific consensus whether it is effective. Some results suggest that it is an effective treatment for certain kinds of muscle pain, while other studies have shown no benefit compared to a placebo. Currently, dry needling is being practiced in the United States, Europe, Australia, and other countries; however, not enough high-quality, long-term, and large-scale studies have been done on the technique to draw clear conclusions about its efficacy.

Dura mater

Dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. The other two meningeal layers are the arachnoid mater and the pia mater. The dura surrounds the brain and the spinal cord and is responsible for keeping in the cerebrospinal fluid. It is derived from neural crest cells.


Headache is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines (sharp, or throbbing pains), tension-type headaches, and cluster headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches.Headaches can occur as a result of many conditions whether serious or not. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Causes of headaches may include dehydration, fatigue, sleep deprivation, stress, the effects of medications, the effects of recreational drugs, viral infections, loud noises, common colds, head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues.

Treatment of a headache depends on the underlying cause, but commonly involves pain medication. A headache is one of the most commonly experienced of all physical discomforts.

About half of adults have a headache in a given year. Tension headaches are the most common, affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%).


iHunch is a term used to describe the common spinal problem of an excessively kyphotic (hunched) thoracic spine driving neck pain and cervicogenic headache. Other terms include iPosture, forward head posture, poking chin posture, computer neck, text neck and dowager’s hump.

International Classification of Headache Disorders

The International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification of all headache-related disorders published by the International Headache Society. It is considered the official classification of headaches by the World Health Organization, and, in 1992, was incorporated into the 10th edition of their International Classification of Diseases (ICD-10). Each class of headache contains explicit diagnostic criteria—meaning that the criteria include quantities rather than vague terms like several or usually—that are based on clinical and laboratory observations.The ICHD was first published in 1988 (now known as the ICHD-1). A second version, the ICHD-2, was published in 2004. The most current version, ICHD-3, was published in 2018.

Manipulation under anesthesia

Manipulation under anesthesia (MUA) or fibrosis release procedures is a multidisciplinary, chronic pain-related manual therapy modality which is used for the purpose of improving articular and soft tissue movement. This is accomplished by way of a combination of controlled joint mobilization/manipulation and myofascial release techniques. Medication-assisted manipulation (MAM) may also be used to describe the procedure, although that term more broadly categorizes the varied forms of existing MUA techniques. In any form, MUA is used by osteopathic/orthopedic physicians and specially trained (MUA certified) chiropractors. It is intended as a means of breaking up adhesions (scar tissue) of or about spinal joints (cervical, thoracic, lumbar, sacral, or pelvic regions), or extremity joint articulations (i.e., knee, shoulder, hip) to which painfully restricted range of motion significantly limits function. Failed attempts at other standard conservative treatment methods (i.e., manipulation, physical therapy, medication), over a sufficient time-frame, is one of the principal patient qualifiers.


NEFERT (Neck Flexion Rotation Test) is a medical examination procedure developed in 1999 by German neurootologist Claus-Frenz Claussen.

NIH classification of headaches

The NIH classification of headaches consists of brief, relatively vague glossary-type definitions of a limited number of headaches.It outlines five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.

Natural apophyseal glides

Natural apophyseal glides (NAGS) refers to a spinal physical therapy treatment technique developed by Brian Mulligan.

Passive accessory intervertebral movements

Passive accessory intervertebral movements (PAIVM) refers to a spinal physical therapy assessment and treatment technique developed by Geoff Maitland. The purpose of PAIVM is to assess the amount and quality of movement at various intervertebral levels, and to treat pain and stiffness of the cervical and lumbar spine.

Rectus capitis posterior minor muscle

The rectus capitis posterior minor (or rectus capitis posticus minor, both being Latin for lesser posterior straight muscle of the head) arises by a narrow pointed tendon from the tubercle on the posterior arch of the atlas, and, widening as it ascends, is inserted into the medial part of the inferior nuchal line of the occipital bone and the surface between it and the foramen magnum, and also takes some attachment to the spinal dura mater.

The synergists are the rectus capitis posterior major and obliquus capitis.

Connective tissue bridges were noted at the atlanto-occipital joint between the rectus capitis posterior minor muscle and the dorsal spinal dura. Similar connective tissue connections of the rectus capitis posterior major have been reported recently as well. The perpendicular arrangement of these fibers appears to restrict dural movement toward the spinal cord. The ligamentum nuchae was found to be continuous with the posterior cervical spinal dura and the lateral portion of the occipital bone. Anatomic structures innervated by cervical nerves C1-C3 have the potential to cause headache pain. Included are the joint complexes of the upper three cervical segments, the dura mater, and spinal cord.

The dura-muscular, dura-ligamentous connections in the upper cervical spine and occipital areas may provide anatomic and physiologic answers to the cause of the cervicogenic headache. This proposal would further explain manipulation's efficacy in the treatment of cervicogenic headache.

Tension headache

Tension headache, also known as tension-type headache (TTH), is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache. Tricyclic antidepressants appear to be useful for prevention. Evidence is poor for SSRIs, propranolol and muscle relaxants.As of 2016 tension headaches affect about 1.89 billion people and are more common in women than men (23% to 18% respectively).

Traditional Korean medicine

Traditional Korean medicine (Hangul: 한의학(Hanuihak), Hanja: 韓醫學) or (Hangul: 향약 (Hyangyak), Hanja: 鄕藥) refers to the traditional medicine practices that originated and developed in Korea.

Vertebral artery dissection

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.Vertebral dissection may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or chiropractic manipulation, but may also happen spontaneously. 1–4% of spontaneous cases have a clear underlying connective tissue disorder affecting the blood vessels. Treatment is usually with either antiplatelet drugs such as aspirin or with anticoagulants such as heparin or warfarin.Vertebral artery dissection is less common than carotid artery dissection (dissection of the large arteries in the front of the neck). The two conditions together account for 10–25% of non-hemorrhagic strokes in young and middle-aged people. Over 75% recover completely or with minimal impact on functioning, with the remainder having more severe disability and a very small proportion (about 2%) dying from complications. It was first described in the 1970s by the Canadian neurologist C. Miller Fisher.

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